Ahead of print

Visit our section with articles published as Ahead of Print. Improving the dissemination of our articles giving more visibility to the authors.

Simplified method using kidney / ureter / bladder x-ray to determine the appropriate length of ureteral stents

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

doi: 10.1590/S1677-5538.IBJU.2017.0620


ORIGINAL ARTICLE

Makoto Taguchi 1, Kenji Yoshida 1, Motohiko Sugi 1, Hidefumi Kinoshita 1, and Tadashi Matsuda 1
1 Department of Urology and Andrology, Kansai Medical University, Osaka, Japan

ABSTRACT

Purpose: To investigate a method to determine the appropriate length of ureteral stents, given that the stent length may lead to exacerbation of urinary symptoms if the stent crosses the bladder midline.

Materials and Methods: We retrospectively reviewed the position of the distal curl of the ureteral stent using kidney/ureter/bladder (KUB) radiographs after ureteroscopic lithotripsy in 165 patients who underwent placement of 24- or 26-cm ureteral stents.

According to the KUB findings, we categorized the position of the distal curl of the ureteral stent into two groups. In Group 1, the stents did not cross the midline (appropriate length); in Group 2, the stents crossed the midline (inappropriate length). We assessed several patient parameters (sex, height, body mass index, and stone side) and the index of ureteral length using KUB radiographs (“C-P”) and computed tomography (CT, “PV”).

Multivariate analysis was performed to identify the most significant factors affecting the position of ureteral stents. We also calculated the cutoff points of the receiver operating characteristic (ROC) curve of C-P and P-V for the position of ureteral stents.

Results: The multivariate analysis showed that C-P was the most significant factor affecting the position of ureteral stents (p < 0.001) in patients with 24- and 26-cm ureteral stents. Comparison of the ROC curves of C-P and P-V showed that C-P was superior to P-V (p < 0.01) in patients with 24- and 26-cm stents.

Conclusion: The use of KUB radiographs was effective and simple in determining the appropriate length of ureteral stents.

Keywords: Kidney; Ureter; Urinary Bladder

[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.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20180046_Bae_et_al

Int Braz J Urol. 2018; 44 (Video #X): XXX-X

[Full Text]


 

Related Post

Prospective Evaluation of Chondroitin Sulfate, Heparan Sulfate and Hyaluronic Acid in Prostate Cancer

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

doi: 10.1590/S1677-5538.IBJU.2017.0569


ORIGINAL ARTICLE

Matheus Neves Ribeiro da Silva 1, 2, Aline Mendes 1, João Roberto Maciel Martins 2, Marcos Tobias Machado 2, Maria Aparecida da Silva Pinhal 1
1 Departamento de Bioquímica, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil; 2 Departmento de Urologia Faculdade de Medicina do ABC, Santo André, SP, Brasil

ABSTRACT

Purpose: The present study evaluates chondroitin sulfate (CS) and heparan sulfate (HS) in the urine and hyaluronic acid (HA) in the plasma of patients with prostate cancer before and after treatment compared to a control group.
Materials and Methods: Plasma samples were used for HA dosage and urine for quantification of CS and HS from forty-four cancer patients and fourteen controls. Clinical, laboratory and radiological information were correlated with glycosaminoglycan
quantification by statistical analysis.
Results: Serum HA was significantly increased in cancer patients (39.68 ± 30.00 ng/ mL) compared to control group (15.04 ± 7.11 ng/mL; p=0.004) and was further increased in high-risk prostate cancer patients when compared to lower risk patients (p = 0.0214). Also, surgically treated individuals had a significant decrease in seric levels of heparan sulfate after surgical treatment, 31.05 ± 21.01 μg/mL (before surgery) and 23.14 ± 11.1 μg/mL (after surgery; p=0.029). There was no difference in the urinary CS and HS between prostate cancer patients and control group. Urinary CS in cancer patients was 27.32 ± 25.99 μg/mg creatinine while in the men unaffected by cancer it was 31.37 ± 28.37 μg/mg creatinine (p=0.4768). Urinary HS was 39.58 ± 32.81 μg/ mg creatinine and 35.29 ± 28.11 μg/mg creatinine, respectively, in cancer patients and control group (p=0.6252).
Conclusions: Serum HA may be a useful biomarker for the diagnosis and prognosis of prostate cancer. However, urinary CS and HS did not altered in the present evaluation.
Further studies are necessary to confirm these preliminary findings.

Keywords: Biomarkers; Glycosaminoglycans; Prostatic Neoplasms

[Full Text]


 

Related Post

Oxidative stress in the bladder of men with LUTS undergoing open prostatectomy: a pilot study

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

doi: 10.1590/S1677-5538.IBJU.2018.0127


ORIGINAL ARTICLE

Marcio Augusto Averbeck 1, 2, 3, Nelson Gianni de Lima 4, Gabriela Almeida Motta 1, Lauro Beltrão 2, Nury Jafar Abboud Filho 2, Clarice Pereira Rigotti 2, William Nascimento dos Santos 2, Steven Kitzberger Jaeger dos Santos 2, Luis Fernando Batista da Silva 2, Ernani Luis Rhoden 2, 3, 5
1 Departamento Pós-graduação em Ciências da Saúde da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil; 2 Serviço de Urologia, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brasil; 3 Serviço de Urologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil; 4 Serviço de Urologia, Hospital de Nossa Senhora dos Navegantes, Torres, RS, Brasil; 5 Disciplina de Urologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil

ABSTRACT

Purpose: This study aims to evaluate the link between preoperative parameters and oxida­tive stress (OS) markers in the bladder wall of men undergoing open prostatectomy.

Materials and Methods: From July 2014 to August 2016, men aged ≥ 50 years and presenting with LUTS were prospectively enrolled. Preoperative assessment included validated questionnaires (IPSS and OAB – V8), lower urinary tract ultrasound and uro­dynamics. Bladder biopsies were taken during open prostatectomy for determination of OS markers. Increased OS was defined by increased concentration of malondialdehyde (MDA) and / or decreased concentration of antioxidant enzymes (superoxide dismutase and / or catalase). P<0.05 was regarded as statistically significant.

Results: Thirty – eight consecutive patients were included. Mean age was 66.36 ± 6.44 ye­ars, mean prostate volume was 77.7 ± 20.63 cm3, and mean IPSS was 11.05 ± 8.72 points. MDA concentration was increased in men with severe bladder outlet obstruction (BOO gra­de V – VI according to the Schaefer’s nomogram) in comparison with BOO grade III – IV (p = 0.022). Patients with severe LUTS also had higher MDA concentration when compared to those with mild LUTS (p = 0.031). There was a statistically significant association between increased post – void residual urine (cut off ≥ 50 mL) and not only higher levels of MDA, but also reduced activity of SOD and catalase (p < 0.05).

Conclusions: This pilot study showed that severity of LUTS and BOO were associated with increased MDA concentration in the bladder wall of men undergoing open prosta­tectomy. Further studies are still needed to assess the role of non – invasive biomarkers of OS in predicting bladder dysfunction in men with LUTS.

Keywords: Urinary Bladder; Lower Urinary Tract Symptoms; Urinary Bladder Neck Obstruction; Oxidative Stress

[Full Text]


 

Related Post

Pelvic floor electromyography and urine flow patterns in children with vesicoureteral reflux and lower urinary tract symptoms

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

doi: 10.1590/S1677-5538.IBJU.2018.0401


ORIGINAL ARTICLE

Lida Sharifi-Rad 1, 2, Seyedeh-Sanam Ladi-Seyedian 1, Hossein Amirzargar 1, Abdol-Mohammad Kajbafzadeh 1
1 Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran; 2 Department of Physical Therapy, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran

ABSTRACT

Objective: To determine the different urine flow patterns and active pelvic floor electromyography (EMG) during voiding in children with vesicoureteral reflux (VUR) as well as presenting the prevalence of lower urinary tract symptoms in these patients.

Materials and Methods: We retrospectively reviewed the charts of children diagnosed with VUR after toilet training from Sep 2013 to Jan 2016. 225 anatomically and neurologically normal children were included. The reflux was diagnosed with voiding cystourethrography. The study was comprised an interview by means of a symptom questionnaire, a voiding diary, uroflowmetry with EMG and kidney and bladder ultrasounds. Urine flow patterns were classified as bell shape, staccato, interrupted, tower and plateau based on the current International Children’s Continence Society guidelines.

Results: Of 225 children with VUR (175 girls, 50 boys), underwent uroflowmetry + EMG, 151 (67.1%) had an abnormal urine flow pattern. An active pelvic floor EMG during voiding was confirmed in 113 (50.2%) children. The flow patterns were staccato in 76 (33.7 %), interrupted in 41 (18.2%), Plateau in 26 (11.5%), tower in 12 (5.3%) and a bell shape or normal pattern in 70 (31.5%). Urinary tract infection, enuresis and constipation respectively, were more frequent symptoms in these patients.

Conclusions: Bladder/bowel dysfunction is common in patients with VUR that increases the risk of breakthrough urinary tract infections in children receiving antibiotic prophylaxis and reduces the success rate for endoscopic injection therapy. Therefore investigation of voiding dysfunction with primary assessment tools can be used prior to treating VUR.

Keywords: Vesico-Ureteral Reflux; Lower Urinary Tract Symptoms; Urinary Bladder

[Full Text]


 

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

[Full Text]


 

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

PSA kinetics before 40 years of age

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

doi: 10.1590/S1677-5538.IBJU.2017.0710


ORIGINAL ARTICLE

Cristiano Linck Pazeto 1, Thiago Fernandes Negris Lima 1, José Carlos Truzzi 2, Nairo Sumita 2, José de Sá 2, Fernando R. Oliveira3, Sidney Glina 1
1 Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil; 2 Fleury Medicina e Saúde São Paulo, SP, Brasil; 3 Departamento de Epidemiologia, Universidade de São Paulo, São Paulo, SP, Brasil

ABSTRACT

Purpose: The baseline PSA has been proposed as a possible marker for prostate cancer.

The PSA determination before 40 years seems interesting because it not suffers yet the drawbacks related to more advanced ages. Considering the scarcity of data on this topic, an analysis of PSA kinetics in this period seems interesting.

Materials and Methods: A retrospective assay in a database of a private diagnostic center was performed from 2003 to 2016. All subjects with a PSA before 40 years were included.

Results: 92995 patients performed PSA between the ages of 21 – 39. The mean value ranged from 0.66 ng / mL (at age 22) to 0.76 ng / mL (at age 39) and the overall mean was 0.73 ng / mL. As for outliers, 3783 individuals presented a baseline PSA > 1.6 ng / mL (p95). A linear regression model showed that each year there is a PSA increase of 0.0055 ng / mL (β = 0.0055; r² = 0.0020; p < 0.001). A plateau in PSA between 23 and 32 years was found and there were only minimal variations among the ages regardless of the evaluated percentile.

Conclusion: It was demonstrated that PSA kinetics before 40 years is a very slow and progressive phenomenon regardless of the assessed percentile. Considering our results, it could be suggested that any PSA performed in this period could represent the baseline value without significant distortions.

Keywords: Prostate-Specific Antigen; Kinetics, Prostatic Neoplasms

[Full Text]


 

Related Post

Comparison between multiparametric MRI with and without post – contrast sequences for clinically significant prostate cancer detection

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

doi: 10.1590/S1677-5538.IBJU.2018.0102


ORIGINAL ARTICLE

Thais Caldara Mussi 1,Tatiana Martins 1, 2, George Caldas Dantas 1, Rodrigo Gobbo Garcia 3, Renee Zon Filippi 4, Gustavo Caserta Lemos 5, Ronaldo Hueb Baroni 1
1 Departamento de Radiologia e Diagnóstico por Imagem, Hospital Israelita Albert Einstein, SP, Brasil; 2 Ecoar Medicina Diagnóstica, Lourdes, Belo Horizonte, MG, Brasil; 3 Departamento de Intervenção Guiada por Imagens, Hospital Israelita Albert Einstein, SP, Brasil; 4 Departamento de Patologia, Hospital Israelita Albert Einstein, SP, Brasil; 5 Departamento de Urologia, Hospital Israelita Albert Einstein, SP, Brasil

ABSTRACT

 

Background: Dynamic-contrast enhanced (DCE) sequence is used to increase detection of small lesions, based on increased vascularization. However, literature is controversy about the real incremental value of DCE in detection of clinically significant (CS) prostate cancer (PCa), since absence of enhancement does not exclude cancer, and enhancement alone is not definitive for tumor. Purpose: To test the hypothesis that DCE images do not increase CS PCa detection on MRI prior to biopsy, comparing exams without and with contrast sequences. Material and Materials and Methods: All men who come to our institution to perform MRI on a 3T scanner without a prior diagnosis of CS PCa were invited to participate in this study. Reference standard was transrectal prostate US with systematic biopsy and MRI/US fusion biopsy of suspicious areas. Radiologists read the MRI images prospectively and independently (first only sequences without contrast, and subsequently the entire exam) and graded them on 5-points scale of cancer suspicion.

Results: 102 patients were included. Overall detection on biopsy showed CS cancer in 43 patients (42.2%), clinically non-significant cancer in 11 (10.8%) and negative results in 48 patients (47%). Positivities for CS PCa ranged from 8.9% to 9.8% for low suspicion and 75.0% to 88.9% for very high suspicion. There was no statistical difference regarding detection of CS PCa (no statistical difference was found when compared accuracies, sensitivities, specificities, PPV and NPV in both types of exams). Inter-reader agreement was 0.59. Conclusion: Exams with and without contrast-enhanced sequences were similar for detection of CS PCa on MRI.

 Keywords: Magnetic Resonance Imaging; Prostatic Neoplasms; Men

[Full Text]


 

Related Post

Changing bulking agent may require change in injection volume for endoscopic treatment of vesicoureteral reflux

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

doi: 10.1590/S1677-5538.IBJU.2018.0033


ORIGINAL ARTICLE

Ali Tekin 1,2, Ismail Yagmur 1,2, Sibel Tiryaki 1,2, Zafer Dokumcu 1, Ibrahim Ulman 1,2, Ali Avanoglu 1,2
1 Department of Pediatric Surgery, Ege University Faculty of Medicine, Izmir, Turkey; 2 Division of Pediatric Urology, Ege University Faculty of Medicine, Izmir, Turkey

ABSTRACT

Introduction: Various bulking agents were utilized for endoscopic correction of VUR. A study reviewing multi-institutional data showed that the amount of injection material has increased over time with the purpose of improving success rates, which also resul­ted in costs. We noticed an opposite trend in our center since we started using a new bulking agent. The aim of this study was to evaluate evolution of our practice with different bulking agents.

Patients and Methods: Records of VUR patients who underwent subureteric injection with polyacrylate polyalcohol copolymer (PPC) and dextronomere hyaluronic aci­de (DxHA) between 2005 and 2014 were reviewed. Variation of different parameters throughout the study period was evaluated along with the success rate. Success was defined as complete resolution of reflux.

Results: A total of 260 patients with 384 refluxing units were included. The success rate was higher in PPC group compared to DxHA group. There was no statistically significant difference between years regarding distribution of VUR grade, body weight, patient height, and age in PPC group. Despite significant reduction in injection volu­me, success rate did not decrease through the years with PPC.

Conclusion: Different bulking agents may require different injection volumes to achieve the same success rate in endoscopic treatment of vesicoureteral reflux. Habits gained with previous experience using other materials should be revised while using a new agent.

Keywords: Vesico-Ureteral Reflux; Endoscopy; Cakut [Supplementary Concept]

[Full Text]


 

Related Post

Artificial sphincter “BR – SL – AS 904” in the treatment of urinary incontinence after radical prostatectomy: efficacy, practicality and safety in a prospective and multicenter study

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

doi: 10.1590/S1677-5538.IBJU.2018.0128


ORIGINAL ARTICLE

Salvador Vilar Correia Lima 1, 2, Evandilson Guenes Campos de Barros 1, Fabio de Oliveira Vilar 1, Flavia Cristina Morone Pinto 2, Thomé Décio Pinheiro Barros 1, 2, José Carlos Truzzi 3, Luiz Gustavo M. de Toledo 4, Francisco Kanasiro 5, João Luiz Amaro 6
1 Serviço de Urologia, Hospital das Clínicas, Universidade Federal de Pernambuco, UFPE, Recife, PE, Brasil; 2 Departamento de Cirurgia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, UFPE, Recife, PE, Brasil; 3 Departamento de Urologia, Instituto do Câncer Dr. Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil; 4 Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil; 5 Serviço de Urologia, Hospital Santa Marcelina, Porto Velho, RO, Brasil; 6 Disciplina de Urologia, Unesp – Universidade Estadual Paulista, São Paulo, SP, Brasil

ABSTRACT

Purpose: The objective of the present study is to test the efficiency and practicality of a new artificial sphincter “BR – SL – AS – 904” in the control of urinary incontinence in post – PR patients and to evaluate their complications.

Patients and Methods: Fifteen patients with incontinence after one year of radical prostatectomy were included prospectively. All patients underwent artificial urethral sphincter (AUS) implant “BR – SL – AS – 904” according to established technique. Inde­pendent variables such as free urinary flow, PAD weight test, ICIQ – SF score and uri­nary symptoms through the IPSS score were compared in different follow-up moments.

Results: Patients submitted to AUS implantation did not present trans – operative or post – operative complications related to the surgical act such as: infection, hematoma, erosion or urinary retention. Device was inert to the body during the follow-up, sho­wing an excellent adaptation of the patients, besides the easy handling. The mean age was 68.20 years 40% of the patients had systemic arterial hypertension, 6.7% diabetes mellitus, 6.7% were hypertensive and diabetic, 13.4% were hypertensive, had diabetes and hypercholesterolemia and 26.7% patients had no comorbidities. It was evidenced that the urinary flow peak during the follow-up remained stable. Decreased averages and median PAD weight test were 135.19 to 75.72 and 106.00 to 23.50, respectively. The IPSS score decreased and the quality of life increased (12.33 to 3.40 and 2.50 to 3.20 respectively). The ICQF – SF questionnaire score also showed a decrease, ranging from 16, 71 to 7.33.

Conclusion: The artificial sphincter implant “BR – SL – AS 904” was reproducible, safe and effective in the control of urinary incontinence in post – PR patients.

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

[Full Text]


 

Related Post

Comment on ‘polygamy, sexual behavior in a population under risk for prostate cancer diagnostic: an observational study from the black sea region in turkey’

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

doi: 10.1590/S1677-5538.IBJU.2018.0459


LETTER TO THE EDITOR

Mete Özkidik 1, Anar İbrahimov 2
1 Department of Urology, Sanliurfa Egitim ve Arastirma Hastanesi, Karşıyaka, Şanlıurfa, Turkey; 2 Ankara university, Ankara, Turkey

ABSTRACT

Not available

[Full Text]


 

Related Post

Surgical techniques for facilitating laparoscopic intracorporeal orthotopic neobladder: initial experience

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

doi: 10.1590/S1677-5538.IBJU.2017.0505


ORIGINAL ARTICLE

Lianchao Jin 1,2, Mingshuai Wang 1, Feiya Yang 1, Yinong Niu 1, Nianzeng Xing 1
1 Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China; 2 Department of Urology, Peking University Shougang Hospital, Beijing, China

ABSTRACT

 

Purpose: To describe our technique and outcomes for laparoscopic intracorporeal ileal neobladder (ICNB) reconstruction.

Materials and Methods: From April 2014 to November 2016, 21 patients underwent laparoscopic ICNB at our tertiary referral centre. ICNB with bilateral isoperistaltic af­ferent limbs and several technique improvements were introduced. Demographics, clinical, and pathological data were collected. Perioperative, 1-year oncologic, 1-year Quality of life and 1-year functional outcomes were reported.

Results: ICNB was successfully performed in all 21 patients without open conversion and transfusion. Mean operative time was 345.6±66.9 min, including 106±22 min for LRC and PLND and 204±46.4 min for ICNB, respectively. Mean established blood loss was 192±146 mL. The overall incidence of 90-d complication was 33.3%, while major complication occurred in 4.8%. One-year daytime and night-time continence rates were 85.7% and 57.1%, respectively. One patient died from myocardial infarction six months postoperatively, and two patients had lung metastasis five months and six months respectively.

Conclusions: We described our experience of 3D LRC with a novel intracorporeal or­thotopic ileal neobladder, and the technique improvements facilitate the procedure. However, further studies are required to evaluate long-term outcomes of the intracor­poreal neobladder with bilateral isoperistaltic afferent limbs.

 Keywords: Laparoscopy; Quality of Life; Cystectomy

[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

Available at: http://www.intbrazjurol.com.br/video-section/20180056_Basiri_et_al
Int Braz J Urol. 2018; 44 (Video #X): XXX-X

[Full Text]


 

Related Post

The role and importance of SBRT in prostate cancer

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

doi: 10.1590/S1677-5538.IBJU.2018.0484


LETTER TO THE EDITOR

Yasemin Cihan 1
1 Department of Radiation Oncology, Kayseri Egitim ve Arastirma Hastanesi, Hastane cad Kayseri, Kayseri, Turkey

ABSTRACT

Not available

[Full Text]


 

Related Post

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

[Full Text]


 

Related Post

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

Available at: http://www.intbrazjurol.com.br/video-section/20180238_Yoo_et_al

Int Braz J Urol. 2018; 44 (Video #X): XXX-X

[Full Text]


 

Related Post

Prognostic significance of body mass index in patients with localized renal cell carcinoma

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

doi: 10.1590/S1677-5538.IBJU.2017.0629


ORIGINAL ARTICLE

Chengtao Wang 1, Zebin Chen 2, Jun Dong 1, Bixiu Wen 1, Yong Fang 2
1 Department of Radiation Oncology, First Affiliated Hospital of Sun Yat – Sen University, Guangzhou, China; 2 Department of Urology, First Affiliated Hospital of Sun Yat – Sen University, Guangzhou, China

 

ABSTRACT

Objective: To investigate the relationship between the pretreatment body mass index (BMI) and the clinical outcomes in patients with localized stage I – III renal cell carcinoma (RCC) surgically treated.

Materials and Methods: From January 2000 to December 2012, 798 patients with stage I – III RCC were recruited from First Affiliated Hospital and Cancer Center of Sun Yat – Sen University. Patients were divided into two groups of BMI < 25 kg / m2 or BMI ≥ 25 kg / m2 according to the World Health Organization classifications for Asian populations. The differences in the long-term survival of these two BMI groups were analyzed.

Results: The 5 – year failure – free survival rates for BMI < 25 kg / m2 and BMI ≥ 25 kg / m2 groups were 81.3% and 93.3%, respectively (P = 0.002), and the 5 – year overall survival rates were 82.5% and 93.8%, respectively (P = 0.003). BMI was a favored prognostic factor of overall survival and failure – free survival in a Cox regression model.

Conclusions: Pretreatment body mass index was an independent prognostic factor for Chinese patients surgically treated, localized stage I – III RCC.

Keywords: Body Mass Index; Carcinoma, Renal Cell; Prognosis

[Full Text]


 

Related Post

Comparison of Gleason upgrading rates in transrectal ultrasound systematic random biopsies versus US-MRI fusion biopsies for prostate cancer

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

doi: 10.1590/S1677-5538.IBJU.2017.0552


ORIGINAL ARTICLE

Paulo Priante Kayano ¹, Arie Carneiro ¹, Tiago Mendonça Lopez Castilho 1, Arjun Sivaraman ², Oliver Rojas Claros ¹, Ronaldo Hueb Baroni ¹, Rodrigo Gobbo Garcia ¹, Guilherme Cayres Mariotti ¹, Oren Smaletz ¹, Renne Zon Filippi ¹, Gustavo Caserta Lemos 1
1 Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; 2 Memorial Sloan Kettering Cancer Center – USA, New York, NY, EUA

ABSTRACT

Purpose: Ultrasound-magnetic resonance imaging (US-MRI) fusion biopsy (FB) im­proves the detection of clinically significant prostate cancer (PCa).

We aimed to compare the Gleason upgrading (GU) rates and the concordance of the Gleason scores in the biopsy versus final pathology after surgery in patients who underwent transrectal ultrasound (TRUS) systematic random biopsies (SRB) versus US-MRI FB for PCa.

Materials and Methods: A retrospective analysis of data that were collected prospec­tively from January 2011 to June 2016 from patients who underwent prostate biopsy and subsequent radical prostatectomy. The study cohort was divided into two groups: US-MRI FB (Group A) and TRUS SRB (Group B).

US-MRI FB was performed in patients with a previous MRI with a focal lesion with a Likert score ≥3; otherwise, a TRUS SRB was performed.

Results: In total, 73 men underwent US-MRI FB, and 89 underwent TRUS SRB. The GU rate was higher in Group B (31.5% vs. 16.4%; p=0.027). According to the Gleason grade pattern, GU was higher in Group B than in Group A (40.4% vs. 23.3%; p=0.020). Analyses of the Gleason grading patterns showed that Gleason scores 3+4 presented less GU in Group A (24.1% vs. 52.6%; p=0.043).

The Bland-Altman plot analysis showed a higher bias in Group B than in Group A (-0.27 [-1.40 to 0.86] vs. -0.01 [-1.42 to 1.39]).

In the multivariable logistic regression analysis, the only independent predictor of GU was the use of TRUS SRB (2.64 [1.11 – 6.28]; p=0.024).

Conclusions: US-MRI FB appears to be related to a decrease in GU rate and an increase in concordance between biopsy and final pathology compared to TRUS SRB, sug­gesting that performing US-MRI FB leads to greater accuracy of diagnosis and better treatment decisions.

Keywords: Prostatic Neoplasms; Magnetic Resonance Spectroscopy; Image-Guided Biopsy

[Full Text]


 

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

[Full Text]


 

Related Post

The learning curve of sting method for endoscopic injection treatment of vesicoureteral reflux

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

doi: 10.1590/S1677-5538.IBJU.2017.0465


ORIGINAL ARTICLE

Ayhan Dalkiliç 1, Göksel Bayar 2, Hasan Demirkan 3, Kaya Horasanli 3
1 Department of Urology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey; 2 Department of Urology, Martyr Prof Dr. Ilhan Varank Sancaktepe Training and Research Hospital, Turkey; 3 Department of Pediatric Urology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey

ABSTRACT

Objective: To identify how many endoscopic injection (EI) procedures, STING method, must be performed before reaching an ideal success rate when simulation training has not been received.

Materials and Methods: The EI procedures performed by two pediatric urology fellows were investigated. The study excluded patients without primary VUR and those with previous EI or ureteroneocystostomy, lower urinary tract dysfunction, and/or duplicate ureters. The EIs used dextranomer hyaluronate and the STING method, as described by O’Donnell and Puri. Groups number was determined by multiple statistical trials. Statistically significance differences were achieved with one combination that had 35 EI procedures each and with 3 different combination of patients, having 12, 24, and 36 patients, respectively. Therefore, groups were established 12 patients. The first fellow performed 54 EIs, and the second performed 51. Therefore, each of the first fellow’s three groups contained 18 EI procedures, and each of the second fellow’s 17.

Results: The study included 72 patients and 105 ureter units. When the data from both fellows were combined, each of the three groups contained 35 procedures. For the first fellow, the success rates in the first, second, and third groups were 38.3%, 66.6%, and 83.3% (p = 0.02), respectively, and for the second fellow, the success rates were 41.2%, 64.7%, and 82.3% (p = 0.045), respectively. The increased success rates for both fellows were very similar.

Conclusions: An acceptable rate of success for EI may be reached after about 20 pro­cedures and a high success rate after about 35-40 procedures.

Keywords: Learning Curve; Endoscopy; Vesico-Ureteral Reflux

[Full Text]


 

Related Post

Predictive factors for prolonged hospital stay after retropubic radical prostatectomy in a high-volume teaching center

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

doi: 10.1590/S1677-5538.IBJU.2017.0339


ORIGINAL ARTICLE

Rafael F. Coelho 1, Mauricio D. Cordeiro 1, Guilherme P. Padovani 1, Rafael Localli 1, Limirio Fonseca 1, José Pontes Junior 1, Giuliano B. Guglielmetti 1, Miguel Srougi 1, William Carlos Nahas 1
1 Divisão de Urologia, Instituto do Câncer de Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil

ABSTRACT

Objective: To evaluate the length hospital stay and predictors of prolonged hospitaliza­tion after RRP performed in a high-surgical volume teaching institution, and analyze the rate of unplanned visits to the office, emergency care, hospital readmissions and perioperative complications rates.

Materials and Methods: Retrospective analysis of prospectively collected data in a standardized database for patients with localized prostate cancer undergoing RRP in our institution between January/2010 – January/2012.

A logistic regression model including preoperative variables was initially built in order to determine the factors that predict prolonged hospital stay before the surgical pro­cedure; subsequently, a second model including both pre and intraoperative variables was analyzed.

Results: 1011 patients underwent RRP at our institution were evaluated. The median hospital stay was 2 days, and 217 (21.5%) patients had prolonged hospitalization. Predictors of prolonged hospital stay among the preoperative variables were ICC (OR. 1.40 p=0.003), age (OR 1.050 p<0.001), ASA score of 3 (OR. 3.260 p<0.001), pros­tate volume on USG-TR (OR, 1.005 p=0.038) and African-American race (OR 2.235 p=0.004); among intra and postoperative factors, operative time (OR 1.007 p=0.022) and the presence of any complications (OR 2.013 p=0.009) or major complications (OR 2.357 p=0.01) were also correlated independently with prolonged hospital stay. The complication rate was 14.5%.

Conclusions: The independent predictors of prolonged hospitalization among preop­erative variables were CCI, age, ASA score of 3, prostate volume on USG-TR and African-American race; amongst intra and postoperative factors, operative time, pres­ence of any complications and major complications were correlated independently with prolonged hospital stay.

Keywords: rostatectomy; Therapeutics; Retrospective Studies

[Full Text]


 

Related Post

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

Int Braz J Urol. 2018; 44 (Video #X): XXX-X

[Full Text]


 

Related Post

Beneficial effects of oltipraz, nuclear factor – erythroid – 2 – related factor 2 (Nrf2), on renal damage in unilateral ureteral obstruction rat model

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

doi: 10.1590/S1677-5538.IBJU.2018.0232


ORIGINAL ARTICLE

Emre Can Polat 1, Huseyin Besiroglu 2, Levent Ozcan 3, Alper Otunctemur 1, Ahmet Tugrul Eruyar 4, Adnan Somay 5, Nurver Ozbay 5, Mustafa Cekmen 6, Ceyla Eraldemır 7, Emin Ozbek 8
1 Department of Urology, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey; 2 Department of Urology, Catalca Ilyas Cokay State Hospital, Istanbul, Turkey; 3 Department of Urology, Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey; 4 Department of Pathology, Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey; 5 Department of Pathology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey; 6 Department of Biochemistry, Istanbul Medeniyet University, Istanbul, Turkey; 7 Department of Biochemistry, Kocaeli University, Kocaeli, Turkey; 8 Department of Urology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey

ABSTRACT

Introduction: We investigated whether Oltipraz (OPZ) attenuated renal fibrosis in a unilateral ureteral obstruction (UUO) rat model.

Materials and Methods: We randomly divided 32 rats into four groups, each consisting of eight animals as follows: Rats in group 1 underwent a sham operation and received no treatment. Rats in group 2 underwent a sham operation and received OPZ. Rats in group 3 underwent unilateral ureteral ligation and received no treatment. Group 4 rats were subjected to unilateral ureteral ligation plus OPZ administration. Transforming growth factor beta-1 (TGF-β1), E-cadherin, nitric oxide (NO) and hydroxyproline levels were measured. Histopathological and immunohistochemical examinations were carried out.

Results: TGF-β1, NO and E-cadherin levels in the UUO group were significantly higher than the sham group and these values were significantly different in treated groups compared to the UUO group. In rats treated with UUO + OPZ, despite the presence of mild tubular degeneration and less severe tubular necrosis, glomeruli maintained a better morphology when compared to the UUO group. Expressions of αSMA in immunohistochemistry showed that the staining positivity decreased in the tubules of the OPZ-treated group.

Conclusions: While the precise mechanism of action remains unknown, our results demonstrated that OPZ exerted a protective role in the UUO-mediated renal fibrosis rat model highlighting a promising therapeutic potency of Nrf2-activators for alleviating the detrimental effects of unilateral obstruction in kidneys.

 

Keywords: Oltipraz [Supplementary Concept]; Renal Insufficiency; Ureter

[Full Text]


 

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
Available at: http://www.intbrazjurol.com.br/video-section/20170688_ Lei_et_al
Int Braz J Urol. 2018; 44 (Video #X): XXX-X

[Full Text]


 

Related Post

Adequate rectal preparation reduces hospital admission for urosepsis after transrectal ultrasound – guided prostate biopsy

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

doi: 10.1590/S1677-5538.IBJU.2018.0181


ORIGINAL ARTICLE

Yu-Chen Chen 1, 2, Hao-Wei Chen 1, 2, Shu-Pin Huang 2, Hsin-Chin Yeh 3, Ching-Chia Li 2
1 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 2 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 3 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

ABSTRACT

Objectives: Previous studies have compared infectious outcomes on the basis of whether rectal preparation was performed; however, they failed to evaluate the quality of each rectal preparation, which may have led to confounding results. This study aimed to com­pare hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy between patients with adequate and traditional rectal preparations.

Materials and Methods: Between January 2011 and December 2016, a total of 510 patients who underwent transrectal ultrasound – guided prostate biopsy at our in­stitutions and were orally administered prophylactic antibiotics (levofloxacin) were included. Two rectal preparations were performed: (1) adequate rectal preparation con­firmed by digital rectal examination and transrectal ultrasound (Group A, n = 310) and (2) traditional rectal preparation (Group B, n = 200). All patient characteristics were recorded. A logistic regression model was used to assess the effects of the two different rectal preparations on urosepsis, adjusted by patient characteristics.

Results: There were a total of three and nine hospitalizations for urosepsis in Groups A and B, respectively. Differences in the demographic data between the two groups were insignificant. Logistic regression showed that adequate rectal preparation before biopsy significantly decreased the risk for urosepsis after biopsy (adjusted odds ratio: 0.2; 95% confidence interval: 0.05 – 0.78; P = 0.021).

Conclusions: Adequate rectal preparation could significantly reduce hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy. The quality of rectal preparation should be evaluated before biopsy. If adequate rectal preparation is not achieved, postponing the biopsy and adjusting the rectal preparation regimen are suggested.

Keywords: Prostate; Prostatic Neoplasms; Ultrasound, High-Intensity Focused, Transrectal

[Full Text]


 

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

Available at: http://www.intbrazjurol.com.br/video-section/20180175_Gorgen_et_al

Int Braz J Urol. 2018; 44 (Video #X): XXX-X

[Full Text]


 

Related Post

A martius flap in the treatment of iatrogenic distal urogenital fistula

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

doi: 10.1590/S1677-5538.IBJU.2017.0444


VIDEO SECTION

Ivan Ignjatovic 1, 2, Dragoslav Basic 1, 2, Milan Potic 1, 2, Ljubomir Dinic 1, Aleksandar Skakic 1
1 Clinical Center Nis, Serbia; 2 University in Nis, Faculty of Medicine Nis, Serbia

ABSTRACT

Introduction: Distal urogenital fistulas (DUF) are usually iatrogenic and are uncommon in Europe. They occur in the ure­thra or near the bladder neck, and can be caused by vaginal hysterectomy, para-urethral cyst surgery, or erosion of the bladder or urethra from tension-free slings or meshes. The psychological and physical health consequences of DUF are devastating because most patients consider themselves “healthy” before surgery. Incontinence can appear after success­ful DUF closure due to previously occult incontinence or urethral incompetence. Additional surgery for incontinence is sometimes necessary to achieve satisfactory outcome.

Materials and Methods: A Martius flap was used in 23 patients between 2000 and 2015. Patient age range was 38-75 years (mean, 58.7). DUF was due to gynecologic surgery for benign disease (15 / 23; 65.2%), mesh / sling erosion (2 / 23; 8.7%), and malignancy (6 / 23; 26.1%). The follow-up period was one year.

Results: DUF was closed in 22 patients (95.6%). Satisfaction and complete dryness was achieved in 16 patients (69.6%) after the first procedure. Postoperative complications were: postoperative hematoma in 1 (4.4%), primary failure in 1 (4.4%), overactive bladder (OAB) syndrome in 3 (13.2%) and postoperative incontinence in 6 (26.4%) patients. A fascial sling was placed in patients with incontinence. All patients were dry after the secondary surgery. Anticholinergics were used for the treatment of OAB syndrome. Discomfort at the flap harvesting site was of minor importance. Finally, 22 out of 23 patients (95.6%) were satisfied.

Conclusion: A Martius flap and additional fascial sling could be successfully used to optimize DUF treatment.

 ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20170444_Ignjatovic_et_al

Int Braz J Urol. 2018; 44 (Video #X): XXX-X

[Full Text]


 

Related Post

Addressing the challenges of reoperative robotic-assisted sacrocolpopexy

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

doi: 10.1590/S1677-5538.IBJU.2018.0037


VIDEO SECTION

Wilson Lin 1, Nitya Abraham 2
1 Yeshiva University Albert Einstein College of Medicine, NY, USA ; 2 Department of Urology, Montefiore Medical Center, NY, USA

ABSTRACT

Sacrocolpopexy is the gold-standard repair for apical pelvic organ prolapse (POP). However, over half of women with POP who undergo the surgery experience recurrence, particularly those with higher preoperative stage, younger age, and greater body weight. We address the challenges of repairing recurrent POP in a patient with a prior transabdominal mesh sacrohysteropexy.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20180037_Lin_et_al

Int Braz J Urol. 2018; 44 (Video #X): XXX-X

[Full Text]


 

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

A review of the possibility of adopting financially driven live donor kidney transplantation

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

doi: 10.1590/S1677-5538.IBJU.2017.0693


REVIEW ARTICLE

Aline Adour Yacoubian 1, 2, Rana Abu Dargham 1, 2, Raja B. Khauli 1, 2
1 Department of Surgery and 2 Division of Urology and Renal Transplantation, American University of Beirut Medical Center, Beirut, Lebanon

ABSTRACT

Kidney transplantation for end-stage renal disease remains the preferred solution due to its survival advantage, enhanced quality of life and cost-effectiveness. The main obstacle worldwide with this modality of treatment is the scarcity of organs. The de­mand has always exceeded the supply resulting in different types of donations. Kidney donation includes pure living related donors, deceased donors, living unrelated do­nors (altruistic), paired kidney donation and more recently compensated kidney dona­tion. Ethical considerations in live donor kidney transplantation have always created a debate especially when rewarding unrelated donors. In this paper, we examine the problems of financially driven kidney transplantation, the ethical legitimacy of this practice, and propose some innovative methods and policies that could be adopted to ensure a better practice with accepted ethical guidelines.

Keywords:  Kidney Transplantation; Kidney Diseases; Review [Publication Type]

[Full Text]


 

Related Post

The present and future enhanced recovery after surgery for bladder cancer

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

doi: 10.1590/S1677-5538.IBJU.2017.0282


LETTER TO THE EDITOR

Michael A. Poch 1, Sephalie Patel 2, Rosemarie Garcia-Getting 2

1 Department of Genito-Urinary Oncology, Moffitt Cancer Center, Tampa, Florida, United States; 2 Department of Anesthesia, Moffitt Cancer Center, Tampa, Florida, United States

ABSTRACT

Not available

[Full Text]


 

Related Post

Lowering positive margin rates at radical prostatectomy by color coding of biopsy specimens to permit individualized preservation of the neurovascular bundles: is it feasible? a pilot investigation

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

doi: 10.1590/S1677-5538.IBJU.2017.0328


ORIGINAL ARTICLE

Leslie A. Deane 1, Wei Phin Tan 1, Andrea Strong 1, Megan Lowe 1, Nency Antoine 1, Ritu Ghai 1, Shahid Ekbal 1
1 Department of Urology, Rush University Medical Center, Chicago, IL, USA

ABSTRACT

Objective: To evaluate whether color-coding of prostate core biopsy specimens aids in preservation of the neurovascular bundles from an oncological perspective.

Materials and Methods: MRI guided transrectal ultrasound and biopsy of the prostate were performed in 51 consecutive patients suspected of being at high risk for harboring prostate cancer. Core specimens were labeled with blue dye at the deep aspect and red dye at the superficial peripheral aspect of the core. The distance from the tumor to the end of the dyed specimen was measured to determine if there was an area of normal tissue between the prostate capsule and tumor.

Results: Of the 51 patients undergoing prostate biopsy, 30 (58.8%) were found to have cancer of the prostate: grade group 1 in 13.7%, 2 in 25.5%, 3 in 7.8%, 4 in 7.8% and 5 in 3.9% of the cohort. A total of 461 cores were analyzed in the cohort, of which 122 showed cancer. Five patients opted to undergo robotic assisted laparoscopic radical prostatectomy. No patients had a positive surgical margin (PSM) or extra prostatic ex­tension (EPE) on radical prostatectomy if there was a margin of normal prostatic tissue seen between the dye and the tumor on prostate biopsy.

Conclusion: Color-coding of prostate biopsy core specimens may assist in tailoring the approach for preservation of the neurovascular bundles without compromising early oncological efficacy. Further study is required to determine whether this simple modi­fication of the prostate biopsy protocol is valuable in larger groups of patients.

Keywords: Robotic Surgical Procedures; Prostatectomy; Laparoscopy

[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

[Full Text]


 

Related Post

Encrusted cystitis caused by corynebacterium urealyticum: a case report with novel treatment strategy of intravesical dimethyl sulfoxide

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

doi: 10.1590/S1677-5538.IBJU.2017.0588


CHALLENGING CLINICAL CASES

Tayyar Alp Ozkan 1, Mustafa Savas Yalcin 2, Ozdal Dillioglugil 2, Ibrahim Cevik 3
1 Department of Urology, Kocaeli Derince Traning and Research Hospital, Kocaeli, Tukey; 2 Department of Urology, Kocaeli University, School of Medicine, Kocaeli, Tukey; 3 Okan University, School of Medicine, Department of Urology, Istanbul, Tukey

ABSTRACT

Encrusted cystitis (EC) was first described as chronic cystitis with mucosal calcification in 1914 (1). It is a very rare chronic inflammatory disease presenting with dysuria, pelvic pain and gross hematuria. Voided urine contains mucus or calcified mucopurulent stone like particles. Urinalysis always reveals alkaline pH. It may be present in healthy individuals with no predisposing etiological factors (2-4). Etiologically, previous urological diseases, immunosuppression, urinary infection with urea splitting bacteria, or urological interventions resulting in bladder mucosa trauma may also be present (5, 6). In the present case report, we describe a novel treatment for EC with intravesical dimethyl sulfoxide.

Keywords: Corynebacterium; Cystitis; Dimethyl Sulfoxide

[Full Text]


 

Related Post

Recto-urethral fistula presenting as fever of unknown origin: a rare complication of prostatic abscess

Vol. 44 (x): 2018 February 2.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0468


RADIOLOGY PAGE

Sun Hwa Lee 1, Seong Jong Yun 2, Seokyong Ryu 1
1 Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea; 2 Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea

ABSTRACT

Not available

[Full Text]


Related Post

The Lithocatch (TM) by Boston Scientific: how to use it and how to solve a common problem

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

doi: 10.1590/S1677-5538.IBJU.2018.0105


VIDEO SECTION

Giuseppe Giusti 1, Marco Lucci Chiarissi 1, Antonello De Lisa 1
1 Department of Urology, University of Cagliari, Cagliari , Italy

ABSTRACT

Introduction: The LithocatchTM basket is a immobilization device commercialized by Boston Scientific. It allows to col­lect multiple stone fragments from the ureter. The ability of the basket to capture a large number of stone fragments, is however responsible for a problem connected to its usage: the entrapment of the basket inside the ureter. In this video we explain how to use it and how to solve this problem.

Material and Methods: After positioning the LithocatchTM over the fragments, the basket is opened and it is rotated through a special handle to collect stones. One frequent problem occurs when too many fragments are collected at once, preventing the extraction of the device. We research our archives to extrapolate the total number of procedures carried out with the LithocatchTM in the last two years and the total number of complications occurred.

Results: We experienced the above mentioned complication in 16 procedures (14% of the total) of 114 surgeries per­formed. The way described to solve this complication was efficient and did not produce any damage to the ureter or to the basket.

Conclusion: The LithocatchTM has an excellent ability to capture small stones so it allows to reduce the length of the pro­cedure. Paying attention to limit the amount of fragments collected, it is possible to avoid the entrapment of the basket. If this complication occurs, the problem can be solved by reducing the size of the stone fragments. The preferable type of energy is the ballistic one.

 

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20180105_Giusti_et_al

Int Braz J Urol. 2018; 44 (Video #X): XXX-X

[Full Text]


Related Post

Robotic excision of complex adrenal mass with retrocaval extension and encasement of renal hilum with renal preservation

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

doi: 10.1590/S1677-5538.IBJU.2017.0384


VIDEO SECTION

Vishnu Raveendran 1, Ramaprasad Manasseri Koduveli 1, Kishore Thekke Adiyat 1
1 Aster Medcity, Kochi, Kerala, India

ABSTRACT

Objective: The purpose of this video is to present robotic excision of a complex adrenal mass with retrocaval extension and encasement of renal hilum in a 16 year old boy. Biochemical screening was negative for metabolically active compo­nent. Computerized tomographic scan with contrast revealed a homogenous mass of approximately 10.8 cm x 6.2 cm x 4.2 cm in the suprarenal area on right side that was extend-ing behind inferior vena cava and encasing renal hilar vessels. Imaging findings were that of a classical ganglioneuroma.

Material and methods: Robot assisted laparoscopic adrenalectomy with sparing of renal hilar vasculature was performed. With patient in lateral position, five ports were used, including one for liver retraction. Da Vinci® system with four arms was docked from over the right shoulder. The displaced renal hilar structures were identified by opening Gerota’s fascia. Mass was dissected completely and removed through Pfan-nensteil incision.

Results: Duration of procedure was 345 minutes and console time was 290 minutes. Blood loss was 250 mL. Post-opera­tive renal doppler showed normal blood flow. He was discharged on post-operative day three. Histopathologic examina­tion of specimen revealed ganglioneuroma arising from adrenal gland.

Conclusion: Ganglioneuroma is a rare adrenal tumor with good prognosis on surgical removal. The advent of robotic surgery has made complex surgical procedures involving vital structures like inferior vena cava be performed using minimally invasive techniques without compromising oncologic principles.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20170384_Raveendran_et_al

Int Braz J Urol. 2018; 44 (Video #X): XXX-X

[Full Text]


Related Post

Retroperitoneal laparoscopic nephroureterectomy with distal and intramural ureter resection for a tuberculous non – functional kidney

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

doi: 10.1590/S1677-5538.IBJU.2017.0326


ORIGINAL ARTICLE

Canqiang Li 1, Yi Yang 1, Le Xu 1, Minjie Qiu 1
1 Department of Urology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, Guangdong, China

 

ABSTRACT

 

Objective: To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection for a tuberculous non-functional kidney.

Materials and Methods: A total of 27 individuals diagnosed with unilateral non-functional kidney secondary to tuberculosis were treated between June 2011 and June 2015. All patients had normal renal function on the contralateral side and underwent the standard four-drug anti-tuberculosis treatment for at least four weeks before surgery. Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients, and the urinary-bladder junction of distal ureter was managed using different auto-suture techniques.

Results: Nineteen male and 8 female patients with an average age of 47.3 years (range, 36-64 years) underwent surgery. All the operations were successfully performed with­out conversion. The median operative time was 109.3 min (range, 75-138 min), the median blood loss was 157.5 mL (range, 70-250 mL), and the median hospitalization time was 3.7 days (range, 3-6 days). No serious perioperative complications occurred. Anti-tuberculosis chemotherapy was prescribed to all patients, with the entire course of treatment lasting six months. No recurrence of tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of 26.7 months (range, 6-54 months).

Conclusion: Retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection is a safe and feasible approach for the treatment of tuberculous non-functional kidneys.

Keywords: Tuberculosis, Renal; Nephroureterectomy; Nephrectomy

[Full Text]


Related Post

Vitamin C inhibits crystallization of struvite from artificial urine in the presence of Pseudomonas aeruginosa

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

doi: 10.1590/S1677-5538.IBJU.2017.0656


ORIGINAL ARTICLE

Muhammed A. P. Manzoor 1, Surya Ram Duwal 2, M. Mujeeburahiman 3, Punchappady-Devasya Rekha 1
1 Yenepoya Research Centre, 2 Department of Biochemistry, 3 Department of Urology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India

ABSTRACT  

Background: Formation of struvite stones is associated with urinary tract infection by urease-producing bacteria. Biogenic crystal growth in natural and synthetic materials is regulated by the action of inhibitors, ranging from small ions, molecules to large macromolecules.

Materials and Methods: We report the dynamics of in vitro crystallization of struvite in presence of vitamin C in synthetic urine using single diffusion gel growth technique. Sodium metasilicate gel of specific gravity 1.05 and the aqueous solution of ammo­nium dihydrogen phosphate were used as the medium for growing the struvite crystals. The crystallization process was induced by a urease positive struvite stone associated Pseudomonas aeruginosa to mimic the infection leading to stone formation. The grown crystals were characterized by ATR-FTIR and powder XRD. The surface morphology was analysed through FE-SEM for comparison between treatments.

Results: We observed decrease in number, dimension, and growth rate of struvite crys­tals with the increasing concentrations of vitamin C. Crystals displayed well-defined faces and dendritic morphology of struvite in both control and biogenic systems.

Conclusion: The results strongly suggest that, vitamin C can modulate the formation of struvite crystals in the presence of uropathogenic bacteria.

 

Keywords: Struvite; Pseudomonas aeruginosa; Ascorbic Acid

[Full Text]


Related Post

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

[Full Text]


Related Post

Retroperitoneoscopic resection of retroperitoneal nonadrenal ganglioneuromas: our technique and clinical outcomes

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

doi: 10.1590/S1677-5538.IBJU.2017.0460


ORIGINAL ARTICLE

Changjin Shi 1, Feng Li 1, Yanchao Wang 1, Long Pei 1, Tao Wang 2
1 Department of Urology, the Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China; 2 Department of Nephrology, Hebei Provincial General Hospital, Shijiazhuang, China

ABSTRACT

Objective: To report our experience of retroperitoneoscopic technique in semi-lateral decubitus position for the retroperitoneal nonadrenal ganglioneuromas in 18 patients, and to evaluate its clinical outcomes.

Materials and Methods: From January 2012 to May 2016, 18 patients with retroperitoneal nonadrenal ganglioneuromas underwent retroperitoneoscopic resection. With the patients in semi-lateral decubitus position, a 4-port retroperitoneal approach was used. Data were collected on the tumor size, tumor location, perioperative outcomes, pathology, and lastknown disease status. We reviewed the operative videos to identify surgical tips and tricks.

Results: All procedures were carried out successfully without converting to open surgery.

The tumors had an average size of 5.2cm. The mean operative time was 86.5 min, with a mean estimated blood loss of 85.4mL. There were three patients suffering from intraoperative complications. Postoperatively, all patients achieved an uneventful recovery; the mean postoperative hospital stay was 5.5 days. The postoperative pathology revealed to be retroperitoneal ganglioneuromas. With a mean follow-up of 39.5 months, all patients were recurrence free. The review of the operative videos revealed several tips and tricks, including keeping peritoneum and posterior Gerota fascia intact to provide a favorable operative exposure of tumors, and placing the harmonic scalpel through different ports during tumor dissection.

Conclusions: With the patient in semi-lateral decubitus position and a 4-port retroperitoneal approach, retroperitoneoscopic resection of retroperitoneal nonadrenal ganglioneuroma is a feasible, effective, and safe procedure. This approach has distinct advantages including direct access to the tumor, optimal exposure of tumor and less intraperitoneal interference.

Keywords: Retroperitoneal Neoplasms; Ganglioneuroma; Pathology

[Full Text]


Related Post

Neurofibromas of the bladder in a child with neurofibromatosis type 1

Vol. 44 (x): 2018 February 2.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0199


RADIOLOGY PAGE

Gulec Mert Dogan 1, Ahmet Siğirci 1, Leyla Karaca 1
1 Department of Radiology Pediatric, Inonu University Malatya, Turkey
No abstract available

[Full Text]


Related Post

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

[Full Text]


 

Related Post

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.


Related Post