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The preoperative stratification of patients based on renal scan data is unable to predict the functional outcome after partial nephrectomy

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

doi: 10.1590/S1677-5538.IBJU.2017.0636


ORIGINAL ARTICLE

Riccardo Bertolo 1, Cristian Fiori 1, Federico Piramide 1, Daniele Amparore 1, Francesco Porpiglia 1
1 Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy

ABSTRACT

Introduction: eGFR-categories are used to predict functional outcome after partial nephrectomy (PN); no study categorized patients according to preoperative renal scan (RS) data. Aim of the study was to evaluate if stratification of patients according to RS is a reliable method to predict minor/major loss of renal function after PN.

Materials and Methods: We considered patients who underwent PN and RS pre-/post-PN for T1 tumor in our Institution (2007-2017). Demographics, perioperative and specifically functional data were analysed. On the basis of the baseline Split Renal Function (SRF), patients were stratified into risk-categories: 1) baseline operated-kidney SRF range 45-55%; 2) baseline operated-kidney SRF <45%. Risk categories were analysed with postoperative functional outcome: postoperative operated-kidney SRF decrease below 90% of baseline was considered significant loss of function. Contingency tables and univariate/multivariate regression were analysed looking for independent factors of postoperative functional impairment.

Results: 224 patients were analysed, 125 (55.8%) maintained >90% of their baseline function. Worse probability of maintaining ≥90 baseline renal function was found in patients with Charlson’s Comorbidity Index (CCI≥3) (p=0.004) and patients with PADUA score ≥8 (p=0.023). After stratification by baseline renal function, ischemia was the only independent factor: no effect on patients with poorer baseline renal function. Patients with baseline SRF 45-55% who did not experience ischemia had the highest probability to maintain ≥90% baseline SRF (p=0.028). Ischemia >25 minutes was detrimental (p=0.017).

Conclusions: Stratification of patients by SRF before PN is not a reliable predictor of renal functional outcome. Ischemia seems to scarcely influence patients with poorer renal function.

Keywords: Acute Kidney Injury; Nephrectomy; Carcinoma, Renal Cell

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Do uroflowmetry and post – void residual urine tests necessary in children with primary nocturnal enuresis?

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

doi: 10.1590/S1677-5538.IBJU.2017.0464


ORIGINAL ARTICLE

Shang-Jen Chang 1, Stephen Shei-Dei Yang 1
1 Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, and School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan

ABSTRACT

Objectives: To examine the benefits of repetitive uroflowmetry and post void residual urine (PVR) tests in children with primary nocturnal enuresis (PNE).

Material and methods: Children aged ≥6 years with PNE who visited our clinics for management of enuresis were included for study. Patients were requested to complete a questionnaire including baseline characteristics and Dysfunctional Voiding Symptom Score (DVSS), 2-day bladder diary, and Rome III criteria for constipation. Two uroflowmetry and PVR tests were requested. Children with congenital or neurogenic genitourinary tract disorders were excluded. All children underwent urotherapy and desmopressin combined with anticholinergics or laxatives if indicated. The definition of abnormal flow patterns (≥1 abnormal), elevated PVR (≥1 abnormal), small maximal voided volume (MVV), nocturnal polyuria (NP) and response to treatment complied with the ICCS standardization document. Kaplan-Meier survival analysis and Cox proportional-hazards regression tests were used to evaluate the predictors of response.

Results: In total, 100 children aged 8.5}2.3 years were enrolled for study (M: F=66:34) with 7.3}7.4 months of follow-up. Poor correlation was observed between DVSS/small MVV and PVR (p>0.05). Univariate analysis revealed that elevated PVR is associated with significantly less hazard of complete response to medical treatment (HR: 0.52, p=0.03), while not significantly associated with abnormal flow patterns, NP, constipation or small MVV. Multivariate analysis revealed that only elevated PVR (HR 0.30, 95% CI 0.12-0.80) and NP (HR 2.8, 95% CI 1.10-7.28) were significant predictors for complete response.

Conclusions: In managing pediatric enuresis, elevated PVR is a significant predictor for lower chance of complete response to treatment whether they had high DVSS or not.

Keywords: Urinary Bladder, Neurogenic; Enuresis; Child

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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

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5-alpha Reductase Inhibitors and risk of male breast cancer: a systematic review and meta-analysis

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

doi: 10.1590/S1677-5538.IBJU.2017.0531


REVIEW ARTICLE

Jiamin Wang 1, Shankun Zhao 1, Lianmin Luo 1, Ermao Li 1, Xiaohang Li 1, ZhiGang Zhao 1
1 Department of Urology & Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of GuangZhou Medical University, Guangzhou, Guangdong, China

 ABSTRACT

 Objective: To assess the relationship between 5α-reductase inhibitors (5ARIs) and the risk of male breast cancer (MBC).

Material and Methods: We systematically searched Medline via PubMed, Embase and the Cochrane Library Central Register up to May 2017 to identify published articles related to 5ARIs and the risk of MBC.

Results: Summary effect estimates were calculated by a random-effect model, and tests for multivariable-unadjusted pooled risk ratios (RR) and heterogeneity, as well as the sensitivity analyses were conducted to assess publication bias. All four studies were conducted in a quality assessment according to the Newcastle Ottawa Scale system. The strength of association between 5ARIs and the prevalence of MBC was evaluated by using summarized unadjusted pooled RR with a 95% confidence interval [CI]. Four studies involving 595.776 participants, mean age range from 60 to 73.2 years old, were included in a meta-analysis, which produced a summary unadjusted RR of the risk of MBC for the treatment of 5ARIs of 1.16 (95% CI 0.85-1.58, P=0.36) and the multivariable-adjusted RR is 1.03, (95% CI 0.75-1.41, p=0.86). There was no heterogeneity among included studies (I2=0%, P=0.49). Estimates of total effects were generally consistent with the sensitivity.

Conclusion: We did not observe a positive association between the use of 5ARIs and MBC. The small number of breast cancer cases exposed to 5ARIs and the lack of na association in our study suggest that the development of breast cancer should not influence the prescribing of 5ARIs therapy.

 Keywords: 5-alpha Reductase Inhibitors; Breast Neoplasms, Male; Meta-Analysis as Topic

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Comparison of inflammatory markers between brucella and non-brucella epididymo-orchitis

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

doi: 10.1590/S1677-5538.IBJU.2018.0004


ORIGINAL ARTICLE

Ali Cift 1, Mehmet Ozgur Yucel 1
1 Department of Urology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey

ABSTRACT

Objectives: Brucellosis is a multi-system infectious disease that is associated with inflammation, which causes an increase in acute phase reactants. Hematological inflammatory markers of brucellosis include mean platelet volume (MPV), red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR).

In this study, we aimed to evaluate the diagnostic value of hematological inflammatory markers in Brucella epididymo-orchitis (BEO), and to investigate the utility of these markers for differential diagnosis from non-Brucella epididymo-orchitis (non-BEO).

Materials and Methods: We retrospectively reviewed the records of 22 BEO and 50 non-BEO patients. Hematological parameters were recorded and compared between the two groups. The main diagnostic criteria for BEO were positive clinical findings (i.e., testicular pain, tenderness and scrotal swelling), a positive Rose Bengal test result, standard tube agglutination (STA) titer ≥ 1/160, and/or a positive blood culture.

Results: The most decisive factors in discriminating between BEO and non-BEO were NLR, RDW, and MPV, in decreasing order of their strength. Regardless of other factors, NLR values < 2.3 significantly increased the odds of BEO (OR=8.080, 95% CI: 1.929-33.843, p=0.004). After adjusting for other factors, RDW values >14.45% significantly increased the odds of BEO (OR=7.020, 95% CI: 1.749-28.176, p=0.006). Independent of the other factors, patients with MPV < 7.65 fL had a 6.336 times higher risk for BEO (95% CI: 1.393 – 28.822, p=0.017).

Conclusion: Hematological inflammatory markers such as NLR, RDW, and MPV can aid in the differential diagnosis of BEO and non-BEO.

Keywords: Brucella; Infectious Disease Medicine; Hematologic Neoplasms

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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

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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

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REPLY TO THE AUTHORS: Re: Endourologic strategies for a minimally invasive management of urinary tract stones in patients with urinary diversion

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

doi: 10.1590/S1677-5538.IBJU.2018.0123.1


LETTER TO THE EDITOR

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

ABSTRACT

Not available

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

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

doi: 10.1590/S1677-5538.IBJU.2018.0123


LETTER TO THE EDITOR

Ines Mendes Pina, 1, Michael S. Floyd Jr. 1, Simon R. Stubington 2
1 Department of Reconstructive Urology, St Helens & Knowsley Hospital NHS Trust, United Kingdom, UK; 2 Department of Urology, Michael Heal Unit, Mid Cheshire Hospital NHS Foundation Trust, United Kingdom, UK

ABSTRACT

Not available

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Impact of PSA density of transition zone as a potential parameter in reducing the number of unnecessary prostate biopsies in patients with psa levels between 2.6 and 10.0 ng/mL

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

doi: 10.1590/S1677-5538.IBJU.2017.0506


ORIGINAL ARTICLE

Hugo A. Socrates Castro 1, Wagner Iared 2, José Eduardo Mourão Santos 1, Raphael Sandes Solha 2, David Carlos Shigueoka 1, Sergio Aron Ajzen 2
1 Departamento de Diagnóstico por Imagem, 2 Departamento de Radiologia, Universidade Federal de São Paulo, Unifesp, São Paulo, SP, Brasil

ABSTRACT

Purpose: To assess the accuracy of prostate-specific antigen (PSA) adjusted for the transition zone volume (PSATZ) in predicting prostate cancer by comparing the ability of several PSA parameters in predicting prostate cancer in men with intermediate PSA levels of 2.6 – 10.0 ng/mL and its ability to reduce unnecessary biopsies.

Materials and Methods: This study included 656 patients referred for prostate biopsy who had a serum PSA of 2.6 – 10.0 ng/mL. Total prostate and transition zone volumes were measured by transrectal ultrasound using the prolate ellipsoid method. The clinical values of PSA, free-to-total (F/T) ratio, PSA density (PSAD) and PSATZ for the detection of prostate cancer were calculated and statistical comparisons between biopsy-positive (cancer) and biopsy-negative (benign) were conducted.

Results: Cancer was detected in 172 patients (26.2%). Mean PSA, PSATZ, PSAD and F/T ratio were 7.5 ng/mL, 0.68 ng/mL/cc. 0.25 ng/mL/cc and 0.14 in patients with prostate cancer and 6.29 ng/mL, 0.30 ng/mL/cc, 0.16 ng/mL/cc and 0.22 in patients with benign biopsies, respectively. ROC curves analysis demonstrated that PSATZ had a higher area under curve (0,838) than F/T ratio (0,806) (P<0.001) and PSAD (0,806) (P<0.001).

With a cut-off value of 0.22 ng/mL/cc, PSATZ had 100% of sensitivity and could have prevented 24% of unnecessary biopsies.

Conclusions: PSATZ may be useful in enhancing the specificity of serum PSA. Compared to other PSA related parameters, it was better in differentiating between prostate cancer and benign prostatic enlargement. Also, PSATZ could reduce a significant number of unnecessary biopsies.

Keywords: Prostate; Biopsy; Diagnosis

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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

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The role of bladder diverticula in the prevalence of acute urinary retention in patients with BPH who are candidates to surgery

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

doi: 10.1590/S1677-5538.IBJU.2017.0605


ORIGINAL ARTICLE

Alexandre Iscaife 1, Gabriel dos Anjos 1, Cristovão Barbosa Neto 1, Willian Carlos Nahas 1, Miguel Srougi 1, Alberto Azoubel Antunes 1
1 Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo – FMUSP, SP, Brasil

 

ABSTRACT

Introduction: The urinary bladder diverticula (BD) secondary to benign prostatic hyperplasia (BPH) is a complication that can lead to urinary stasis, stone, urinary tract infection (UTI) and tumors. It’s role in acute urinary retention (AUR) is not totally understood.

Objectives: To determine the effect of BD size on AUR rates in patients with BPH candidates to surgery.

Subjects and Methods: We performed a retrospective cohort study of 47 patients with BPH and BD who underwent BPH surgery associated to complete bladder diverticulectomy from 2006 to 2016. We analyzed risk factors for AUR in patients with BD using univariate, multivariate and correlation analysis.

Results: There was a difference in the size of the diverticula, with 6.8 cm vs. 4.5 cm among patients with and without AUR respectively (p=0.005). The ROC curve showed a correlation between the size of BD and the risk of AUR. The value of 5.15 cm presented a sensitivity of 73% and a specificity of 72%. The area under the curve was 0.75 (p=0.01). Comparing groups with BD >5.0 cm vs. ≤5.0 cm, the AUR incidence was 74% and 27.8% respectively with an OR of 2.65 (1.20-5.85) (p=0.005). In the multivariate analysis, only the size of the diverticula reached statistical significance (p=0.012).

Conclusions: The diameter of BD is an independent risk factor for AUR in patients with BPH and BD who are candidates to surgery. A diameter greater than 5.15 cm increases the risk of AUR.

Keywords: Bladder Diverticulum [Supplementary Concept]; Prostatic Hyperplasia; Urinary Retention

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Related Post

Functional outcomes and quality of life after transobturatory slings: hand – made vs. commercial slings

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

doi: 10.1590/S1677-5538.IBJU.2017.0524


ORIGINAL ARTICLE

Danilo Budib Lourenço 1, Fernando Korkes 1, José Eduardo Vetorazzo Filho 2, Silvia da Silva Carramão 3, Antônio Pedro Flores Auge 3, Luis Gustavo Morato de Toledo 2
1 Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; 2 Departamento de Urologia; 3 Departamento de Ginecologia, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil

 

ABSTRACT

 

Surgical correction is the most efficient treatment for stress urinary incontinence (SUI), and transobturator sling (TO) has optimal results. The high cost of commercially available sling kits makes it difficult the access in most Brazilian public health services. Hand-made polypropylene slings, on the other hand, have been previously reported. The aim of the present study was to compare the effectiveness and safety of commercial vs. hand-made polypropylene mesh slings.

Data from 57 women who underwent consecutive TO sling surgery to treat SUI were pros­pectively collected between 2012 and 2014, and divided in two groups for further compa­rison. In Group-1, 31 women underwent surgery with commercial slings. In Group-2, 26 women underwent hand-made polypropylene slings. Women were compared according to epidemiological data, perioperative evaluation, quality of life, urodynamic study, cure and complication rates. Results were objectively (stress test with Valsalva maneuver, with at least 200mL vesical repletion) and subjectively evaluated by the Patient Global Impression of Improvement(PGI-I), Visual Analog Scale (VAS) and ICIQ-SF. Success was defined as PGI-I, VAS and negative stress test.

Group-1 (n=31) and Group-2 (n=26) had a mean age of 60 vs. 58years (p=0.386). All de­mographic data were similar. The mean VLPP was 75.6cmH2O vs. 76.6cmH2O (p=0.88). The mean follow-up was 24.3 vs. 21.5months (p=0.96). Success rates were 74.2% vs. 80.2% (p=0.556), with ICIQ-SF variation of 12.6 vs.15.5 (p=0.139) and PGI-I of 71% vs. 80% (p=0.225). There was only one major complication (urethrovaginal fistula in Group-1). In conclusion, handmade and commercial slings have similar effectiveness and safety. The manufacture technique has important key-points stated in the present manuscript.

Keywords: Urinary Incontinence, Stress; Pelvic Floor; Suburethral Slings

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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

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Evaluation of apoptosis indexes in currently used oral alpha-blockers in prostate: a pilot study

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

doi: 10.1590/S1677-5538.IBJU.2017.0668


ORIGINAL ARTICLE

Mehmet Demir 1, Yigit Akin 1, 2, Kubra Asena Kapakin Terim 3, Mehmet Gulum 4, Evren Buyukfirat 5, Halil Ciftci 1, Ercan Yeni 1
1 Department of Urology, Harran University School of Medicine, Sanliurfa, Turkey; 2 Department of Urology, Izmir Katip Celebi University School of Medicine, Izmir, Turkey; 3 Department of Pathology, Ataturk University School of Veterinary Medicine, Erzurum, Turkey; 4 Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey; 5 Department of Anaesthesiology, Harran University School of Medicine, Sanliurfa, Turkey

 

ABSTRACT

Objectives: Apoptosis effect of oral alpha-blockers is known in the prostate. Apoptosis index of silodosin has not been proved, yet. Aims are to present apoptosis index of silodosin in prostate and to compare this with other currently used alpha-blocker’s apoptosis indexes together with their clinical effects.

Materials and Methods: Benign prostatic hyperplasia (BPH) patients were enrolled among those admitted to urology outpatient clinic between June 2014 and June 2015. Study groups were created according to randomly prescribed oral alpha-blocker drugs as silodosin 8mg (Group 1; n=24), tamsulosin 0.4mg (Group 2; n=30), alfuzosin 10mg (Group 3; n=25), doxazosin 8mg (Group 4; n=22), terazosin 5mg (Group 5; n=15). Pa­tients who refused to use any alpha-blocker drug were included into Group 6 as control group (n=16). We investigated apoptosis indexes of the drugs in prostatic tissues that were taken from patient’s surgery (transurethral resection of prostate) and/or prostate biopsies. Immunochemical dyeing, light microscope, and Image Processing and Analy­sis in Java were used for evaluations. Statistical significant p was p<0.05.

Results: There were 132 patients with mean follow-up of 4.2±2.1 months. Pathologist researched randomly selected 10 areas in each microscope set. Group 1 showed statisti­cal significant difference apoptosis index in immunochemical TUNEL dyeing and im­age software (p<0.001). Moreover, we determined superior significant development in parameters as uroflowmetry, quality of life scores, and international prostate symptom score in Group 1.

Conclusions: Silodosin has higher apoptosis effect than other alpha-blockers in pros­tate. Thus, clinic improvement with silodosin was proved by histologic studies. Besides, static factor of BPH may be overcome with creating apoptosis.

Keywords: Prostate; Prostatic Hyperplasia; 5-alpha Reductase Inhibitors

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Comparing the short – term outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors in patients with coronary artery disese: a prospective, randomized, controlled study

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

doi: 10.1590/S1677-5538.IBJU.2017.0309


ORIGINAL ARTICLE

Deniz Bolat 1, Bulent Gunlusoy 1, Ozgu Aydogdu 1, Mehmet Erhan Aydin 1, Cetin Dincel 1
1 Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey

ABSTRACT

 

Introduction: To compare the perioperative outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors (TURBT) in patients with coronary artery disease (CAD).

Materials and Methods: A total of 90 CAD patients with newly diagnosed bladder cancer who underwent TURBT were randomized into monopolar TURBT (M-TURBT) and bipolar TURBT (B-TURBT) groups. Primary outcome was safety of the procedures including obturator jerk, bladder perforation, clot retention, febrile urinary tract infection and TUR syndrome. The secondary outcome was the efficacy of TURBT procedures, including complete tumor resection, sampling of the deep muscle tissue and sampling of the qualified tissues without any thermal damage.

Results: Mean ages of the patients in M-TURBT and B-TURBT groups were 71.36±7.49 and 73.71±8.15 years, respectively (p=0.157). No significant differences were found between M-TURBT and B-TURBT groups regarding complete tumor resection (76.2% vs. 87.5%, p=0.162) and muscle tissue sampling rates (71.4% vs. 64.6%,p=0.252). Obturator jerk was detected in 16.7% of the patients in M-TURBT group and 2.1% in B-TURBT group (p=0.007). No statistically significant differences were found between the groups regarding intraoperative and postoperative complications.

Conclusions: Both monopolar and bipolar systems can be used safely and effectively during TURBT procedure in CAD patients. Due to the more frequently seen obturator jerk in M-TURBT than B-TURBT, careful surgical approach is needed during M-TURBT.

 

Keywords: Urinary Bladder Neoplasms; Prostatectomy; Coronary Artery Disease

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The protective effect of Papaverine and Alprostadil in rat testes after ischemia and reperfusion injury

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

doi: 10.1590/S1677-5538.IBJU.2017.0600


ORIGINAL ARTICLE

Mehmet Ali Karagoz 1,Omer Gokhan Doluoglu 1, Hatice Ünverdi 2, Berkan Resorlu 3, Mehmet Melih Sunay 4, Arif Demirbas 4, Tolga Karakan 1, 4, Arif Aydin 5
1 Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey; 2 Deparment of Pathology Ankara Training Research Hospital, Ankara, Turkey; 3 Department of Urology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey; 4 Saglik Bakanligi Ankara Egitim ve Arastirma Hastanesi Ankara, Ankara, Turkey; 5 Department of Urology, Faculty of Medicine, Necmettin Erbakan University Meram, Konya, Turkey

ABSTRACT  

Objective: To investigate the effect of papaverine and alprostadil on testicular torsion-detorsion injury in rats.

Materials and Methods: A total of 40 male Wistar-Albino rats were used in this study. Four hours of right testicular torsion was applied to each group, excluding sham oper­ated group. The torsion-detorsion (T/D), T/D + papaverine and T/D + alprostadil groups received saline, papaverine and alprostadil at the same time as surgical detorsion, respectively. At 14 days after the surgical detorsion, ischaemic changes and the degree of damage were evaluated with Cosentino scoring and the Johnson tubular biopsy score (JTBS).

Results: JTBS was determined as 8.8±2.7 in the Sham group, 5.08±1.9 in the T/ D+papaverine group, 5.29±2.3 in the T/D +alprostadil group and 2.86±1.9 in the TD group. The JTBS was determined to be statistically significantly high in both the T/D + papaverine group and the T/D + alprostadil group compared to the T/D group (p=0.01, p=0.009). In the T/D + papaverine group, 3 (43 %) testes were classified as Cosentino 2, 3 (43%) as Cosentino 3 and 1 (14 %) as Cosentino 4. In the T/D +alprostadil group, 5 (50 %) testes were classified as Cosentino 2, 3 (30 %) as Cosentino 3 and 2 (20%) as Cosentino 4.

Conclusion: The present study indicated that spermatic cord administration of alprosta­dil and papaverine showed a protective effect against ischemia/reperfusion injury after right-side testes torsion and histological changes were decreased after testicular isch­emia reperfusion injury.

Keywords: Papaverine; Alprostadil; Spermatic Cord Torsion

[Full Text]


Related Post

Effect of phyllanthus niruri on metabolic parameters of patients with kidney stone: a perspective for disease prevention

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

doi: 10.1590/S1677-5538.IBJU.2017.0521


ORIGINAL ARTICLE

Nidia D. Pucci 1, Giovanni S. Marchini 2, Eduardo Mazzucchi 2, Sabrina T. Reis 3, Miguel Srougi 2, Denise Evazian 1, William C. Nahas 2
1 Divisão de Nutrição e Dietética, Instituto Central, Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina. São Paulo, Brasil; 2 Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brasil; 3 Laboratório de Investigação Médica, Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brasil

ABSTRACT  

 

Phyllanthus niruri (P.niruri) or stone breaker is a plant commonly used to reduce stone risk, however, clinical studies on this issue are lacking.

Objective: to prospectively evaluate the effect of P. niruri on the urinary metabolic param­eters of patients with urinary lithiasis.

Materials and Methods: We studied 56 patients with kidney stones <10mm. Clinical, meta­bolic, and ultrasonography assessment was conducted before (baseline) the use of P. niruri infusion for 12-weeks (P. niruri) and after a 12-week (wash out) Statistical analysis includ­ed ANOVA for repeated measures and Tukey’s/McNemar´s test for categorical variables. Significance was set at 5%.

Results: Mean age was 44±9.2 and BMI was 27.2±4.4kg/m2. Thirty-six patients (64%) were women. There were no significant changes in all periods for anthropometric and several serum measurements, including total blood count, creatinine, uric acid, sodium, potassium, calcium, urine volume and pH; a significant increase in urinary potassium from 50.5±20.4 to 56.2±21.8 mg/24-hour (p=0.017); magnesium/creatinine ratio 58±22.5 to 69.1±28.6mg/ gCr24-hour (p=0.013) and potassium/creatinine ratio 39.3±15.1 to 51.3±34.7mg/gCr24- hour (p=0.008) from baseline to wash out. The kidney stones decreased from 3.2±2 to 2.0±2per patient (p<0.001). In hyperoxaluria patients, urinary oxalate reduced from 59.0±11.7 to 28.8±16.0mg/24-hour (p=0.0002), and in hyperuricosuria there was a de­crease in urinary uric acid from 0.77±0.22 to 0.54±0.07mg/24-hour (p=0.0057).

Conclusions: P.niruri intake is safe and does not cause significant adverse effects on serum metabolic parameters. It increases urinary excretion of magnesium and potassium caused a significant decrease in urinary oxalate and uric acid in patients with hyperoxaluria and hyperuricosuria. The consumption of P.niruri contributed to the elimination of urinary calculi.

Keywords: Kidney Calculi; Disease; Urolithiasis

[Full Text]


Related Post

Complete supine percutaneous nephrolithotomy with GoPro®. Ten steps for success

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

doi: 10.1590/S1677-5538.IBJU.2017.0337


VIDEO SECTION

Fabio Carvalho Vicentini 1, Hugo Daniel Barone dos Santos 1, Carlos Alfredo Batagello 1, Julia Rothe Amundson 2, Evaristo Peixoto Oliveira Neto 1, Giovanni Scala Marchini 1, Miguel Srougi 1, Willian Carlos Nahas 1, Eduardo Mazzucchi 1
1 Divisão de Urologia, Grupo de Endourologia do Hospital das Clínicas, Faculdade de Medicina da Uni­versidade de São Paulo, USP, São Paulo, SP, Brasil; 2 University of Miami, Miller School of Medicine, Miami, EUA

ABSTRACT

 

Objective: To show a video of a complete supine Percutaneous Nephrolithotomy (csPCNL) performed for the treatment of a staghorn calculus, from the surgeon’s point of view. The procedure was recorded with a GoPro® camera, demonstrating the ten essential steps for a successful procedure.

Materials and methods: The patient was a 38 years-old woman with 2.4cm of left kidney lower pole stone burden who presented with 3 months of lumbar pain and recurrent urinary tract infections. She had a previous diagnosis of polycystic kidney disease and chronic renal failure stage 2. CT scan showed two 1.2cm stones in the lower pole (Guy’s Stone Score 2). She had a previous ipsilateral double J insertion due to an obstructive pyelonephritis. The csPCNL was uneventful with a single access in the lower pole. The surgeon had a Full HD GoPro Hero 4 Session® camera mounted on his head, controlled by the surgical team with a remote control. All of the mains steps were recorded. Informed consent was ob­tained prior to the procedure.

Results: The surgical time was 90 minutes. Hemoglobin drop was 0.5g/dL. A post-operative CT scan was stone-free. The patient was discharged 36 hours after surgery. The camera worked properly and didn’t cause pain or muscle discomfort to the surgeon. The quality of the recorded movie was excellent.

Conclusion: GoPro® camera proved to be a very interesting tool to document surgeries without interfering with the pro­cedure and with great educational potential. More studies should be conducted to evaluate the role of this equipment.

ARTICLE INFO
Available at: http://www.intbrazjurol.com.br/video-section/20170337_Vicentini_et_al

[Full Text]


 

Related Post

Robotic adenomectomy using a laparoscopic dissector

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

doi: 10.1590/S1677-5538.IBJU.2017.0609


VIDEO SECTION

Lessandro Curcio Gonçalves 1, Felipe Monnerat Lott 2, Rafael Rosa 1
1 Serviço de Urologia, Hospital Federal de Ipanema, Rio de Janeiro, RJ, Brasil; 2 Departamento de Urologia, Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brasil

ABSTRACT

Introduction: Only few reports are known about the use of robotic surgery for prostate benign enlargement. The robotic surgery can be improved by laparoscopic tricks. We show a video of robotic adenomectomy where a laparoscopic dissector is used to help create the plan between prostatic capsule and adenoma.
Materials and methods: A 62 years old male had severe urinary flow outlet obstruction. Medical therapy was not effective.
Ultrasound detected a 92gr enlarged prostate with a large middle lobe. Robotic assisted adenomectomy was scheduled.
The procedure followed this sequence: opening of Retzius space, superficial suture of the Dorsal vein complex, horizontal cistotomy. The plan was created with electrocautery and blunt dissection with the laparoscopic dissector. Haemostatic sutures were placed between prostate fossa and the posterior bladder neck and closure of the cistotomy.
Results: Whole operation time was 160 minutes, with a blood loss of 80cc. There was no perioperative or post-operative complication. Catheter was removed after 4 days. Post-operatory uroflowmetry shows a peak flow of 30ml/sec. Pathological examination is negative for tumor. After 60 days IPSS was 8.
Conclusion: Robotic prostate adenomectomy using the laparoscopic dissector is a safe and effective minimally invasive treatment for benign prostatic enlargement. It is a novel technique to find and dissect the plane between prostatic adenoma
and capsule. This could be one more use of laparoscopic technology to improve surgical outcomes in robotic field.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20170609_Goncalves_et_al

[Full Text]


Related Post

Completely endophytic renal tumor: A laparoscopic approach

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

doi: 10.1590/S1677-5538.IBJU.2017.0534


VIDEO SECTION

Victor Espinheira Santos 1, Rafael Ribeiro Meduna 1, Wilson Bachega Jr. 1, Gustavo Cardoso Guimarães 1
1 Serviço de Urologia, Departamento de Cirurgia Pélvica, AC Camargo Cancer Center, São Paulo, SP, Brasil

 

ABSTRACT

Kidney cancer is the third most common urologic malignancy and a 2% annual increase in the incidence has occurred over the past two decades, largely because of the increased utilization of imaging. The majority of these tumors are small, so the indications for nephron-sparing surgery and for minimally invasive surgery are continually expanding. Complex kidney lesions, such as those completely endophytic, are still a challenge even for experienced surgeons.

Our objective is to demonstrate the operative technique for laparoscopic partial nephrectomy with the aid of intra-operative ultrasound in a man with a totally endophytic renal lesion.

Case: A 52 years old man, asymptomatic, with incidental renal mass of 2.9 cm, completely endophytic (R.E.N.A.L score 9p) submitted to partial laparoscopic nephrectomy. Surgical time was 2 hours, with 20 minutes of ischemia. Pathological anatomy confirmed tumor of clear cells T1a, free margins.

ARTICLE INFO: Available at: http://www.intbrazjurol.com.br/video-section/20170534_Santos_et_al

[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

Evaluation of urodynamic parameters after sling surgery in men with post-prostatectomy urinary incontinence

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

doi: 10.1590/S1677-5538.IBJU.2017.0243


ORIGINAL ARTICLE

Odair Gomes Paiva 1, João Paulo Cunha Lima 1, Carlos Alberto Bezerra 1
1 Disciplina de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil

 

ABSTRACT

Objective: To evaluate urodynamic alterations after sub-urethral sling surgery (SSU) in patients with post-prostatectomy urinary incontinence (PPUI).

Materials and Methods: We evaluated data of 22 patients submitted to radical prosta­tectomy (RP) or transurethral resection of prostate (TURP) that presented post-surgical urinary incontinence and were treated with SSU implant in a pilot study previously performed in our institution.

Methods: Those patients with PPUI were evaluated by urodynamic exam (UD) before and after surgery, and the parameters were compared, including uroflow, cystometry and micturition study. Exclusion criteria included patients without pre-operatory uro­dynamic study, those with urethral stenosis, those not healed of prostate cancer, pa­tients without clinical conditions to be submitted to urodynamic study and those with severe neurological diseases or that refused to sign the consent form. Results were analyzed statistically by Fisher, Wilcoxon or Mann-Whitney tests.

Results: During free uroflow, none parameters showed any statistical significant differences. During cystometry, there were also no statistical differences and the same was observed at pressure versus flow study; the exception was at maximal flow detrusor pressure (PdetQmax), that was lower at post-operatory (p=0.028). In relation to the presence of urinary dysfunctions associated to PPUI, we observed a significant reduc­tion of detrusor overactivity (p=0.035) in relation to pre-operatory period.

Conclusion: SSU surgery significantly reduced detrusor overactivity and PdetQMax; however, there were no alterations of other evaluated urodynamic parameters.

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

[Full Text]


 

Related Post

Changes observed in prostate biopsy practices in an inner city hospital with a high risk patient population following the 2012 uspstf psa screening recommendations

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

doi: 10.1590/S1677-5538.IBJU.2017.0348


ORIGINAL ARTICLE

Andrew W. Tam 1, Johnathan A. Khusid 1, Igor Inoyatov 1, Adan Z. Becerra 2, 3, Jonathan Davila 1, Jyoti D. Chouhan 1, Jeffrey P. Weiss 1, Llewellyn M. Hyacinthe 1, Brian K. McNeil 1, Andrew G. Winer 1
1 Department of Urology, University Hospital of Brooklyn, State University of New York Downstate College of Medicine, Brooklyn, NY, USA; 2 Department of Public Health Sciences and Division of Epidemiology, University of Rochester Medical Center, Rochester, NY, USA; 3 Department of Surgery, University of Rochester Medical Center, Surgical Health Outcomes and Research Enterprise (SHORE), Rochester, NY, USA

ABSTRACT

Introduction: We compared characteristics of patients undergoing prostate biopsy in a high-risk inner city population before and after the 2012 USPSTF recommendation against PSA based prostate cancer screening to determine its effect on prostate biopsy practices.

Materials and Methods: This was a retrospective study including patients who received biopsies after an abnormal PSA measurement from October 2008-December 2015. Patients with previously diagnosed prostate cancer were excluded. Chi-square tests of independence, two sample t-tests, Mann-Whitney U tests, and Fisher’s exact tests were performed.

Results: There were 202 and 208 patients in the pre-USPSTF and post-USPSTF recommendation cohorts, respectively. The post-USPSTF cohort had higher median PSA (7.8 versus 7.1ng/mL, p=0.05), greater proportion of patients who were black (96.6% versus 90.5%, p=0.01), and greater percentage of biopsy cores positive for disease (58% versus 29.5%, p<0.001). Multivariable analysis supported that the increase in PSA was independent of the increase in the proportion of patients who were black. The proportion of patients who were classified as D’Amico intermediate and high-risk disease increased in the post-USPSTF cohort and approached statistical significance (70.1% versus 58.8%, p=0.12).

Conclusions: Our study suggests that the USPSTF recommendations may have led to na increase in pre-biopsy PSA as well as greater volume of disease. Also, a greater proportion of patients were being classified with intermediate or high risk disease. While the clinical significance of these findings is unknown, what the data suggests is somewhat troubling. Future research should further examine these changes in a larger cohort as well as resultant long-term outcomes.

Keywords: Mass Screening; Prostatic Neoplasms; Prostate-Specific Antigen

[Full Text]


Related Post

Re: Dipyridamole reduces penile apoptosis in a rat model of post-prostatectomy erectile dysfunction

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

doi: 10.1590/S1677-5538.IBJU.2018.0016


LETTER TO THE EDITOR

Shanzun Wei 1,2, Ming Ma 1,2, Changjing Wu 1, Botao Yu 1,2, Jiuhong Yuan 1,2
1 Andrology Laboratory and 2 Department of Urology, Westchina Hospital, SiChuan University, China

ABSTRACT

No abstract available

[Full Text]


Related Post

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 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0525


ORIGINAL ARTICLE

Abdullah Cirakoglu 1, Erdal Benli 1, Ahmet Yuce 1
1 Department of Urology, Ordu University, Faculty of Medicine, Ordu, Turkey

 

ABSTRACT

Aim: Although prostate cancer (PCa) is the most common cancer type in men, a replaceable risk factor has not yet been established. In our study, we assessed the relationship between the number of sexual partners, age of first sexual experience and age of first masturbation and prostate cancer incidence.

Materials and Methods: In Ordu University Department of Urology between January 2013 and September 2016, in PSA elevation and rectal examination, patients with prostate biopsy were evaluated due to nodule palpation in the prostate. At younger ages and at present, their first masturbation ages, first sexual debut ages, and total sexual partner numbers were recorded. The correlation between the obtained data and PCa frequency was evaluated.

Results: The study included 146 patients with PCa identified on biopsy and 171 patients with benign biopsy results who answered the questions. 66.7% of the ones whose biopsy results were benign and 40.6% of cancer suspects had only one sexual partner.

The median number of sexual partners was 1±4 (1-100) in the benign group and 2±6 (1-500) in the malignant group (p=0.039). There was a negative correlation between age of first sexual debut and number of partners (r: -0,479; p <0.001).

Conclusion: In our study, it appears that there may be an association between the number of sexual partners and prostate cancer in the patient group with PSA level above 4ng/mL. Avoidance of sexual promiscuity or participation in protected sex may be beneficial to protect against prostate cancer.

Keywords: Prostatic Neoplasms; Marriage; Sexual Behavior

[Full Text]


Related Post

Objective measurements of the penile angulation are significantly different than self-estimated magnitude among patients with penile curvature

Vol. 44 (x): 2018 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0418


ORIGINAL ARTICLE

Giovanni Liguori 1, Andrea Salonia 2, Giulio Garaffa 3, Giovanni Chiriacò 1 , Nicola Pavan 1, Giorgio Cavallini 4, Carlo Trombetta 1
1 Department of Urology, University of Trieste, Trieste, Italy; 2 Department of Urology, Università Vita- Salute San Raffaele, Milan, Italy; 3 St Peter’s Andrology and the Institute of Urology, University College London Hospitals, London, UK; 4 Andrological Unit, Gynepro Medical Team; Bologna, Italy

 

ABSTRACT

Introduction: The study was aimed to assess the presence of actual differences between the objective and the perceived magnitude of a curvature between patients affected by Peyronie’s disease (PD) and congenital penile curvature (CPC).

Materials and Methods: Wee analysed a cohort of 88 consecutive patients seeking medi­cal help for either CPC or PD. All patients were invited to provide a self-made drawing of their penis in erection in order to obtain self-provided description of the deformity. An objective measurement of the deformity was also performed drawing two intersecting lines through the center of the distal and proximal straight section of the penile shaft.

Results: Our findings showed significant differences between patient self-estimation and the objective measurements of the penile angulation performed by trained experts, with only 32% of patients correctly assessing their own curvature. Overall, patients tended to overestimate (56%) their degree of curvature, but the results are different in patients with PD than those with CPC. In the 60 men (68%) who did not accurately assess their curvature, PD patients generally overestimated their curvature versus CPC patients (67% vs 16%). On the contrary CPC patients underestimated their curvature compared to PD (42% vs. 4%).

Conclusion: In order to improve patients’ satisfaction rates, the surgeon needs to take into consideration the patient’s perception of the deformity when planning the type of surgical correction.

Keywords: Penile Induration; Penis; Penile Erection

[Full Text]


 

Related Post

The history of varicocele: from antiquity to the modern ERA

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

doi: 10.1590/S1677-5538.IBJU.2017.0386


ORIGINAL ARTICLE

Antonio Marte 1
1 Unità di Chirurgia Pediatrica, Università della Campania – Luigi Vanvitelli, Napoli, Italia

 

ABSTRACT

Men have most likely been affected by varicocele since the assumption of the upright position. In De Medicina, written during the first century AD, Celsus credits the Greeks with the first description of a varicocele, and he recorded his own acute observation: “The veins are swollen and twisted over the testicle, which becomes smaller”. Celsus himself is credited with the distinction between varicocele (dilation of surface veins) and “cirsocele” (dilation of deep veins). There has been a long history of treatment attempts and failures, some of which are remarkably strange, that have sometimes cul­minated in tragedy, as in the case of French professor Jacques-Mathieu Delpech (1772- 1832). Although some questions regarding the etiopathology and treatment of varico­cele remain unanswered, a succession of more or less conservative attempts involving all medical cultures has been performed throughout history. The report by W.S. Tull­och in 1952 brought varicocele into the era of modern evidence-based medicine, and varicocele surgery finally progressed beyond the aim of merely relieving scrotal pain and swelling. From 1970 to 2000, varicocelectomies gained worldwide attention for the treatment of male infertility. Several innovative procedures to correct varicoceles began to appear in the world’s literature as interventional radiology, microsurgery, laparoscopy, and robotics, while comprehensive review articles were also published on the subject of varicocelectomies. Microsurgery is nowadays used worldwide and it can be considered to be the gold standard for correcting infertility linked to varicocele.

Keywords:  Varicocele; history of medicine

[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

Re: Gaseous bladder tamponade secondary to emphysematous cystitis

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

doi: 10.1590/S1677-5538.IBJU.2017.0701


LETTER TO THE EDITOR

Yu-Chen Chen 1,2, Hao-Wei Chen 1,2, Yung-Shun Juan 3, Wen-Jeng Wu 3, Chia-Chun Tsai 3
1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 2 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Taiwan; 3 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

 ABSTRACT

No abstract available

[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

Laparoscopic management of paraganglioma in a pregnant woman: a case report

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

doi: 10.1590/S1677-5538.IBJU.2017.0698


CHALLENGING CLINICAL CASES

Mohammad Hadi Radfar 1, Behnam Shakiba 1, Amir Afyouni 1, Hassan Hoshyar 1
1 Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

ABSTRACT

Introduction: Paraganglioma is an extremely rare catecholamine-producing tumor during pregnancy. Paraganglioma carries high risks of fetal and maternal mortality during pregnancy. We report a pregnant woman with paraganglioma in the second trimester.

Case Description: A 24-year-old pregnant woman presented with severe hypertension in the 17th week of gestation. Hormonal examination and Magnetic Resonance Imaging (MRI) confirmed the diagnosis of extra adrenal pheochromocytoma (paraganglioma). She underwent laparoscopic tumor excision successfully.

Conclusions: A high index of suspicion is needed to diagnose paraganglioma in a pregnant patient with hypertension. Laparoscopic tumor removal for paraganglioma seems to be a feasible and safe procedure during pregnancy.

Keywords: Laparoscopy; Paraganglioma; Pregnant Women

[Full Text]


Related Post

BCG instillations can mimic prostate cancer on multiparametric MRI

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

doi: 10.1590/S1677-5538.IBJU.2017.0621


RADIOLOGY PAGE

Pablo Garrido-Abad 1, Miguel Ángel Rodríguez-Cabello 1, Cristina González-Gordaliza 2, Roberto Vera-Berón 3, Arturo Platas-Sancho 1
1 Department of Urology, Hospital Universitario Sanitas La Moraleja, Madrid, Spain; 2 Department of Radiology, Hospital Universitario Sanitas La Moraleja, Madrid, Spain; 3 LABCO (SYNLAB) Pathology, Madrid, Spain

ABSTRACT

No abstract available

[Full Text]


 

Related Post

Diagnostic accuracy of multiparametric magnetic resonance imaging in detecting extracapsular extension in intermediate and high – risk prostate cancer

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

doi: 10.1590/S1677-5538.IBJU.2016.0485


ORIGINAL ARTICLE

Cristina Dominguez 1, Mauricio Plata 1, Juan Guillermo Cataño 1, Mauricio Palau 2, Diego Aguirre 3, Jorge Narvaez 3, Stephanie Trujillo 3, Felipe Gómez 1, Carlos Gustavo Trujillo 1, Juan Ignacio Caicedo 1, Camilo Medina 1
1 Department of Urology; 2 Department of Pathology; 3 Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia, CO

ABSTRACT

Objectives: To evaluate the diagnostic performance of preoperative multiparametric magnetic resonance imaging (mp-MRI) as a predictor of extracapsular extension (ECE) and unfavorable Gleason score (GS) in patients with intermediate and high-risk pros­tate cancer (PCa).

Materials and Methods: Patients with clinically localized PCa who underwent radi­cal prostatectomy (RP) and had preoperative mp-MRI between May-2011 and Decem­ber-2013. Mp-MRI was evaluated according to the European Society of Urogenital Ra­diology MRI prostate guidelines by two different readers. Histopathological RP results were the standard reference.

Results: 79 patients were included; mean age was 61 and median preoperative prosta­te-specific antigen (PSA) 7.0. On MRI, 28% patients had ECE evidenced in the mp-MRI, 5% seminal vesicle invasion (SVI) and 4% lymph node involvement (LNI). At RP, 39.2% had ECE, 26.6% SVI and 12.8% LNI. Sensitivity, specificity, accuracy, positive predic­tive value (PPV), and negative predictive value (NPV) of mp-MRI for ECE were 54.9%, 90.9%, 76%, 81% and 74.1% respectively; for SVI values were 19.1%, 100%, 77.3%, 100% and 76.1% respectively and for LNI 20%, 98.4%, 86.7%, 66.7% and 88.7%.

Conclusions: Major surgical decisions are made with digital rectal exam (DRE) and ultrasound studies before the use of Mp-MRI. This imaging study contributes to rule out gross extraprostatic extension (ECE, SVI, LNI) without competing with pathological studies. The specificity and NPV are reasonable to decide surgical approach. A highly experienced radiology team is needed to provide accurate estimations of tumor exten­sion and aggressiveness.

Keywords: Prostatic Neoplasms; Magnetic Resonance Imaging; Prostatectomy

[Full Text]


Related Post

Extensive renal sinus lipomatosis in xanthogranulomatous pyelonephritis simulating liposarcoma

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

doi: 10.1590/S1677-5538.IBJU.2017.0509


RADIOLOGY PAGE

Sabrina de Mello Ando 1, Raquel Andrade Moreno 1, Públio Cesar Cavalcante Viana 1, Fernando Ide Yamauchi 1
1 Departamento de Radiologia, Hospital das Clínicas da Universidade de São Paulo HC-FMUSP, São Paulo, Brasil

ABSTRACT

Renal replacement lipomatosis is a condition characterized by varying degrees of renal parenchymal atrophy and perirenal fibrofatty proliferation secondary to chronic inflammation such as xanthogranulomatous pyelonephritis. In severe cases, imaging findings can be misdiagnosed as retroperitoneal liposarcoma.

[Full Text]


 

Related Post

Differences in the percutaneous nephrolithotomy practice patterns among Latin American urologists with and without endourology training

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

doi: 10.1590/S1677-5538.IBJU.2017.0599


ORIGINAL ARTICLE

Braulio O. Manzo 1, Edgar Lozada 1, Fabio C. Vicentini 2, Francisco Javier Sanchez 3, Gildardo Manzo 1
1 Hospital Regional de Alta Especialidade do Bajío, México; 2 Hospital das Clínicas da universidade de São Paulo, São Paulo, SP, Brasil; 3 Centro de Urologia do México (UROCEM), México

ABSTRACT

Purpose: Although the worldwide percutaneous nephrolithotomy (PCNL) practice patterns determined via a survey sent to members of the Endourological Society have been published, differences in PCNL practice patterns among Latin American urologists based on endourological or lithiasis training have not been published.

To determine the PCNL practice patterns among Latin American urologists with and without training in endourology.

Materials and Methods: The SurveyMonkey® web platform was used to develop a 27- item survey on PCNL for the treatment of renal stones, and the survey was sent via e-mail and other electronic media to 2000 urologists from 15 Latin American countries. Endourology-trained (group 1) and nontrained urologists (group 2) were analyzed. The group results were compared using the chi-squared and Fisher’s exact tests. SPSS version 20 for Windows was used for all analyses.

Results: A total of 331 urologists responded to the survey (rate of 16.55%): 221 (66.7%) in group 1 and 110 (33.2%) in group 2). In groups 1 and 2, 91.9% and 63.2% performed PCNL, respectively; 85.1% and 58.5% used preoperative tomography, respectively; 12.7% and 4.7% used preoperative nephrolitometry nomograms, respectively; 45.2% and 32.1% used endoscopic combined intrarenal surgery, respectively; 68.3% and 38.7% used mul­tiple percutaneous tract realization, respectively; and 19.9% and 5.7% used minimally invasive PCNL, respectively (all p=0.0005).

Conclusions: Statistically significant differences were observed in PCNL practice patterns of Latin American urologists with and without training in endourology. Specific training in endourology significantly influence the practice patterns of Latin American urologists.

Keywords: Nephrolithotomy, Percutaneous; Health Care Surveys; Kidney Calculi

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Related Post

Idiosyncratic reaction after injection of polyacrylate – polyalcohol copolymer

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

doi: 10.1590/S1677-5538.IBJU.2017.0446


CHALLENGING CLINICAL CASES

Cristiano Linck Pazeto 1, Fábio José Nascimento 1, Lucila Heloisa Simardi Santiago 2, Sidney Glina 1
1 Departamento de Urologia, Faculdade de Medicina do ABC (FMABC), Santo André, SP, Brasil; 2 Departamento de Patologia, Faculdade de Medicina do ABC (FMABC), Santo André, SP, Brasil

ABSTRACT

Context: Polyacrylate-polyalcohol copolymer is a synthetic product, non-biodegrada­ble, with low rate of therapeutic failure and lower incidence of reactions at the site of injection, when compared to biodegradable agents. We report an unprecedent, exube­rant and persistent inflammatory reaction following injection of that substance.

Patient: a 17 years-old patient with vesico-ureteral reflux and complete pyelocaliceal right duplication was submitted to treatment with polyacrylate-polyalcohol copolymer (STING technique). In the seventh day of post-operatory, she presented intense dysuria and hypogastric pain, without laboratory exams alterations; a symptomatic treatment was started. After two months, the symptoms persisted and an ultrasound detected thickening of bladder wall close to the uretero-vesical junction. After that exam, a cys­tostopic biopsy showed epithelial hyperplasia with increased edema of lamina propria, suggesting an adverse reaction to the polymer. After four months, there was complete remission, but the reflux persisted with the same grade.

Hypothesis: This is an unprecedent reaction following injection of this copolymer. The presence of characteristics such as absence of infection, temporal relation between treatment and beginning of symptoms, and detection of epithelial hyperplasia at the local of injection reinforce the hypothesis of association of the substance and adverse reaction. In that patient, important complains motivated early investigation of urinary tract, that confirmed those aspects. Maybe if that reaction had occurred in patients with lower capacity of expression (such as in infants) it would be unnoticed.

Keywords: lidocaine-polyacrylate [Supplementary Concept]; Vesico-Ureteral Reflux; Hyperplasia

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Related Post

Ureteroscopy and stone treatment in the elderly (≥70 years): prospective outcomes over 5- years with a review of literature

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

doi: 10.1590/S1677-5538.IBJU.2017.0516


ORIGINAL ARTICLE

Sarah Prattley 1, James Voss 1, Stephanie Cheung 1, Robert Geraghty 1, Patrick Jones 1, Bhaskar K. Somani 1
 1 University Hospital Southampton, NHS Trust, United Kingdom, UK

ABSTRACT  

Objective: To assess outcomes of ureteroscopy for treatment of stone disease in the elderly. Ureteroscopy (URS) is an increasingly popular treatment modality for urolithiasis and its applications are ever expanding with the development of newer technologies. Its feasibi­lity and outcomes within the elderly population to our knowledge remain under-reported.

Materials and Methods: We examined the patient demographics and surgical outcomes from our prospective database for patients ≥70 years who underwent URS for urolithiasis, in a 5-year period between March 2012 and December 2016.

Results: A total of 110 consecutive patients underwent 121 procedures (1.1 procedure/ patient) with a mean age of 77.2 years (range: 70-91 years). Stone location was in the kid­ney/ pelviureteric junction (PUJ) in 29%, ureter in 37% and in multiple locations in 34%. The initial and final stone free rate (SFR) was 88% and 97% respectively. While 73% were done as true day case procedures, 89% patients were discharged within 24 hours. Eleven patients (9%) underwent complications of which 10 were Clavien I/II including acute urinary retention, urinary tract infection, stent symptoms and pneumonia. One patient underwent Clavien IV complication where they needed intensive care unit admission for urosepsis but fully recovered and were discharged home subsequently.

Conclusion: Ureteroscopy is a safe and effective method of managing urolithiasis in elder­ly patients. Although most patients are discharged within 24-hours, consideration needs to be made for patients where social circumstances can impact their discharge planning.

Keywords: Ureteroscopy; Calculi; Therapeutics

[Full Text]


 

Related Post

Durasphere® EXP: a non-biodegradable agent for treatment of primary Vesico-Ureteral reflux in children

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

doi: 10.1590/S1677-5538.IBJU.2017.0514


ORIGINAL ARTICLE

Unsal Ozkuvanci 1, Muhammet Irfan Donmez 2, Faruk Ozgor 1, Akif Erbin 1, Özge Pasin 3, Ahmet Yaser Muslumanoglu 1
1 Department of Urology Haseki Training and Research Hospital, Fatih, Istanbul, Turkey; 2 Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey; 3 Department of Biostatistics, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey

ABSTRACT

 

Introduction: Durasphere® EXP (DEXP) is a compound of biocompatible and non­-biodegradable particles of zirconium oxide covered with pyrolytic carbon. The aim of this study is to evaluate the durability of off-label use of DEXP in the treatment of primary vesicoureteral reflux in children.

Materials and Methods: Patients who underwent subureteric injection of DEXP for the correction of primary VUR were retrospectively reviewed . Patients aged >18 years as well as those who had grade-I or -V VUR, anatomic abnormalities (duplicated system, hutch diverticulum), neurogenic bladder or treatment refractory voiding dysfunction were excluded. Radiologic success was defined as the resolution of VUR at the 3rd month control. Success was radiographically evaluated at the end of the first year.

Results: Thirty-eight patients (9 boys, 29 girls; mean age, 6.3±2.7 years) formed the study cohort. Forty-six renal units received DEXP (grade II: 22; grade III: 18; grade IV: 6). Mean volume per ureteric orifice to obtain the mound was 0.70±0.16mL. First con­trol VCUG was done after 3 months in all patients. After the first VCUG, 6 patients had VUR recurrence. Short-term radiologic success of DEXP was 84.2%. Rate of radiologic success at the end of the first year was 69.4% (25/32). Lower age (p:0.006) and lower amount of injected material (p:0.05) were associated with higher success rates at the end of 1 year.

Conclusion: This is the first study to assess the outcomes of DEXP for treatment of primary VUR in children. After 1 year of follow-up, DEXP had a 69.4% success rate.

Keywords: Durasphere [Supplementary Concept]; Vesico-Ureteral Reflux; Child

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Related Post

On thin ice: barriers to adoption of surveillance for patients with stage I testicular seminoma. Survey of US radiation oncologists

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

doi: 10.1590/S1677-5538.IBJU.2017.0454


ORIGINAL ARTICLE

Aditya Jain 1,2, Catherine Degnin 2, Yiyi Chen 2, Mike Craycraft 3, Arthur Hung 2, Jerry Jaboin 2, Charles R. Thomas, Jr. 2, Timur Mitin 2
1 Boston University, Boston, MA, USA; 2 Oregon Health and Science University, Portland, OR, USA. 3 Testicular Cancer Society, Cincinnati, OH, USA

ABSTRACT

Purpose: Most men with stage I testicular seminoma are cured with surgery alone, which is a preferred strategy per national guidelines. The current pattern of practice among US radiation oncologists (ROs) is unknown.

Materials and Methods: We surveyed practicing US ROs via an online questionnaire. Respondent’s characteristics, self-rated knowledge, perceived patient compliance rates with observation were analyzed for association with treatment recommendations.

Results: We received 353 responses from ROs, of whom 23% considered themselves experts. A vast majority (84%) recommend observation as a default strategy, however this rate drops to 3% if the patient is believed to be noncompliant. 33% of respondents believe that survival is jeopardized in case of disease recurrence, and among these respondents only 5% support observation. 22% of respondents over-estimate the likeli­hood of noncompliance with observation to be in the 50-80% range. Responders with a higher perceived noncompliance rate are more likely to recommend adjuvant therapy (Fisher’s exact p<0.01). Only 7% of respondents recommend observation for stage IS seminoma and 45% administer adjuvant RT in patients with elevated pre-orchiectomy alpha-fetal protein levels.

Conclusions: Many US ROs over-estimate the likelihood that stage I testicular semi­noma patients will be noncompliant with surveillance and incorrectly believe that overall survival is jeopardized if disease recurs on surveillance. Observation is quickly dismissed for patients who are not deemed to be compliant with observation, and is generally not accepted for patients with stage IS disease. There is clearly an oppor­tunity for improved physician education on evidence-based management of stage I testicular seminoma.

Keywords: Seminoma; Chemotherapy, Adjuvant; Radiotherapy; Health Care Surveys

[Full Text]


 

Related Post

The diagnostic value of FNDC5/Irisin in Renal Cell Cancer

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

doi: 10.1590/S1677-5538.IBJU.2017.0404


ORIGINAL ARTICLE

Diler Us Altay 1, Esref Edip Keha 2, Ersagun Karagüzel 3, Ahmet Menteşe 2, Serap Ozer Yaman 2, Ahmet Alver 2
1 Department of Chemistry and Chemical Processing Technology, Ulubey Vocational School, Laboratory Technology Program, Ordu University, Ordu, Turkey; 2 Department of Medical Biochemistry, Faculty of Medicine, Karadeniz Technical University Trabzon, Turkey; 3 Department of Urology, Faculty of Medicine, Karadeniz Technical University Trabzon, Turkey

ABSTRACT

Purposes: The aim of this study was to determine the diagnostic significance of fibro­nectin type III domain containing protein 5 (FNDC5)/Irisin levels in the sera of patients with renal cell cancer.

Materials and Methods: In the study, 48 individuals were evaluated. The patient group included 23 subjects diagnosed with renal tumor, and the control group of 25 healthy individuals. Patients diagnosed with renal tumor received surgical treatment consisting of radical or partial nephrectomy. Blood specimens were collected and serum FNDC5/ Irisin and carcinoembryonic antigen (CEA) levels were determined using enzyme-linked immunosorbent assay (ELISA).

Results: FNDC5/irisin and CEA levels in renal cancer patients were significantly higher compared with the control group (p=0.0001, p=0.009, respectively). Also, FNDC5 levels was more sensitive and specific than CEA levels. The best cut-off points for FNDC5/ irisin were >105pg/mL and CEA were >2.67ng/mL for renal cancer.

Conclusions: FNDC5/Irisin may be used as a diagnostic biomarker for renal cancer.

Keywords: Carcinoma, Renal Cell; FNDC5 protein, rat [Supplementary Concept]; Urologic Neoplasms

[Full Text]


 

Related Post

The pubovesical complex-sparing technique on laparoscopic radical prostatectomy

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

doi: 10.1590/S1677-5538.IBJU.2017.0359


VIDEO SECTION

Rafael Batista Rebouças 1,2,3, Rodrigo Campos Monteiro 1,3, João Paulo Pereira Lima 1, Filipe de Pádua B. F. Almeida 1,Cesar Araujo Britto 4, Marcos Tobias Machado 5, Carlo Passerotti 6,7
1 Departamento de Urologia, Hospital da Polícia Militar Edson Ramalho, João Pessoa, PB, Brasil; 2 Departamento de Urologia, Universidade de João Pessoa – UNIPE, João Pessoa, PB, Brasil; 3 Departamento de Uro-oncológica, Hospital São Vicente de Paulo, João Pessoa, PB, Brasil; 4 Departamento de Urologia, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil; 5 Faculdade de Medicina do ABC, Santo André, SP, Brasil; 6 Centro de Cirurgia Robótica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil; 7 Departamento de Urologia, Escola de Medicina de São Paulo – Laboratório de Investigação Médica (LIM55), São Paulo, SP, Brasil

ABSTRACT

Introduction: Preservation of urinary continence is a great challenge in Radical Prostatectomy. In order to improve functional results, Asimakopoulos et al. (2010) described a robot-assisted surgical technique with preservation of the pubovesical complex (PVC). We present a pure laparoscopic execution.

Presentation: A 61-year-old male patient with a diagnosis of prostate cancer, with PSA 6.54ng/ml, DRE: T1C and Gleason 6 (3+3) 1/12 fragments. All therapeutic possibilities were discussed, including active surveillance. The patient opted for surgical treatment.

A transperitoneal technique was used. We started the dissection on the left side, in the limit between the detrusor and the base of the prostate. The left seminal vesicle was dissected and left neurovascular bundle released by a high anterior dissection. We repeated the same procedure on the right side. The urethra was then divided, prostatic apex was laterally drawn and PVC was released. The bladder neck was divided and an urethrovesical anastomosis was achieved. A pelvic drain was placed.

Results: The total operative time was 150 minutes. The estimated blood loss was 300mL. The drain was removed on the 1st postoperative day and the patient was discharged. The Foley catheter was removed after 7 days and the patient remained completely dry. Hystopathology revealed adenocarcinoma Gleason 6, negative margins. PSA after 30 days was <0.04ng/mL, and the patient reported partial penile erection.

Conclusion: The Pubovesical Complex-Sparing Technique on Laparoscopic Radical Prostatectomy was feasible and safe.

Further adequately designed studies are needed to confirm whether this technique enhances early functional outcomes.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20170359_Reboucas_et_al

[Full Text]


Related Post

Sexual complications of penile frature in men who have sex with men

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

doi: 10.1590/S1677-5538.IBJU.2017.0520


ORIGINAL ARTICLE


Rodrigo Barros 1, Gabriel Lacerda 1, Alex Schul 1, Paulo Ornellas 1, Leandro Koifman 1, Luciano A. Favorito 2, 3
1 Hospital Municipal Souza Aguiar, Rio de Janeiro, RJ, Brasil; 2 Universidade Estadual do Rio de Janeiro (UERJ), RJ, Brasil; 3 Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil

ABSTRACT  

Objectives: Evaluate the demographic data, etiology, operative findings and results of surgical treatment of penile fracture (PF) in men who have sex with men(MSM) with emphasis on sexual complications.

Materials and Methods: We studied 216 patients underwent surgical correction of PF at our hospital. Patients self-identified as MSM were followed for at least 6 months. Demographic data, presentation, operative findings, International Index of Erection Function – 5 (IIEF-5) and the Premature Ejaculation Diagnostic Tool.

Results: Of 216 PF cases, 4 (1.8%) were MSM. All cases resulted from sexual activity and all patients reported using the “doggy style” position during anal intercourse. Unilateral or bilateral injury of corpus cavernosum was found in 2 patients each. One (25%) patient had complete urethral injury associated with bilateral corpus caverno­sum lesion. During the follow-up period, all patients developed some type of sexual complication. One patient reported penile pain during intercourse. Another patient experienced low sexual desire and premature ejaculation. This patient was also dis­satisfied with the aesthetic result of the surgical scar and complained about decreased penis size after surgery. The third case developed delayed ejaculation. The fourth pa­tient experienced mild to moderate erectile dysfunction. This same patient presented with penile curvature. Finally, palpable fibrotic nodules in the operative area were observed in all cases.

Conclusions: Sexual activity in the “doggy style” position was the commonest cause of PF in MSM. Sexual dysfunction is always present in gay man after surgery for PF. However, additional studies with larger samples should be coinducted.

Keywords: Penis; Homosexuality; Coitus

[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

Ureteral access sheaths: a comprehensive comparison of physical and mechanical properties

Vol. 44 (x): 2018 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0575


ORIGINAL ARTICLE

Nishant Patel 1, Manoj Monga 1
1 Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, USA

ABSTRACT

Introduction: Ureteral access sheaths (UAS) facilitate flexible ureteroscopy in the treatment of urolithiasis. The physical properties of UAS vary by manufacturer and model.

We compared three new UAS: Glideway (GW, Terumo, 11/13Fr, 12/14Fr), Pathway (PW, Terumo 12/14F) and Navigator HD (NHD, Boston Scientific, 11/13Fr, 12/14Fr) in the domains of safety characteristics, positioning characteristics, lubricity and radioopacity.

Materials and Methods: In vitro testing of the three UAS included safety testing- tip perforation force, sheath edge deformation and dilator extraction forces. Positioning characteristics tested included tip bending, stiffness (resistance to coaxial buckling forces), kinking (resistance to perpendicular forces), and insertion forces. Lubricity was assessed by measured frictional forces of the outer sheath. Finally, radio-opacity was tested utilizing fluoroscopic imaging of the three 12F sheaths and inner dilators.

Results: The PW (0.245 lb) and GW (0.286 lb) required less force for tip perforation compared to the NHD (0.628 lb). The NHD sheath edge deformation was mild compared to more severe deformation for the PW and GW. The PW (1.008 lb) required greater force than the GW (0.136 lb) and NHD (0.043 lb) for inner dilator removal. The GW (3.69 lbs) and NHD (4.17 lb) had similar inner dilator tip stiffness when bent, while the PW had the weakest inner dilator tip, 1.91 lbs. The PW (0.271 lb) was most susceptible to buckling and kinking (1.626 lb). The most lubricious UAS was the NHD (0.055 lbs for 12F). The NHD (0.277 lbs) required the least insertional force through a biological model and possessed the greatest radio-opacity.

Conclusions: Comparison of different commercially available UAS in various sizes reveals that there are mechanical differences in sheaths that may play a role clinically.

The Terumo sheaths’ (GW and PW) were outperformed by the Boston Scientific NHD in simulating safety, ease of use and radio-opacity.

Keywords: Ureteroscopy; Ureter; instrumentation [Subheading]

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Related Post

Nephrogenic adenoma of the bladder: a single institution experience assessing clinical factors

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

doi: 10.1590/S1677-5538.IBJU.2017.0155


ORIGINAL ARTICLE

Yooni Yi 1, Angela Wu 2, Anne P. Cameron 1
1 Deparment of Urology and 2 Deparment of Pathology, University of Michigan, Michigan, USA

ABSTRACT

Introduction: Nephrogenic adenoma (NA) was first described by Davis in 1949 as a “hamartoma” of the bladder. There are many proposed predisposing factors for NA in­cluding chronic inflammation, renal transplantation, and bladder cancer. We examined our experience with NA to determine predisposing factors and determine if there was any increased risk for development of subsequent malignancy.

Materials and Methods: All patients with a pathologic diagnosis of bladder NA from 2001-2013 were included. Patient history, clinical factors including possible predispos­ing factors for NA, and follow-up were reviewed.

Results: Among 60 patients, 68% were males with an average age of 61, an average BMI of 28.7, and 60% had a smoking history. In evaluating pro-inflammatory factors, 26.7% underwent either Bacillus Calmette-Guerin or mitomycin C, 30% had recurrent urinary tract infections, and 25% had a history of catheterization. Recurrence of NA after initial resection occurred only in 14.7% of patients who underwent follow-up cystoscopy. A history of concurrent bladder cancer was seen in 41.7% of patients, but there were no cases of de novo bladder cancer diagnosed after NA.

Conclusion: To the best of our knowledge, this is the largest series of patients with NA of the bladder. NA occurs in a heterogeneous population of patients, but most often with underlying inflammation. NA occurred concurrent with bladder cancer; however there were no cases of de novo bladder cancer after NA, reassuring that NA is likely a benign reactive condition.

 Keywords: Urinary Bladder Neoplasms; Adenoma; Urologic Diseases

[Full Text]


Related Post

Review of post bariatric surgery effects on common genitourinary physiology

Vol. 44 (x): 2018 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0416


REVIEW ARTICLE

Aline A. Yacoubian 1, Rami Nasr 1
1 Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon

ABSTRACT

Background: Obesity is a worldwide challenging health problem. Weight loss through medical management of obesity has not always been successful, thus, giving rise to the need for surgical intervention. Bariatric surgery has been shown to be helpful for morbidly obese patients. However, studies have also shown the effect of surgery on stone formation, fertility and erectile function. This review summarizes the main find­ings of several studies that analyze stone formation and fertility in men as well as erectile function post bariatric surgery. The underlying pathophysiologic alterations post bariatric surgery include increased absorption of oxalate leading to hyperoxaluria, hypocitraturia and increased urinary calcium oxalate supersaturation. Contradicting data exist on the effect of bariatric surgery on fertility and erectile function. Further studies are needed to analyze the mechanisms.

Keywords: Obesity; Bariatric Surgery; Nephrolithiasis; Fertility

[Full Text]


 

Related Post

Laparoscopic approach to pheochromocytoma in pregnancy: case report

 Vol. 44 (x): 2018 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0540


CHALLENGING CLINICAL CASES

Felipe de Almeida e Paula 1,2,3, Ravisio Israel dos Santos Junior 1,2,3, Odivaldo Antonio Ferruzzi 2, Rafael Osti de Melo 3, Mariana Takaku 1,2
1 Hospital Regional do Câncer de Presidente Prudente, Presidente Prudente, SP, Brasil; 2 Santa Casa de Misericórdia de Presidente Prudente, Presidente Prudente, SP, Brasil; 3 Faculdade de Medicina de Presidente Prudente, Universidade do Oeste Paulista, Presidente Prudente, SP, Brasil

ABSTRACT

A 32-year-old 22-week pregnant hypertensive woman with sporadic episodes of headaches, sweating, and facial flushing was diagnosed with pheochromocyto­ma through biochemical and imaging tests. Perioperative management included a multidisciplinary approach, symptom stabilization with ɑ blockade followed by ß blockade, and tumor resection by laparoscopic adrenalectomy at 24 weeks gesta­tion. The diagnosis was confirmed by histopathological examination and immuno­histochemistry tests. The decision for surgical removal of the tumor was based on maternal symptoms, tumor size, gestational age, the possibility of doing a laparos­copy, and the expertise of the surgical team.

Keywords: Pheochromocytoma; Pregnancy; Laparoscopy

[Full Text]


Related Post

Salvage surgical procedure for artificial sphincter extrusion

Vol. 44 (x): 2018 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0462


CHALLENGING CLINICAL CASES

Flavio Trigo Rocha 1, Jean Felipe Prodocimo Lesting 1
1 Centro de Incontinência Urinaria, Hospital Sírio Libanês, SP, Brasil

ABSTRACT

Case Hypothesis: Surgical removal is the standard treatment for artificial sphincter extrusion. However in some specific situations is possible to maintain the prosthesis with good results.

Case report: We report a 60 years old patient presenting sphincter pump extrusion one month after artificial urinary sphincter (AUS) AMS 800™ placement for treating post-radical prostatectomy urinary incontinence (PRPUI). He also had a penile prosthesis implant one year before that was replaced in the same surgery the sphincter was implanted. As patient refused sphincter removal and there were no signals of active infection he was treated by extensive surgical washing with antibiotics and antiseptics.

Pump was repositioned in the opposite side of the scrotum. Patient had good evolution with sphincter activation 50 days later. After 10 months of follow up, patient is socially continent and having regular sexual intercourse. Savage surgery may be an option in select cases of artificial sphincter extrusion.

Promising future implications: Like in some patients with penile prosthesis some patients with artificial sphincter extrusion can be treated without removing the device.

This may be a line of research about conservative treatment of artificial sphincter complications.

Keywords: Urinary Incontinence; Surgical Procedures, Operative; Urinary Sphincter, Artificial

[Full Text]


 

Related Post

PCA3 rs544190G>A and prostate cancer risk in an eastern Chinese population

Vol. 44 (x): 2018 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0146


ORIGINAL ARTICLE

Dalong Cao 1, 2, Chengyuan Gu 1, 2, Dingwei Ye 1, 2, Bo Dai 1, 2, Yao Zhu 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

Background: The association of prostate cancer antigen 3 (PCA3) polymorphism (SNP, rs544190G>A) with metastatic prostate cancer in European descent has been reported.

Our aim of the current study was to re-validate the effect of PCA3 polymorphism on prostate cancer risk in an Eastern Chinese population and then estimate possible genetic discrepancies among population.

Materials and Methods: Taqman assay was employed to determine genotype of SNP rs544190 in 1015 ethnic Han Chinese patients with prostate cancer and 1032 cancerfree controls. Simultaneously, odds ratios (OR) and 95% confidence intervals (95%CI) for risk relationship were calculated by logistic regression models.

Results: The statistically significant relationship between PCA3 rs544190G>A and higher prostate cancer risk was not found. Stratification analysis revealed that there was no remarkable association of rs544190 variant AG/AA genotype with prostate cancer risk in every subgroup, except for patients with Gleason score ≤7(3+4).

Conclusion: Although the results demonstrated that SNP rs544190 was not involved in prostate cancer risk in Eastern Chinese descent, unlike in European population, these might have clinical implications on prostate cancer heterogeneity around the World.

To validate these findings, well-designed studies with different ethnic populations are warranted.

Keywords: Prostatic Neoplasms; prostate cancer antigen 3, human [Supplementary Concept]; Polymorphism, Single Nucleotide

[Full Text]


 

Related Post

Clinical and pathologic factors predicting reclassification in active surveillance cohorts

Vol. 44 (x): 2018 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0320


REVIEW ARTICLE

Pablo S. Sierra 1, Shivashankar Damodaran 2, David Jarrard 2, 3
1 Fundacion Valle del Lili -Universidad Icesi, Cali, Colombia; 2 Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; 3 University of Wisconsin Carbone Cancer Center, Madison, WI, USA

ABSTRACT

The incidence of small, lower risk well-differentiated prostate cancer is increasing and almost half of the patients with this diagnosis are candidates for initial conservative management in an attempt to avoid overtreatment and morbidity associated with sur¬gery or radiation. A proportion of patients labeled as low risk, candidates for Active Surveillance (AS), harbor aggressive disease and would benefit from definitive treat¬ment. The focus of this review is to identify clinicopathologic features that may help identify these less optimal AS candidates.
A systematic Medline/PubMed Review was performed in January 2017 according to PRISMA guidelines; 83 articles were selected for full text review according to their relevance and after applying limits described.
For patients meeting AS criteria including Gleason Score 6, several factors can assist in predicting those patients that are at higher risk for reclassification including higher PSA density, bilateral cancer, African American race, small prostate volume and low testosterone. Nomograms combining these features improve risk stratification.
Clinical and pathologic features provide a significant amount of information for risk stratification (>70%) for patients considering active surveillance. Higher risk patient subgroups can benefit from further evaluation or consideration of treatment. Recom¬mendations will continue to evolve as data from longer term AS cohorts matures.

Keywords: Prostatic Neoplasms; Neoplasm Grading

[Full Text]


 

Related Post

99mTc-DTPA Diuretic Renography with 3 hours late output fraction in the evaluation of hydronephrosis in children

Vol. 44 (x): 2018 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0131


ORIGINAL ARTICLE

Carlos J. R. Simal 1, 2
1 Departamento de Anatomia e Imagem, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brasil; 2 Divisão de Medicina Nuclear, Hospital Felicio Rocho, Belo Horizonte, Minas Gerais, Brasil

ABSTRACT

Objective: Dynamic renal scintigraphy complemented by late gravity assisted postvoid images to 60 minutes is a frequently used diagnostic test in the evaluation of hydrone­phrosis. The objective of this study is to evaluate the effectiveness in acquiring images at 180 minutes to calculate the late output fraction (LOF) of 99mTc-DTPA in the diagno­sis of ureteropelvic junction obstruction (UPJO).

Materials and Methods: A retrospective study of 177 patients (196 renal units) of sus­pected cases of clinical UPJO was conducted. The patients were submitted to at least two dynamic renal scintigraphies of 99mTc-DTPA, with the addition of furosemide (F0), with a mean age of 4.3+3.8 years for the first study, and a follow-up of 2.7+2.5 years.

Results: For diagnosis based on renal curves, a 100% sensitivity, 82.2% specificity, positive predictive value (PPV) of 10.4% and negative predictive value (NPV) of 100% were estimated. For diagnosis based on LOF, a 100% sensitivity, 96.3% specificity, PPV of 35.7% and NPV of 100% were estimated.

Conclusion: A LOF <10% is indicative of UPJO, and a LOF >15% is indicative of no UPJO. The data demonstrate that LOF presents equivalent sensitivity and NPV, and higher specificity and PPV in comparison to diagnosis based on renal curves, and is useful in the evaluation and follow-up of suspected cases of UPJO.

Keywords: Hydronephrosis; Ureteral Obstruction; Cakut [Supplementary Concept]; Technetium Tc 99m Pentetate

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Related Post

Accidental cystectomy during laparoscopic excision of prostatic utricle cyst – a rare complication

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

doi: 10.1590/S1677-5538.IBJU.2017.0284


CHALLENGING CLINICAL CASES

Vikash Kumar  1, Chirag Punatar 1, Kunal Jadhav  1, Sharad Sagade 1
1 Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India

ABSTRACT

Prostatic utricle cyst is a rare congenital anomaly. Symptomatic cysts require treat­ment. Surgical excision is the treatment of choice, but is challenging due to close prox­imity to vas deferens, ejaculatory ducts, bladder, prostate, rectum and pelvic nerves. Complications include rectal injury, ureteral injury, impotence, infertility and faecal incontinence. We here report a rare complication in which bladder was accidentally re­moved during laparoscopic excision of prostatic utricle cyst. To best of our knowledge such a complication has never been reported previously. We also describe the possible cause of this accident and suggest ways to prevent this disastrous complication.

 

Keywords: Cystectomy; Intraoperative Complications; Prostate

[Full Text]


 

Related Post

Preoperative care of Polypoid exposed mucosal template in bladder exstrophy: the role of high-barrier plastic wraps in reducing inflammation and polyp size

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

doi: 10.1590/S1677-5538.IBJU.2017.0196


ORIGINAL ARTICLE

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

ABSTRACT

Objective: To assess the role of high-barrier plastic wrap in reducing the number and size of polyps, as well as decreasing the inflammation and allergic reactions in exstrophy cases, and to compare the results with the application of low-barrier wrap.

Materials and Methods: Eight patients with bladder exstrophy-epispadias complex (BEEC) that had used a low density polyethylene (LDPE) wrap for coverage of the exposed polypoid bladder in preoperative care management were referred. The main complaint of their parents was increase in size and number of polyps. After a period of 2 months using the same wrap and observing the increasing pattern in size of polyps, these patients were recommended to use a high-barrier wrap which is made of polyvinylidene chloride (PVdC), until closure. Patients were monitored for the number and size of polyps before and after the change of barriers. The incidence of para-exstrophy skin infection/inflammation and skin allergy were assessed. Biopsies were taken from the polyps to identify histopathological characteristics of the exposed polyps.

Results: The high barrier wrap was applied for a mean ± SD duration of 12±2.1 months. Polyps’ size and number decreased after 12 months. No allergic reaction was detected in patients after the usage of PVdC; three patients suffered from low-grade skin allergy when LDPE was applied. Also, pre-malignant changes were observed in none of the patients in histopathological examination after the application of PVdC.

Conclusion: Polyps’ size and number and skin allergy may significantly decrease with the use of a high-barrier wrap. Certain PVdC wraps with more integrity and less evaporative permeability may be more “exstrophy-friendly”.

 

Keywords: Bladder Exstrophy; Cosmetics; Infection; Polyps

[Full Text]


 

Related Post

Positive surgical margins are predictors of local recurrence in conservative kidney surgery for pT1 tumors

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

doi: 10.1590/S1677-5538.IBJU.2017.0039


ORIGINAL ARTICLE

Patricio Garcia Marchiñena 1, Sebastián Tirapegui 1, Ignacio Tobia Gonzalez 1, Alberto Jurado 1, Guillermo
Gueglio 1
1 Department of Urology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

ABSTRACT

Objectives: The clinical significance of positive surgical margin (PSM) after a Nephron Sparing Surgery (NSS) is controversial. The aim of this study is to evaluate the association between PSM and the risk of disease recurrence in patients with pT1 kidney tumors who underwent NSS.

Materials and Methods: Retrospective cohort study. A total of 314 patients submitted to a NSS due to stage pT1 renal tumor between January 2010 and June 2015 were included. Recurrence-free survival was estimated. The Cox model was used to adjust the tumor size, histological grade, pathological stage, age, surgical margins and type of approach.

Results: Overall PSM was 6.3% (n=22). Recurrence was evidenced in 9.1% (n=2) of patients with PSM and 3.5% (n=10) for the group of negative surgical margin (NSM).

The estimated local recurrence-free survival rate at 3 years was 96.4% (95% CI 91.9 to 100) for the NSM group and 87.8% (95% CI 71.9 to 100) for PSM group (p=0.02) with no difference in metastasis-free survival. The PSM and pathological high grade (Fuhrman grade III or IV) were independent predictors of local recurrence in the multivariate analysis (HR 12.9, 95%CI 1.8-94, p=0.011 / HR 38.3, 95%CI 3.1-467, p=0.004 respectively). Fuhrman grade proved to be predictor of distant recurrence (HR 8.1, 95%CI 1.6-39.7, p=0.011).

Conclusions: The PSM in pT1 renal tumors showed to have higher risk of local recurrence and thus, worse oncological prognosis.

 

Keywords: Kidney; Surgical Procedures, Neoplasms; Prognosis

[Full Text]


 

Related Post

Laparoscopic dismembered pyeloplasty combined with port entrance flexible renoscopic lithotripsy

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

doi: 10.1590/S1677-5538.IBJU.2017.0401


VIDEO SECTION

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

ABSTRACT

 

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

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

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

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

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

 

ARTICLE INFO

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

[Full Text]


Related Post

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

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

doi: 10.1590/S1677-5538.IBJU.2017.0376


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

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

[Full Text]


Related Post

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

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

doi: 10.1590/S1677-5538.IBJU.2016.0581


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

[Full Text]


Related Post

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

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

doi: 10.1590/S1677-5538.IBJU.2017.0233


REVIEW ARTICLE

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

ABSTRACT

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

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

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

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

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

[Full Text]


Related Post

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

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

doi: 10.1590/S1677-5538.IBJU.2017.0429


ORIGINAL ARTICLE

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

 

ABSTRACT  

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

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

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

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

 Keywords: Laparoscopy; Neoplasms; Neoplasms, Multiple Primary

[Full Text]


Related Post

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

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

doi: 10.1590/S1677-5538.IBJU.2017.0225


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Carcinoma, Renal Cell; Neutrophils; Lymphocytes

[Full Text]


Related Post

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

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

doi: 10.1590/S1677-5538.IBJU.2017.0324


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

[Full Text]


Related Post

Extrarenal Angiomyolipoma: differential diagnosis of retroperitoneal masses

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

doi: 10.1590/S1677-5538.IBJU.2016.0670


RADIOLOGY PAGE

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

[Full Text]


Related Post

Robot-Assisted Nephropexy

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

doi: 10.1590/S1677-5538.IBJU.2017.0390


VIDEO SECTION

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

ABSTRACT

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

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

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

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

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

ARTICLE INFO

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

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

[Full Text]


 

Related Post

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

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

doi: 10.1590/S1677-5538.IBJU.2017.0014


SURGICAL TECHNIQUE

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

 

ABSTRACT

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

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

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

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

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

Keywords: Urinary Diversion, Cystectomy, Urinary Bladder

[Full Text]


Related Post

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

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

doi: 10.1590/S1677-5538.IBJU.2017.0067


VIDEO SECTION

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

 

ABSTRACT

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

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

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

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

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

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

 

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

 

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Kaan Gokcen 1, Gokce Dundar 2, Gokhan Gokce 1, Emin Yener Gultekin 1
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Sachin Sarode 1, Sunil Mhaske 2, Vinayak G. Wagaskar 1, Bhushan Patil 1, Sujata K. Patwardhan 1, Ganesh Gopalakrishnan 3
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Saphenous-sparing laparoscopic inguinal lymphadenectomy

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

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VIDEO SECTION

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

ABSTRACT

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

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

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

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

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

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

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ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Acute Kidney Injury; Kidney; Lithotripsy

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ORIGINAL ARTICLE

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

ABSTRACT

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


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