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

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

doi: 10.1590/S1677-5538.IBJU.2017.0221


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

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

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Laparoscopic partial nephrectomy for tumors 7cm and above. Perioperative outcomes

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

doi: 10.1590/S1677-5538.IBJU.2016.0642


ORIGINAL ARTICLE

Matvey Tsivian 1, Efrat Tsivian 1, Yury Stanevsky 2, Roman Bass 2, A. Ami Sidi 2, Alexander Tsivian 2
1 Division of Urology and Department of Surgery, Duke University Medical Center Durham, NC; 2 Department of Urologic Surgery, The E. Wolfson Medical Center, Holon and Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel

ABSTRACT

Purpose: To assess and report the outcomes of laparoscopic partial nephrectomy )LPN) for T2 renal masses.

Materials and Methods: Retrospective review of patients undergoing LPN for clinically localized renal masses ≥7cm between the years 2005-2016. Descriptive analyses were generated for demographics, lesion characteristics, perioperative variables (operative time, warm ischemia time (WIT), estimated blood loss (EBL), intra-operative and post-operative complications (IOC and POC) and pathologic variables (pathology, subtype and Fuhrman grade).

Results: A total of 27 patients underwent LPN for a T2 renal mass at our institution be­tween 2005 and early 2016 of which 19 were males. The mean age was 66 (52-72). All procedures were transperitoneal with 16 on the right and 11 on the left. Median opera­tive time was 200 minutes (IQR 181-236) and median WIT 19 minutes (IQR 16-23). EBL was 125mL (IQR 75-175). One case was converted to laparoscopic radical nephrectomy due to suspected tumor thrombus in the renal vein. Surgical margins were positive in one renal tumor in a patient with multiple tumors. There was a total of 2 IOC (7.4%) and 3 POC (11%) classified as Clavien grade 3.

Conclusions: To our knowledge, this series is the first to describe the outcomes of LPN for cT2 renal masses. In our series, LPN for larger renal masses appears feasible with favorable perioperative outcomes. Additional data are needed to further explore the benefits of minimally invasive surgical approaches to larger renal masses.

Keywords:  Nephrectomy; Laparoscopy; Neoplasms

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Partial nephrectomy for T3aN0M0 renal cell carcinoma: shall we step forward?

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

doi: 10.1590/S1677-5538.IBJU.2016.0598


ORIGINAL ARTICLE

Ding Peng 1, Zhi-song He 1, Xue-song Li 1, Qi Tang 1, Lei Zhang 1, Kai-wei Yang 1, Xiao-teng Yu 1, Cui-jian Zhang 1, Li-qun Zhou 1
1 Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China

ABSTRACT

Objectives: To evaluate the prognosis of non-metastatic T3a renal cell carcinoma (RCC) with partial nephrectomy (PN).

Patients and Methods: We retrospectively evaluated 125 patients with non-metastatic T3a RCC. Patients undergoing PN and radical nephrectomy (RN) were strictly matched by clinic-pathologic characteristics. Log-rank test and Cox regression model were used for univariate and multivariate analysis.

Results: 18 pair patients were matched and the median follow-up was 35.5 (10-86) months. PN patients had a higher postoperative eGFR than RN patients (P=0.034). Cancer-specific survival (CSS) and recurrence-free survival (RFS) did not differ be­tween two groups (P=0.305 and P=0.524). On multivariate analysis, CSS decreased with positive surgical margin and anemia (both P <0.01) and RFS decreased with Furh­man grade, positive surgical margin, and anemia (all P<0.01).

Conclusions: For patients with non-metastatic pT3a RCC, PN may be a possible option for similar oncology outcomes and better renal function.

Keywords: Carcinoma, Renal Cell; Nephrectomy; Patients

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

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

doi: 10.1590/S1677-5538.IBJU.2016.0638


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Acute Kidney Injury; Kidney; Lithotripsy

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

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

doi: 10.1590/S1677-5538.IBJU.2017.0052


ORIGINAL ARTICLE

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

ABSTRACT

Objective: Fournier’s gangrene is a type of necrotizing soft tissue infection of the peri­neal, genital and perianal region that has a rapidly progressive and potentially fatal course. In the present study, our goal was to compare the patients submitted to surgical debridement for Fournier Gangrene with Vacuum-asisted Closure (VAC) and without VAC therapy after debridement.

Materials and Methods: We retrospectively analyzed 313 patients underwent surgical debridement for FG in our hospital. Patients were divided into two groups as patients performed surgical debridement with VAC therapy and surgical debridement with primer closure and without VAC therapy. Demographic characteristics, hospitalization time, re­quirement of re-constructive treatment, area of necrosis and localization, requiring per-operative colostomy, percutaneous cystostomy or orchiectomy status, presence of septic shock, etiology of Furnier Gangrene (FG) and Fournier gangrene severity index score were recorded for statistical analysis.

Results: 111 (35.5%) patients received vacuum-assisted closure therapy and remained 202 (64.5%) patients did not receive vacuum – assisted closure after surgical debridement due to Fournier’s gangrene. Mortality rate was calculated as 15.7%. Mean hospitalization time of patients were 23.7±1.1 days. The requirement of reconstructive surgery, septic shock, Fournier gangrene severity index, requirement of colostomy, mortality rate and hospitalization time was significantly lower in patients who received VAC therapy.

Conclusions: Vacuum-assisted closure therapy is suggested for the treatment of Fourni­er gangrene. Early implementation of vacuum – assisted closure therapy can decrease mortality rate and hospitalization time of patients with Fournier gangrene and increase the recovery time.

Keywords: Fournier Gangrene; Negative-Pressure Wound Therapy; Debridement; Fasciitis, Necrotizing

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REPLY BY THE AUTHORS: Re: Persistent Mullerian Duct Syndrome: a rare entity with a rare presentation in need of multidisciplinary management

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

doi: 10.1590/S1677-5538.IBJU.2017.0072.1


LETTER TO THE EDITOR

Lin Da Aw 1,2, Murizah M. Zain 1, Sandro C. Esteves 3,4, Peter Humaidan 2,4
1 Department of Obstetrics & Gynaecology, Hospital Sultanah Bahiyah, Kedah Darul Aman, Malaysia; 2 Fertility Clinic, Skive Regional Hospital, Denmark; 3 Androfert, Andrology & Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, Brazil; 4 Faculty of Health, Aarhus University, Denmark

No abstract available

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Re: Persistent Mullerian Duct Syndrome: a rare entity with a rare presentation in need of multidisciplinary management

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

doi: 10.1590/S1677-5538.IBJU.2017.0072


LETTER TO THE EDITOR

Lisieux Eyer de Jesus 1
1 Departmento Cirurgia Pediátrica, Hospital Universitario Antonio Pedro, Niterói, RJ

No abstract available

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A solitary urothelial tumor arising from one of bilateral ureteroceles

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

doi: 10.1590/S1677-5538.IBJU.2017.0087


RADIOLOGY PAGE

Yu Xi Terence Law 1, Irfan Khan Sagir 2, Lincoln Tan Guan Lim 1
1 Department of Urology, National University Hospital, National University Health System, Singapore; 2 Department of Pathology, National University Hospital, National University Health System, Singapore

No abstract available

[Full Text]


Editorial Comment: Use of indocyanine green angiography in microsurgical subinguinal varicocelectomy – lessons learned from our initial experience

Vol. 43 (x): 2017 August 2.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0107.1


EDITORIAL

Marcello Cocuzza 1
1 Departamento de Urologia, Universidade de São Paulo, SP, Brasil

No abstract available

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Quality of life and urolithiasis: the patient – reported outcomes measurement information system (PROMIS)

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

doi: 10.1590/S1677-5538.IBJU.2016.0649


ORIGINAL ARTICLE

Nishant Patel 1, Robert D. Brown 1, Carl Sarkissian 1, Shubha De 1, Manoj Monga 1
1 Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

ABSTRACT

Background: With a high rate of recurrence, urolithiasis is a chronic disease that impacts quality of life. The Patient Reported Outcomes Measurement Information System is an NIH validated questionnaire to assess patient quality of life. We evaluated the impact of urolithiasis on quality of life using the NIH-sponsored PROMIS-43 questionnaire.

Materials and Methods: Patients reporting to the kidney stone clinic were interviewed to collect information on stone history and demographic information and were asked to complete the PROMIS-43 questionnaire. Quality of life scores were analyzed using gender and age matched groups for the general US population. Statistical comparisons were made based on demographic information and patient stone history. Statistical significance was P<0.05.

Results: 103 patients completed the survey. 36% of respondents were male, the average age of the group was 52 years old, with 58% primary income earners, and 35% primary caregivers. 7% had never passed a stone or had a procedure while 17% passed 10 or more stones in their lifetime. Overall, pain and physical function were worse in patients with urolithiasis. Primary income earners had better quality of life while primary caregivers and those with other chronic medical conditions were worse. Patients on dietary and medical therapy had better quality of life scores.

Conclusions: Urolithiasis patients subjectively have worse pain and physical function than the general population. The impact of pain on quality of life was greatest in those patients who had more stone episodes, underscoring the importance of preventive measures. Stone prevention measures improve quality of life.

Keywords: Kidney Calculi; Quality of Life; Pain

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Re: Assessment of sexual functions in partners of women with complaints of urinary incontinence

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

doi: 10.1590/S1677-5538.IBJU.2016.0647


LETTER TO THE EDITOR

Mustafa Kadihasanoglu 1, Emin Özbek 1

Department of Urology, Istanbul Training and Research Hospital, Istanbul, Turkey

No abstract available

[Full Text]


Re: Preliminary assessment of neck circumference in benign prostatic hyperplasia in patients with metabolic syndrome

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

doi: 10.1590/S1677-5538.IBJU.2017.0197


LETTER TO THE EDITOR

Huseyin Besiroglu 1, Emin Ozbek 2
1 Department of Urology, Çatalca Ilyas Çokay State Hospital, Istanbul, Turkey; 2 Department of Urology, Istanbul Training and Research Hospital, Istanbul, Turkey

No abstract available

[Full Text]


 

Use of indocyanine green angiography in microsurgical subinguinal varicocelectomy – lessons learned from our initial experience

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

doi: 10.1590/S1677-5538.IBJU.2017.0107


SURGICAL TECHNIQUE

Chak-Lam Cho 1, Kwan-Lun Ho 1, Wayne Kwun-Wai Chan 1, Ringo Wing-Hong Chu 1, In-Chak Law 1
1 Division of Urology, Department of Surgery, Kwong Wah Hospital, Hong Kong

ABSTRACT

Microsurgical subinguinal varicocelectomy (MSV) is generally considered the gold standard nowadays in view of the lower risk of complications and recurrence. To achieve complete ligation of veins while preserving testicular artery (TA) during the procedure remains challenging despite the application of high power optical magni­fication and micro-Doppler ultrasonography. The use of intraoperative indocyanine green angiography (ICGA) with infrared fluorescence operative micro-scope in MSV potentially lowers the incidence of TA injury and shortens the learning curve of nov-ice surgeons. We present our initial experience in the application of the technique in nine patients and explore the potential of the new adjunct.

 

Keywords: Varicocele; Microsurgery; Indocyanine Green

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Schooling impacts on the overactive bladder diagnosis in women

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

doi: 10.1590/S1677-5538.IBJU.2016.0575


ORIGINAL ARTICLE

Larissa R. Ferreira 1, Monica O. Gameiro 2, Paulo R. Kawano 3, Hamilto A. Yamamoto 1, Rodrigo Guerra 3, Leonardo O. Reis 3, João L. Amaro 1
1 Departamento de Urologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, Brasil; 2 Serviço de Reabilitação Perineal, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo, Botucatu, Brasil; 3 Faculdade de Medicina de Campinas, Pontifícia Universidade Católica de Campinas – PUC Campinas, Campinas, Brasil

ABSTRACT

Objective: To evaluate the overactive bladder (OAB) diagnosis using OAB-V8 and ICIQ-OAB questionnaires in women with different schooling and cultural levels.

Materials and Methods: Three hundred and eighty six healthy women answered a clinical questionnaire filling out information about schooling, demographic and gyne­cological data. The OAB-V8 and ICIQ-OAB questionnaires were used to evaluate OAB diagnosis and symptoms; and the QS-F questionnaire, to determine the sexual func­tion. All questionnaires were validated in Portuguese.

Results: The mean age was 37.3 years-old. Regarding to schooling level, 23.1% had concluded primary education; 65.8%, secondary school; and 11.1% had higher edu­cation. Considering the OAB-V8 (score ≥8), 51.8% of evaluated women had OAB di­agnosis. There was a positive linear correlation between the OAB-V8 and ICIQ-OAB questionnaires in its sections “a” (r=0.812, p<0.001) and “b” (r=759, p<0.001). There was a positive linear correlation between age and the amount of time used to answer the OAB-V8, ICIQ-OAB and QS-F questionnaires (p<0.001).

The ICIQ-OAB was the hardest to answer for all schooling levels when compared to the other questionnaires. Women who had concluded primary and secondary education sig­nificantly demanded more help to answer all questionnaires than those with higher edu­cation (p<0.05). Furthermore, women with higher education took significantly less time answering all questionnaires when compared to their less educated counterparts (primary and secondary schooling), since they were quicker to answer each individual question.

Conclusion: Educational level and ageing had an impact on women response using different questionnaires for OAB and sexual function evaluations.

Keywords: Women; Urinary Bladder; Diagnosis

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Lysozyme gene treatment in testosterone induced benign prostate hyperplasia rat model and comparasion of its’ effectiveness with botulinum toxin injection

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

doi: 10.1590/S1677-5538.IBJU.2016.0677


ORIGINAL ARTICLE

Osman Ergün 1, Pınar Aslan Koşar 2, İbrahim Onaran 2, Hakan Darıcı 3, Alim Koşar 4
1 Department of Urology, Konya Training and Research Hospital, Konya, Turkey; 2 Department of Medical Biology and Genetic, Süleyman Demirel University, Isparta, Turkey; 3 Deparment of Histology and Embryology, Süleyman Demirel University, Isparta, Turkey; 4 Department of Urology, Süleyman Demirel University, Isparta, Turkey

ABSTRACT

Objectives: To compare the effects and histopathological changes of botulinum neurotoxin type A and lysozyme gene injections into prostate tissue within a testosterone induced benign prostate hyperplasia rat model.

Materials and Methods: 40 male Wistar rats were randomized into four Groups. Group-1: Control, Group-2: Testosterone replacement, Group-3: Testosterone+botulinum neurotoxin type A, Group-4: Testosterone+plazmid DNA/liposome complex.

Results: Estimated prostate volume of the testosterone injected Groups were higher than the control (p <0.05). Actual prostate weight of the testosterone injected Groups was higher than the control Group (p <0.05). Testosterone undecanoate increased the prostate weight by 39%. Botulinum neurotoxin type A treatment led to an estimated prostate volume and actual prostate weights decreased up to 32.5% in rats leading to prostate apoptosis. Lysozyme gene treatment led to an estimated prostate volume and actual prostate weights decrease up to 38.7%.

Conclusion: Lysozyme gene and botulinum neurotoxin type A treatments for prostate volume decreasing effect have been verified in the present study that could be anew modality of treatment in prostatic benign hyperplasia that needs to be verified in large randomized human experimental studies.

Keywords: Prostatic Hyperplasia; Botulinum Toxins; Testosterone

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Focal cryotherapy: step by step technique description

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

doi: 10.1590/S1677-5538.IBJU.2016.0664


VIDEO SECTION

Cristina Redondo 1, Victor Srougi 2, José Batista da Costa 3, Mohammed Baghdad 4, Guillermo Velilla 3, Igor Nunes-Silva 3, Sebastien Bergerat 3, Silvia Garcia-Barreras 3, François Rozet 3, Alexandre Ingels 4, Marc Galiano 4, Rafael Sanchez-Salas 4, Eric Barret 4, Xavier Cathelineau 4
1 Hospital Universitario de Getafe – Servicio de Urología, Getafe, Spain; 2 Hospital das Clínicas da Facul­dade de Medicina da USP – Urologia, São Paulo, Brasil; 3 Institut Mutualiste Montsouris Ringgold stan­dard institution, Paris, Île-de-France, France; 4 L´Institut Mutualiste Montsouris – Urology, Paris, France

ABSTRACT

Introduction and objective: Focal cryotherapy emerged as an efficient option to treat favorable and localized prostate cancer (PCa). The purpose of this video is to describe the procedure step by step.

Materials and methods: We present the case of a 68 year-old man with localized PCa in the anterior aspect of the prostate.

Results: The procedure is performed under general anesthesia, with the patient in lithotomy position. Briefly, the equip­ment utilized includes the cryotherapy console coupled with an ultrasound system, argon and helium gas bottles, cryo­probes, temperature probes and an urethral warming catheter. The procedure starts with a real-time trans-rectal prostate ultrasound, which is used to outline the prostate, the urethra and the rectal wall. The cryoprobes are pretested and placed in to the prostate through the perineum, following a grid template, along with the temperature sensors under ultrasound guidance. A cystoscopy confirms the right positioning of the needles and the urethral warming catheter is installed. Thereafter, the freeze sequence with argon gas is started, achieving extremely low temperatures (-40ºC) to induce tumor cell lysis. Sequentially, the thawing cycle is performed using helium gas. This process is repeated one time. Results among several series showed a biochemical disease-free survival between 71-93% at 9-70 month- follow-up, incontinence rates between 0-3.6% and erectile dysfunction between 0-42% (1-5).

Conclusions: Focal cryotherapy is a feasible procedure to treat anterior PCa that may offer minimal morbidity, allowing good cancer control and better functional outcomes when compared to whole-gland treatment.

 

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20160664_redondo_et_al

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Retroperitoneal access for robotic renal surgery

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

doi: 10.1590/S1677-5538.IBJU.2016.0633


VIDEO SECTION

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

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

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

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

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

ARTICLE INFO

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

[Full Text]


Abobotulinum – a toxin injection in patients with refractory idiopathic detrusor overactivity: injections in detrusor, trigone and bladder neck or prostatic urethra, versus detrusor – only injections

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

doi: 10.1590/S1677-5538.IBJU.2016.0622


ORIGINAL ARTICLE

Maryam Emami 1, Pejman Shadpour 1, Amir H. Kashi 1, Masoud Choopani 1, Mohammadreza Zeighami 1
1 Hasheminejad Kidney Center (HKC), Iran University of Medical Sciences (IUMS), Tehran, Iran

ABSTRACT

 

Purpose: To evaluate if the injections of abobotulinum-A toxin in trigone and blad­der neck/prostatic urethra in addition to detrusor provides better symptoms relief and urodynamic findings in patients with idiopathic detrusor overactivity (IDO) refractory to medical treatment.

Materials and Methods: A total of 74 patients with IDO refractory to anticholinergics received injections in detrusor, trigone and bladder neck/prostatic urethra (Group A, N=36) versus detrusor only injections (Group B, N=38) of abobotulinum-A toxin. All patients were evaluated by a standard overactive bladder symptom score (OABSS) questionnaire and cystometrography before and 6 weeks after the operation. OABSS questionnaire was also completed 20 weeks after the operation.

Results: The magnitude of OABSS reduction from baseline to 6 weeks after operation in groups A and B patients was 13.4±2.2 versus 11.7±2.1 (p=0.001). Cystometry results were similar in both groups except for higher volume at urgent desire to void in Group B patients (p <0.001). The mean±SD change in residual volume in Group A at 6 weeks after the operation was -4.8±28.6mL (p=0.33) compared to 21.3±16.9mL in Group B patients (p <0.001).

Conclusions: In patients with IDO, adding trigone, and bladder neck/prostatic urethra as sites of abobotulinum- A toxin injection produces greater reductions in OABSS score and less residual urine volume but a lower volume at urgent desire to void in comparison with detrusor only injections.

Keywords:  Urinary Bladder, Overactive; Botulinum Toxins

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A neural network – based algorithm for predicting stone – free status after ESWL therapy

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

doi: 10.1590/S1677-5538.IBJU.2016.0630


ORIGINAL ARTICLE

Ilker Seckiner 1, Serap Seckiner 2, Haluk Sen 1, Omer Bayrak 1, Kazım Dogan 1, Sakip Erturhan 1
1 Department of Urology, Gaziantep University, Gaziantep, Turkey; 2 Department of Endustrial Engineering, Gaziantep University, Gaziantep, Turkey

ABSTRACT

Objective: The prototype artificial neural network (ANN) model was developed using data from patients with renal stone, in order to predict stone-free status and to help in planning treatment with Extracorporeal Shock Wave Lithotripsy (ESWL) for kidney stones.

Materials and Methods: Data were collected from the 203 patients including gender, single or multiple nature of the stone, location of the stone, infundibulopelvic angle primary or secondary nature of the stone, status of hydronephrosis, stone size after ESWL, age, size, skin to stone distance, stone density and creatinine, for eleven variables.

Regression analysis and the ANN method were applied to predict treatment success using the same series of data.

Results: Subsequently, patients were divided into three groups by neural network software, in order to implement the ANN: training group (n=139), validation group (n=32), and the test group (n=32). ANN analysis demonstrated that the prediction accuracy of the stone-free rate was 99.25% in the training group, 85.48% in the validation group, and 88.70% in the test group.

Conclusions: Successful results were obtained to predict the stone-free rate, with the help of the ANN model designed by using a series of data collected from real patients in whom ESWL was implemented to help in planning treatment for kidney stones.

Keywords: Calculi; Lithotripsy; therapy [Subheading]

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Outcomes of miniaturized percutaneous nephrolitotomy in infants: single centre experience

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

doi: 10.1590/S1677-5538.IBJU.2016.0629


ORIGINAL ARTICLE

Eyyup Sabri Pelit 1, Bülent Kati 1, Cengiz Çanakci 2, Süleyman Sağir 1, Halil Çiftçi 1
1 Department of Urology, Harran University Faculty of Medicine, Sanliurfa, Turkey; 2 Bolvadin State Hospital, Istanbul, Turkey

 

ABSTRACT

Objectives: The present study was aim to evaluate the safety and efficacy of Mini-PNL to treat kidney stones in patients aged <3 years. This is the one of the largest series in the literature in this age group of patients.

Material and methods: From May 2012 to April 2016, the medical records of 74 infant patients who underwent mini-PNL for renal stones were reviewed retrospectively. All infants were evaluated with the plain abdominal radiograph, urinary ultrasound, noncontrast computerized tomography and/or intravenous urogram. Pre-operative, intraoperative and post-operative data were analyzed.

Results: A total of 74 infant (42 male, 32 female) with a mean age 21.5±8.2 (10-36) months were included in this study. The mean size of the stones was 22.0±5.9 (14-45) mm. A 17 Fr rigid pediatric nephroscope with a pneumatic intracorporeal lithotripsy were used through 20-22 Fr access sheath. The stone-free rate was 84.7% at 1 month after the operation. Mean operative time was 74.0 (40-140) min. Mean fluoroscopy screening time was as 4.3(3.1-8.6) min. Average hospitalization time was 3.8 (2-9) day.

Auxiliary procedures were performed to 11(15.3%) patients (7 extracorporeal shock wave lithotripsy, 3 re- percutaneous nephrolitotomy, 1 retrograde intrarenal surgery).

No major complication classified as Clavien IV-V observed in study group.

Conclusions: Mini-PNL with pneumatic intracorporeal lithotripsy can be performed safely and effectively to manage kidney stones in infants with high stone free rate and low complications.

Keywords: Nephrostomy, Percutaneous; Kidney Calculi; Infant

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2017.0078


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Serum; Delayed Graft Function; Creatinine

[Full Text]


Nephrometry scores and perioperative outcomes following robotic partial nephrectomy

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

doi: 10.1590/S1677-5538.IBJU.2016.0571


ORIGINAL ARTICLE

Renato B. Corradi 1, Emily A. Vertosick 2, Daniel P. Nguyen 1, Antoni Vilaseca 1, Daniel D. Sjoberg 2, Nicole Benfante 1, Lucas N. Nogueira 3, Massimiliano Spaliviero 1, Karim A. Touijer 1, Paul Russo 1, Jonathan A. Coleman 1
1 Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, USA; 2 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA; 3 Departamento de Cirurgia, Serviço de Urologia, Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brasil

 

ABSTRACT

Objectives: Based on imaging features, nephrometry scoring systems have been conceived to create a standardized and reproducible way to characterize renal tumor anatomy.

However, less is known about which of these individual measures are important with regard to clinically relevant perioperative outcomes such as ischemia time (IT), estimated blood loss (EBL), length of hospital stay (LOS), and change in estimated glomerular filtration rate (eGFR) after robotic partial nephrectomy (PN). We aimed to assess the utility of the RENAL and PADUA scores, their subscales, and C-index for predicting these outcomes.

Materials and Methods: We analyzed imaging studies from 283 patients who underwent robotic PN between 2008 and 2014 to assign nephrometry scores (NS): PADUA, RENAL and C-index. Univariate linear regression was used to assess whether the NS or any of their subscales were associated with EBL or IT. Multivariable linear regression and linear regression models were created to assess LOS and eGFR.

Results: The three NS were significantly associated with EBL, IT, LOS, and eGFR at 12 months after surgery. All subscales with the exception of anterior/posterior were significantly associated with EBL and IT. Collecting system, renal rim location, renal sinus, exophytic/endophytic, and nearness to collecting system were significant predictors for LOS. Only renal rim location, renal sinus invasion and polar location were significantly associated with eGFR at 12 months.

Conclusions: Tumor size and depth are important characteristics for predicting robotic PN outcomes and thus could be used individually as a simplified way to report tumors features for research and patient counseling purposes.

Keywords: Kidney Neoplasms; Nephrectomy; Robotics

[Full Text]


 

Re: Insufficient conclusions regarding the association between overactive bladder symptoms and degree of dementia

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

doi: 10.1590/S1677-5538.IBJU.2017.0171


LETTER TO THE EDITOR

Jae Heon Kim 1
1 Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University Medical College, Seoul, Korea

No abstract available

[Full Text]


Adjuvant radiotherapy for the primary treatment of adrenocortical carcinoma: Are we offering the best?

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

doi: 10.1590/S1677-5538.IBJU.2017.0095


ORIGINAL ARTICLE

Victor Srougi 1, Jose Bessa Junior 2, Fabio Y. Tanno 1, Amanda M. Ferreira 3, Ana O. Hoff 4, João E. Bezerra 4, Cristiane M. Almeida 5, Madson Q. Almeida 3, 4, Berenice B. Mendonça 3, William C. Nahas 1, Jose L. Chambô 1, Miguel Srougi 1, Maria C. B. V. Fragoso 3, 4
1 Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil; 2 Divisão de Urologia, Universidade de Feira de Santana, BA, Brasil; 3 Unidade de Suprerrenal da Divisão de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, Brasil; 4 Divisão de Endocrinologia do Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil; 5 Divisão de Radioterapia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil

 

ABSTRACT

Purpose: To evaluate the role of ARDT after surgical resection of ACC.

Materials and Methods: Records of patients from our institutional ACC database were retrospectively assessed. A paired comparison analysis was used to evaluate the onco­logical outcomes between patients treated with surgery followed by ARDT or surgery only (control). The endpoints were LRFS, RFS, and OS. A systematic review of the literature and meta-analysis was also performed to evaluate local recurrence of ACC when ARDT was used.

Results: Ten patients were included in each Group. The median follow-up times were 32 months and 35 months for the ARDT and control Groups, respectively. The re­sults for LRFS (p=0.11), RFS (p=0.92), and OS (p=0.47) were similar among subsets. The mean time to present with local recurrence was significantly longer in the ARDT group compared with the control Group (419±206 days vs. 181±86 days, respectively; p=0.03). ARDT was well tolerated by the patients; there were no reports of late toxicity. The meta-analysis, which included four retrospective series, revealed that ARDT had a protective effect on LRFS (HR=0.4; CI=0.17-0.94).

Conclusions: ARDT may reduce the chance and prolong the time to ACC local recur­rence. However, there were no benefits for disease recurrence control or overall sur­vival for patients who underwent this complementary therapy.

 

Keywords: Adrenocortical Carcinoma; Radiotherapy, Adjuvant; Therapeutics

[Full Text]


Anastomosing hemangioma simulating renal cell carcinoma

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

doi: 10.1590/S1677-5538.IBJU.2016.0653


RADIOLOGY PAGE

Mariana Athaniel Silva Rodrigues 1, Eduardo Kaiser Ururahy Nunes Fonseca 1, Fernando Ide Yamauchi 1, Ronaldo Hueb Baroni 1
1 Departamento de Imagem, Hospital Israelita Albert Einstein, São Paulo – Brasil

ABSTRACT

The anastomosing hemangioma is a recent described rare variant, which histologically simulates an angiosarcoma and occurs primarily in the genitourinary tract. We present a case of renal anastomosing hemangioma from a radiologic perspective, describing its imaging features and reviewing its presentation and management.

Keywords: Radiology; Kidney; Magnetic Resonance Imaging

[Full Text]


Laparoscopic pectopexy: initial experience of single center with a new technique for apical prolapse surgery

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

doi: 10.1590/S1677-5538.IBJU.2017.0070


ORIGINAL ARTICLE

Ahmet Kale 1, Alper Biler 2, Hasan Terzi 1, Taner Usta 3, Ebru Kale 4
1 Department of Obstetrics and Gynecology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey; 2 Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey; 3 Department of Obstetrics and Gynecology, Bagcılar Training and Research Hospital, Istanbul, Turkey; 4 Department of Biochemistry, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey

ABSTRACT

Objective: To share our first experience with laparoscopic pectopexy, a new technique for apical prolapse surgery, and to evaluate the feasibility of this technique.

Materials and Methods: Seven patients with apical prolapse underwent surgery with laparoscopic pectopexy. The lateral parts of the iliopectineal ligament were used for a bilateral mesh fixation of the descended structures. The medical records of the patients were reviewed, and the short-term clinical outcomes were analyzed.

Results: The laparoscopic pectopexy procedures were successfully performed, without intraoperative and postoperative complications. De novo apical prolapse, de novo urgency, de novo constipation, stress urinary incontinence, anterior and lateral defect cystoceles, and rectoceles did not occur in any of the patients during a 6-month follow-up period.

Conclusion: Although laparoscopic sacrocolpopexy has shown excellent anatomical and functional long-term results, laparoscopic pectopexy offers a feasible, safe, and comfortable alternative for apical prolapse surgery. Pectopexy may increase a surgeon’s technical perspective for apical prolapse surgery.

 

Keywords: Laparoscopy; Pelvic Organ Prolapse; Vagina

[Full Text]


Inflammatory pseudotumor of kidney: a challenging diagnostic entity

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

doi: 10.1590/S1677-5538.IBJU.2017.0063


RADIOLOGY PAGE

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

No abstract available

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2017.0055


ORIGINAL ARTICLE

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

ABSTRACT

Objective: The aim of this study is to analyze post pubertal results of pre pubertal tunica albuginea plication with non-absorbable sutures in the correction of CPC.

Materials and Methods: The files of patients who underwent tunica albuginea plication without incision (dorsal/lateral) were retrospectively reviewed. Patients younger than 13 years of age at the time of operation and older than 14 years of age in November 2015 were included. Patients with a penile curvature of less than 30 degrees & more than 45 degrees and penile/urethral anomalies were excluded. All of the patients un­derwent surgery followed by circumcision.

Results: The mean age of patients at the time of the operation was 9.7 years (range, 6-13 years). The mean degree of ventral penile curvature measured during the opera­tion was 39 degrees while it was 41 degrees in the lateral curvatures. All of the patients were curvature-free at the end of the operation. At the time of the follow-up examination, the mean age was 16.7 years (range, 14-25 years). Six patients had a straight (0-10 degrees) penis during erection and seven patients had recurrent penile curvatures ranging from 30 to 50 degrees.

Conclusion: Pre pubertal tunica albuginea plication of congenital penile curvature (30-45 degrees) with non-absorbable sutures performed without incision is a minimal invasive method especially when performed during circumcision. However, recurrence might be observed in half of the patients after puberty.

 

Keywords: Penile Diseases; Penile Induration; Circumcision, Male

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2017.0023


ORIGINAL ARTICLE

Omer Kutlu 1, 2, Ersagun Karaguzel 2, Ali Ertan Okatan 2, Ahmet Mentese 3, Esin Yulug 4, Ilke Onur Kazaz 2, Selcuk Kutlu 5, Eyup Dil 2, Huseyin Eren 2, Ahmet Alver 6
1 Department of Urology, School of Medicine, Akdeniz University, Antalya, Turkey; 2 Department of Urology School of Medicine, Karadeniz Technical University, Trabzon, Turkey; 3 Program of Medical Laboratory Techniques, Vocational School of Health Sciences. Karadeniz Technical University, Trabzon, Turkey; 4 Department of Histology and Embryology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey; 5 Department of Urology, Aydin State Hospital, Aydin, Turkey; 6 Department of Biochemistry, School of Medicine, Karadeniz Technical University, Trabzon, Turkey

 

ABSTRACT

 

Purpose: Despite the nerve-sparing technique, many patients suffer from erectile dysfunction after radical prostatectomy (RP) due to cavernous nerve injury. The aim of this study was to evaluate dipyridamole as a potential treatment agent of post-radical prostatectomy erectile dysfunction.

Material and methods: A total of 18 male Sprague-Dawley rats were randomized into three experimental Groups (SHAM+DMSO, BCNI+DMSO and BCNI+DIP). An animal model of bilateral cavernous nerve crush injury (BCNI) was established to mimic the partial nerve damage during nerve-sparing RP. After creating of BCNI, dimethyl sulphoxide (DMSO) was administered transperitoneally as a vehicle to SHAM+DMSO and BCNI+DMSO Groups. BCNI+DIP Group received dipyiridamole (10mg/kg/day) as a solution in DMSO for 15 days. Afterwards, rats were evaluated for in vivo erectile response to cavernous nerve stimulation. Penile tissues were also analyzed biochemically for transforming growth factor-β1 (TGF-β1) level. Penile corporal apoptosis was determined by TUNEL method.

Results: Erectile response was decreased in rats with BCNI and there was no significant improvement with dipyridamole treatment. TGF-β1 levels were increased in rats with BCNI and decreased with dipyridamole treatment. Dipyridamole led to reduced penile apoptosis in rats with BCNI and there was no significant difference when compared to sham operated rats.

Conclusions: Although fifteen-day dipyridamole treatment has failed to improve erectile function in rats with BCNI, the decline in both TGF-β1 levels and apoptotic indices with treatment may be helpful in protecting penile morphology after cavernous nerve injury.

Keywords: Erectile Dysfunction; Dipyridamole; Penis

[Full Text]


 

New concept for treating female stress urinary incontinence with radiofrequency

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

doi: 10.1590/S1677-5538.IBJU.2016.0621


ORIGINAL ARTICLE

Patrícia Lordelo 1, Andrea Vilas Boas 2, Danielle Sodré 1, Amanda Lemos 1, Sibele Tozetto 3, Cristina Brasil 1
1 Centro de Atenção ao Piso Pélvico (CAAP), Divisão de Fisioterapeutas e Pós-Graduação, Escola Bahiana de Medicina e Saúde Pública (EBMSP), BA, Brasil; 2 Centro de Atenção ao Piso Pélvico (CAAP), Divisão de Programas de Ginecologia e Pós-Graduação, Escola Bahiana de Medicina e Saúde Pública (EBMSP), BA, Brasil; 3 Divisão de Ciências Morfofuncionais, Universidade Federal do Recôncavo Baiano, BA, Brasil

 

ABSTRACT

Purpose: To evaluate the clinical response and adverse effects of radiofrequency on the urethral meatus in the treatment of stress urinary incontinence in women.

Materials and Methods: This phase one study included ten women with Stress Uri­nary Incontinence (SUI). The evaluation consisted of 1 hour Pad tests to quantify urine loss and to assess the degree of procedure satisfaction by using the Likert scale. To evaluate safety, we observed the number of referred side effects.

Results: Average age was 53.10 years±7.08 years. In assessing the final Pad Test, 70% showed a reduction and 30% a worsening of urinary loss. Using the Pad Test one month later, there was a reduction in all patients (p=0.028). The degree of satisfaction was 90% and no side effects have been observed. One patient reported burning sensation.

Conclusion: The treatment of SUI with radiofrequency on the urethral meatus has no adverse effects, being a low risk method that reduces urinary loss in women. However, to increase the validity of the study, larger clinical trials are warranted.

Keywords: Pulsed Radiofrequency Treatment; Urinary Incontinence, Stress; Women

[Full Text]


 

Fosfomycin: a good alternative drug for prostate biopsy prophylaxis the results of a prospective, randomized trial with respect to risk factors

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

doi: 10.1590/S1677-5538.IBJU.2016.0619


ORIGINAL ARTICLE

Erdem Kisa 1, Mustafa Ugur Altug 2, Oguz Alp Gurbuz 3, Harun Ozdemir 4
1 Department of Urology, Tepecik Education and Research Hospital, Izmir, Turkey; 2 Department of Urology, Acibadem University School of Medicine, Istanbul, Turkey; 3 Department of Microbiology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey; 4 Department of Urology, Haseki Education and Research Hospital, Istanbul, Turkey

ABSTRACT

Purpose: To determine the risk factors and the efficiency of rectal swab samples to prevent infectious complications in prostate biopsy, and compare fosfomycin with cip­rofloxacin use in prophylaxis.

Materials and methods: Between May and October 2014, pre-biopsy risk factors and their effect in ciprofloxacin and fosfomycin prophylaxis were determined. Pre-biopsy urinalysis, urine culture and rectal swab samples were obtained from all of the patients. Rectal swabs were obtained upon admission, and biopsy was performed in the follow­ing 3-7 days. The place of rectal swab samples and efficiency of fosfomycin use was evaluated.

Results: Pre-biopsy rectal swabs were obtained from 110 patients who revealed 60.9% fluoroquinolone resistance (FQR), and 32.7% fluoroquinolone sensitivity (FQS). Fosfo­mycin resistance was present in 3 patients. Ciprofloxacin use in last 6 months was the only risk factor for FQR. Antibiotic prophylaxis was given to both groups with and without risk factors, according to swab results, and no infective complications were observed. Among the group where fosfomycin was used empirically, one patient had an infection needing hospitalization, however this constitutes no statistical difference between the Group that fosfomycin used empirically or according to swab results (p=0.164).

Conclusions: In prostate biopsy prophylaxis, ciprofloxacin may be used liberally in patients without risk factors, but it should be given according to the rectal swab results in the patients with risk, and fosfomycin may be used independently of risk factors and rectal swab results.

Keywords: Fosfomycin; Prostate; Biopsy

[Full Text]


 

miR–483-5p promotes prostate cancer cell proliferation and invasion by targeting RBM5

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

doi: 10.1590/S1677-5538.IBJU.2016.0595


ORIGINAL ARTICLE

Zhi-Gang Yang 1, Xu-Dong Ma 1, Zhao-Hui He 2, Ying-xin Guo 1
1 Department of Urology, Baotou Central Hospital, Inner Mongolia Medical University, China; 2 Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, China

ABSTRACT

Objective: miR-483-5p has been identified as a miRNA oncogene in certain cancers. However, its role in prostate cancer has not been sufficiently investigated. In this study, we investigated the role of miR-483-5p in prostate cancer and examined RBM5 regula­tion by miR-483-5p.

Material and methods: Expression levels of miR-483-5p were determined by quantita­tive real-time PCR. The effect of miR-483-5p on proliferation was evaluated by MTT assay, cell invasion was evaluated by trans-well invasion assays, and target protein expression was determined by western blotting in LNCaP, DU-145, and PC-3 cells. Luciferase reporter plasmids were constructed to confirm the action of miR-483-5p on downstream target gene RBM5 in HEK-293T cells.

Results: we observed that miR-483-5p was upregulated in prostate cancer cell lines and tissues. A miR-483-5p inhibitor inhibited prostate cancer cell growth and invasion in DU-145 and PC-3 cells. miR-483-5p directly bound to the 3’ untranslated region (3’UTR) of RBM5 in HEK-293T cells. RBM5 overexpression inhibited prostate cancer cell growth and invasion in LNCaP cells. Enforced RBM5 expression alleviated miR- 483-5p promotion of prostate cancer cell growth and invasion in LNCaP cells.

Conclusion: The present study describes a potential mechanism underlying a miR-483- 5p/RBM5 link that contributes to prostate cancer development.

Keywords:  MIRN483 microRNA, human [Supplementary Concept]; RBM5 protein, human [Supplementary Concept]; Prostatic Neoplasms; Growth

[Full Text]


Serum tissue factor as a biomarker for renal clear cell carcinoma

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

doi: 10.1590/S1677-5538.IBJU.2017.0007


ORIGINAL ARTICLE

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

 

ABSTRACT

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

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

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

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

Keywords: Kidney Neoplasms; Thromboplastin; Biomarkers

[Full Text]


 

Comparison of two different suture techniques in laparoscopic partial nephrectomy

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

doi: 10.1590/S1677-5538.IBJU.2016.0550


ORIGINAL ARTICLE

Onur Kaygisiz 1, Sinan Çelen 2, Berna Aytac Vuruşkan 3, Hakan Vuruşkan 1
1 Department of Urology, Uludag University, Faculty of Medicine, Bursa, Turkey; 2 Afyon Sandikli Government Hospital, Afyon, Turkey; 3 Department of Surgical Pathology, Faculty of Medicine, Uludag University, Bursa, Turkey

ABSTRACT

Objective: To comparatively evaluate the traditional interrupted knot-tying and run­ning suture renorrhaphy with Monocryl® in laparoscopic partial nephrectomy (LPN).

Materials and Methods: A retrospective analysis of 62 consecutive patients undergo­ing LPN using traditional interrupted knot-tying suture renorrhaphy (Group 1; n=31) or running suture technique renorrhaphy with 2-0 monofilament polyglecaprone (Monocryl®, Ethicon) (Group 2; n=31) from December 2011 to October 2015 at the University. All patients underwent LPN performed by an experienced laparoscopic sur­geon. The demographic, perioperative and postoperative parameters were compared between the groups, and the effect of both suture techniques on the warm ischemic time (WIT) and trifecta were evaluated.

Results: The running suture renorrhaphy with Monocryl® reduced WIT, estimated blood lost and length of hospitalization stay significantly without increasing postoperative complication rate during LPN in comparison with interrupted knot-tying suture.

Conclusion: The renorrhaphy using the running suture with Monocryl® is an effective and safe technique with the advantage of shortening WIT even in more challenging and larger tumors during LPN.

Keywords: Nephrectomy; Laparoscopy; Suture Techniques

[Full Text]


Medical ozone therapy reduces oxidative stress and testicular damage in an experimental model of testicular torsion in rats

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

doi: 10.1590/S1677-5538.IBJU.2016.0546


ORIGINAL ARTICLE

Mustafa Tusat 1, Ahmet Mentese 2, Selim Demir 3, Ahmet Alver 4,5, Mustafa Imamoglu 6
1 Department of Pediatric Surgery, Kilis State Hospital, Kilis, Turkey; 2 Program of Medical Laboratory Techniques, Vocational School of Health Sciences, Karadeniz Technical, University, Trabzon, Turkey; 3 Department of Nutrition and Dietetics, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey; 4 Department of Medical Biochemistry, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey; 5 Department of Medical Biochemistry, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey; 6 Department of Pediatric Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey

 

ABSTRACT

Objective: Testicular torsion (TT) refers to rotation of the testis and twisting of the spermatic cord. TT results in ischemia-reperfusion (I/R) injury involving increased oxidative stress, inflammation and apoptosis, and can even lead to infertility. The aim of this study was to investigate the effect of ozone therapy on testicular damage due to I/R injury in an experi­mental torsion model.

Materials and Methods: 24 male Sprague-Dawley rats were divided into 3 groups; sham-operated, torsion/detorsion (T/D), and T/D+ozone. Ozone (1mg/kg) was injected intraperi­toneally 120 minutes before detorsion and for the following 24h. Blood and tissue samples were collected at the end of 24h. Johnsen score, ischemia modified albumin (IMA), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were determined.

Results: Levels of IMA, TOS, OSI, and histopathological scores increased in the serum/tissue of the rats in the experimental T/D group. Serum IMA, TOS, and OSI levels and tissue histo­pathological scores were lower in the rats treated with ozone compared with the T/D group.

Conclusion: Our study results suggest that ozone therapy may exhibit beneficial effects on both biochemical and histopathological findings. Clinical trials are now necessary to con­firm this.

Keywords:  Ischemia; Oxidative Stress; Spermatic Cord Torsion

[Full Text]


Prospective evaluation of vesicourethral anastomosis outcomes in robotic radical prostatectomy during early experience in a university hospital

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

doi: 10.1590/S1677-5538.IBJU.2016.0466


SURGICAL TECHNIQUE

Lucas Medeiros Burttet 1, Gabrielle Aguiar Varaschin 2, Andre Kives Berger 3, Leandro Totti Cavazzola 2, 4, Milton Berger 1, 2, Brasil Silva Neto 1, 2
1 Departamento de Urologia, Hospital de Clínicas de Porto Alegre, RS, Brasil; 2 Universidade Federal do Rio Grande do Sul, RS, Brasil; 3 Institute of Urology, University of Southern California, Los Angeles, CA, USA; 4 Departamento de Cirurgia Geral, Hospital de Clínicas de Porto Alegre, RS, Brasil

ABSTRACT  

Purpose: Robotic assisted radical prostatectomy (RARP) presents challenges for the surgeon, especially during the initial learning curve. We aimed to evaluate early and mid-term functional outcomes and complications related to vesicourethral anastomosis (VUA), in patients who underwent RARP, during the initial experience in an academic hospital. We also assessed possible predictors of postoperative incontinence and compared these results with the literature.
Materials and Methods: We prospectively collected data from consecutive patients that underwent RARP. Patients with at least 6 months of follow-up were included in the analysis for the following outcomes: time to complete VUA, continence and complications related to anastomosis. Nerve-sparing status, age, BMI, EBL, pathological tumor staging, and prostate size were evaluated as possible factors predicting early and midterm continence. Results were compared with current literature.
Results: Data from 60 patients was assessed. Mean time to complete VUA was 34 minutes, and console time was 247 minutes. Continence in 6 months was 90%. Incidence of urinary leakage was 3.3%, no patients developed bladder neck contracture or postoperative urinary retention. On multivariate analysis, age and pathological staging was associated to 3-month continence status.
Conclusion: Our data show that, during early experience with RARP in a public university hospital, it is possible to achieve good results regarding continence and other outcomes related to VUA. We also found that age and pathological staging was associated to early continence status.

Keywords: Minimally Invasive Surgical Procedures; Prostatectomy; Urinary Incontinence

[Full Text]


Gas surrounding the urinary bladder in emphysematous cystitis

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

doi: 10.1590/S1677-5538.IBJU.2016.0555


RADIOLOGY PAGE

Zhenyu Yang 1, Chang Sheng 1
1 Department of Urology, Pudong New Area People’s Hospital, Shanghai, China

ABSTRACT

We report a rare case of emphysematous cystitis in a 66-year-old woman with a history of diabetes mellitus. The predisposition of diabetes mellitus and infection of gas-forming bacteria is considered to precede the manifestation of emphysematous cystitis. The present recommended diagnosis test is computed tomography, which have definite value in the evaluation of gas accumulation in bladder wall, or na air-fluid level in bladder.

Keywords: Cystitis; Tomography, X-Ray Computed; Diabetes Mellitus

[Full Text]


Inflatable penile prosthesis as tissue expander: what is the evidence?

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

doi: 10.1590/S1677-5538.IBJU.2016.0528


ORIGINAL ARTICLE

Paul H. Chung 1, Jordan A. Siegel 1, Timothy J. Tausch 1, Alexandra K. Klein 1, Jeremy M. Scott 1, Allen F. Morey 1
1 Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

ABSTRACT

Objective: Many patients who undergo inflatable penile prosthesis (IPP) replacement are often upsized to larger cylinders, suggesting the IPP may serve as a tissue expander and increase internal penile length. The objective of this study is to evaluate whether cylinder length increases with subsequent IPP insertion.

Materials and Methods: We queried American Medical Systems and Coloplast Patient Information Form databases to identify patients who underwent IPP placement and replacement between 2004-2013. Patients were grouped by device type and time to replacement (<2 or ≥2 years). We selected the 2-year mark for subgroup analysis to allow time for tissue expansion to occur and to exclude patients who underwent early explantation (e.g. erosion or infection).

Results: Two thousand, seven hundred and forty nine patients (1,532 AMS 700 LGX, 717 AMS 700 CX, and 500 Coloplast Titan) met the inclusion criteria. Mean time between implants was earlier for LGX (29 months) than CX (39 months) and Titan (48 months) patients (p<0.001). Patients who underwent device replacement at <2 years did not experience an increase in mean cylinder length. On the contrary, patients who underwent device replacement at ≥2 years did experience significant increases in mean cylinder length (LGX 1.2 cm, CX 1.1 cm, and Titan 0.9 cm, p<0.001). The mean increases in length at ≥2 years were similar between the 3 devices (p=0.20). Sixty percent of patients demonstrated increases of >0.5 cm and 40% demonstrated increases of ≥1 cm.

Conclusions: As demonstrated, the IPP may provide tissue expansion over time. Further evaluation is needed to determine if increased cylinder length correlates to increased functional length and patient satisfaction.

Keywords: Penile Prosthesis; Erectile Dysfunction; Surgical Procedures, Operative

[Full Text]


 

Synthetic mesh repair of an anterior perineal hernia following robotic radical urethrocystectomy

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

doi: 10.1590/S1677-5538.IBJU.2016.0534


CHALLENGING CLINICAL CASES

Horacio J. Alvarez Garzón 1,2, Thomas Maubon 3, Camille Jauffret 3, Pierre Vieille 2, Brigitte Fatton 2, Renaud de Tayrac 2
1 Department of Urology, Hospital Privado Centro Medico de Córdoba, Argentina; 2 Department of Obstetrics and Gynaecology, Nîmes University Hospital, Nîmes, France; 3 Department of Urology and Surgical Oncology, Institut Paoli Calmettes, Marseille, France

ABSTRACT

Introduction: Perineal hernia is a protrusion of intra-abdominal viscera through a defect in the pelvic floor and is a rare but challenging complication after extensive abdominoperineal surgery. There have been small series published after colorectal exenteration, but no cases have been reported after radical cystectomy and urethrectomy.

Case Presentation: A 68 years old woman developed an anterior perineal hernia, with no vaginal prolapse, after an anterior exenteration for bladder cancer. A perineal approach with the use of a synthetic polypropylene mesh was chosen to resolve the condition. After 6 months of follow-up, the patient has no symptoms or recurrence of the anterior perineal hernia.

Conclusion: To our knowledge, this case is the first report of perineal hernia after radical urethrocystectomy. Although being a case report, this article describes a potential and challenging complication after extensive anterior pelvic surgery, that could increase its incidence in the future. Literature review shows that whether perineal, abdominal or combined approach is chosen, surgery must respect hernia repair principles.

Keywords: Perineum; Pelvis; Cystectomy

[Full Text]


Electron microscopic changes of detrusor in benign enlargement of prostate and its clinical correlation

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

doi: 10.1590/S1677-5538.IBJU.2016.0350


ORIGINAL ARTICLE

Sher Singh Yadav 1,Rohit Bhattar 1, Lokesh Sharma 2, Gautam Banga 3, T. C. Sadasukhi 4
1 Department of Urology and Renal Transplantation, SMS Medical College, Jaipur, Rajasthan, India; 2 Department of Urology, NIMS Medical College, Jaipur, Rajasthan, India; 3 SCI International Hospital, New Delhi, India; 4 Department of Urology, Mahatma Gandhi Hospital, Jaipur, Rajasthan, India

ABSTRACT

Aims: To study the ultra structural changes in bladder musculature in cases of BPE and their clinical relevance.

Material and Methods: In this descriptive longitudinal, controlled, observational study patients were enrolled into three groups, group 1, group 2A and group 2B. Control group (group-1) consisted of age matched normal male patients, who underwent sur­veillance or diagnostic cystoscopy for microscopic hematuria or irritative symptoms. Case group (group-2) comprised of patients with BPE, undergoing TURP. Case group (group-2) was further classified into: Category 2A (patients not on catheter) and cat­egory 2B (patients on catheter). All relevant clinical parameters like IPSS, prostate size, Qmax, PVR were recorded. Cystoscopy and bladder biopsy were performed in all patients. Various ultrastructural parameters like myocytes, fascicular pattern, intersti­tial tissue, nerve hypertrophy and cell junction pattern were analyzed under electron microscope and they were clinically correlated using appropriate statistical tests.

Results: Control group had significant difference as compared to case group in terms of baseline parameters like IPSS, flow rate and prostate size, both preoperatively and postoperatively, except for PVR, which was seen only preoperatively. There was statis­tically significant difference in ultrastructural patterns between case and control group in all five electron microscopic patterns. However, no significant difference was found between the subcategories of case groups.

Conclusions: BPE is responsible for ultra structural changes in detrusor muscle and these changes remain persistent even after TURP. Nerve hypertrophy, which was not thoroughly discussed in previous studies, is also one of the salient feature of this study.

Keywords:  Prostatic Hyperplasia; Prostate; Urinary Bladder

[Full Text]


Robotic Assisted Laparoscopic Excision of a Retroperitoneal Ganglioneuroma

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

doi: 10.1590/S1677-5538.IBJU.2016.0465


VIDEO SECTION

Lucas Medeiros Burttet 1, Fernando Jahn da Silva Abreu 1, Gabrielle Aguiar Varaschin 1, Brasil Silva Neto 1, Milton Berger 1
1 Serviço de Urologia – Hospital de Clínicas de Porto Alegre, RS, Brasil

ABSTRACT

Introduction: Ganglioneuromas are rare benign neoplasms of the sympathetic nervous system. We describe the case of an incidentally found ganglioneuroma in a woman. To our knowledge this is the first described case of robotic excision of a retroperitoneal ganglioneuroma.

Case: A 41-year-old female had an incidental retroperitoneal mass found during a routine US. CT scan and MRI showed an 8.3cm homogeneous mass, adjacent to left kidney upper pole, with peripheral contrast enhancement. Metabolic tests were normal. Patient was positioned in a left flank position and five ports were introduced transperitoneally. A 4-arm Da Vinci SI was docked at a 45º angle to the table. Lesion was dissected along with left adrenal gland, beginning at the left renal hilum and proceeding cephalad. Results: Operating time was 325min and blood loss was 50ml. Patient was discharged after 72hours. There were no post-operative complications. Pathology showed ganglionic cells with neural tissue, and normal adrenal.

Discussion: Ganglioneuromas rare benign tumors originating from neural crest and typically affect young adults. Most frequent locations are posterior mediastinum, retroperitoneum and adrenal gland. As in this case, ganglioneuromas are usually silent, slow growing tumors discovered incidentally or by mass effect. US and CT imaging may suggest the diag­nosis while MRI findings can be specific for ganglioneuroma. Percutaneous biopsy is an option. Although benign, usually requires surgical excision for treatment.

Conclusions: Our case shows that a robotic approach is feasible and allows for meticulous and safe dissection of vascular structures, facilitating adequate hemostasis while maintaining oncological principles.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20160465-burttet_et_al

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2016.0578


SURGICAL TECHNIQUE

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

ABSTRACT

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

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

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

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

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

Keywords:  Penile Induration; Penis; Erectile Dysfunction

[Full Text]


Surgical management of female paraurethral cyst with concomitant stress urinary incontinence

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

doi: 10.1590/S1677-5538.IBJU.2014.0582


VIDEO SECTION

Tarik Yonguc 1, Ibrahim Halil Bozkurt 1, Salih Polat 1, Serkan Yarimoglu 1, Ismail Gulden 1, Volkan Sen 1, Suleyman Minareci 1
1Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey

ABSTRACT

 

Paraurethral cysts are usually asymptomatic and frequently detected incidentally during routine pelvic examination; however, patients can present with complaints of a palpable cyst or with lower urinary tract symptoms (LUTS) and also dyspareunia. In most cases, diagnosis can be made on physical examination but for more detailed evaluation and to differentiate from malign lesions ultrasonography (US), voiding cystourethrogram (VCUG), computerized tomography (CT), or magnetic resonance imaging (MRI) can also be used. Management of symptomatic paraurethral cyst is surgical excision.

In this video our objective is to show the surgical management of female paraurethral cyst with concomitant stress uri­nary incontinence (SUI).

A 37 year-old woman presented with an 8-year history of progressive urinary symptoms, consisting of dysuria, urinary frequency, urgency urinary incontinence, SUI and dyspareunia. Physical examination in the lithotomy position revealed a cystic lesion located in the left anterolateral vaginal wall. Also cough stress test for SUI was positive. Her preoperative ICI-Q, UDI-6, IIQ-7 and SEAPI scores were 16, 8, 9 and 18 respectively. Vaginal US revealed a solitary 2 cm paraurethral cyst, localized in the distal urethra. Pelvic MRI also revealed a benign cystic lesion in the distal urethra. The patient un­derwent surgical excision of the cyst and anterior colporrhaphy for SUI. At third month visit the patient was very satis­fied. The ICI-Q, UDI-6, IIQ-7 and SEAPI scores were 0.

Sometimes the LUTS concurring with the parauretral cyst can be dominant. Herein we want to show that extra surgical procedures can be necessary with paraurethral cyst excision for full patient satisfaction.

ARTICLE INFO

Available at: Available at: http://www.intbrazjurol.com.br/video-section/20140582-Onguc_et_al

[Full Text]


The influence of previous robotic experience in the initial learning curve of laparoscopic radical prostatectomy

Vol. 43 (x): 2017 April 4.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0526


ORIGINAL ARTICLE

José Anastácio Dias Neto 1, Marcos F. Dall’oglio 1, João Roberto Colombo Jr. 1, Rafael F. Coelho 1, William Carlos Nahas 1
1 Divisão de Urologia, Universidade de São Paulo Escola Médica, São Paulo, SP, Brasil

ABSTRACT

Introduction: This study analyzed the impact of the experience with Robotic-Assisted Laparoscopic Prostatectomy (RALP) on the initial experience with Laparoscopic Radi­cal Prostatectomy (LRP) by examining perioperative results and early outcomes of 110 patients. LRPs were performed by two ro-botic fellowship trained surgeons with daily practice in RALP.

Patients and Methods: 110 LRP were performed to treat aleatory selected patients. The patients were divided into 4 groups for prospective analyses. A transperitoneal ap­proach that simulates the RALP technique was used.

Results: The median operative time was 163 minutes (110-240), and this time signifi­cantly decreased through case 40, when the time plateaued (p=0.0007). The median blood loss was 250mL. No patients required blood transfusion. There were no life-threatening complications or deaths. Minor complications were uniformly distributed along the series (P=0.6401). The overall positive surgical margins (PSM) rate was 28.2% (20% in pT2 and 43.6% in pT3). PSM was in the prostate apex in 61.3% of cases. At the 12-month follow-up, 88% of men were continent (0-1 pad).

Conclusions: The present study shows that there are multiple learning curves for LRP. The shallowest learning curve was seen for the operative time. Surgeons transitioning between the RALP and LRP techniques were considered competent based on the low perioperative complication rate, absence of major complications, and lack of blood transfusions. This study shows that a learning curve still exists and that there are factors that must be considered by surgeons transitioning between the two techniques.

 Keywords:  Laparoscopy; Prostatectomy; Robotic Surgical Procedures

[Full Text]


Effect of Mitomycin – C and Triamcinolone on Preventing Urethral Strictures

Vol. 42 (x): 2016 September 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0191


ORIGINAL ARTICLE

Omer Kurt 1, Fethullah Gevher 2, Cenk Murat Yazici 1, Mustafa Erboga 3, Mucahit Dogru 4, Cevat Aktas 3
1 Department of Urology, Namık Kemal University, School of Medicine, Tekirdag, Turkey; 2 Department of Urology, Anadolu Hospital, Istanbul, Turkey; 3 Department of Histology, Namık Kemal University, School of Medicine, Tekirdag, Turkey; 4 Department of Radiology, Namık Kemal University, School of Medicine, Tekirdag, Turkey

ABSTRACT

Urethral stricture is a common disease with high recurrence rate. Several manipulations were defined to prevent the recurrence but the results were disappointing. This study aimed to evaluate the efficacy of triamcinolone and mitomycin-C on urethral stricture formation and their effect on inhibition of urethral fibrosis. A total of 24 New Zealand rabbits were divided into 3 groups. Urethras of rabbits were traumatized with pediatric resectoscope. Resection area was irrigated with 10mL saline, swapped with a cotton wool soaked with 0.5mg/mL MMC and injected by 40mg triamcinolone in groups 1, 2 and 3 respectively. Retrograde urethrogram was performed at 28th day of procedure and the urethra was removed for histopathologic evaluation. There were significant differences in urethral diameters and in lumen reduction rate between the control and study groups (p<0.001). Compared to control group, all treatment groups showed mild fibrosis, less collagen bundle irregularity, and lower numbers of fibroblasts (p=0.003). The Tunnel assay showed that the number of apoptotic cells in the submucosal connective tissue was quantitatively higher in control groups (p=0.034). In the view of efficacy and safety, MMC and triamcinolone have the potential to replace the use of stents, clean intermittent catheterization, or long term catheters following internal urethrotomy. There were no statistically significant differences between two agents in terms of preventing urethral stricture formation in the present study. Mitomycin C and triamcinolone decreased the recurrence rates of urethral stricture.

 

Keywords: Endoscopy; Mitomycin; Triamcinolone; Urethral Stricture

[Full Text]


 

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

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

doi: 10.1590/S1677-5538.IBJU.2017.0049


VIDEO SECTION

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

ABSTRACT

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

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

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

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

ARTICLE INFO

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

[Full Text]


 

Alternative approach of a Fibroepithelial polyp

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

doi: 10.1590/S1677-5538.IBJU.2016.0471


VIDEO SECTION

Cristiano Linck Pazeto 1, Willy Baccaglini 1, Thiago Fernandes Negris Lima 1, Alexandre Gomes S. Simões 1, Sidney Glina 1
1 Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil

ABSTRACT

A 41-year-old male presented at Emergency Department (ED) with right flank pain associated with hematuria for 3 days. Patient had a previous history of nephrolithiasis. The physical examination and blood tests were normal. Urine analyses showed haematuria > 1.000.000/μL. After clinical evaluation, a computer tomography (CT) showed right ureteral dilata­tion caused by a 5 mm proximal stone and a distal intraluminal mass of 8 cm in length. In this setting, an ureteroscopic biopsy was performed and revealed a large polypoid lesion histologically suggestive of fibroepithelial polyp. Due to technical difficulties (intraluminal mass length and technical issue for the passage of guidewire) and after discussing all available minimally invasive options, we opted for a laparoscopic approach. Instead of ureterectomy of the affected segment of the ureter, as classically performed, we proceeded with an ureterotomy, blunt dissection of the tumor and ureterolithotomy, with complete removal of the mass. This approach did not require ureteral anastomosis and the ureteral dilatation facilitated its primary closure. No complications occurred, even after 3 years of follow-up.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20160471-pazeto_et_al/

[Full Text]


 

A case of retroperitoneal fibrosis responding to steroid therapy

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

doi: 10.1590/S1677-5538.IBJU.2016.0520


CHALLENGING CLINICAL CASES

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

ABSTRACT

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

Keywords: Retroperitoneal Fibrosis; Therapeutics; Steroids

[Full Text]


 

Short-term efficacy and safety of low-intensity extracorporeal shock wave therapy in erectile dysfunction: a systematic review and meta-analysis

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

doi: 10.1590/S1677-5538.IBJU.2016.0245


REVIEW ARTICLE

Zi-jun Zou 1, Liang-you Tang 1, Zhi-hong Liu 1, Jia-yu Liang 1, Ruo-chen Zhang 1, Yu-jie Wang 1, Yong-quan Tang 1, Rui Gao 2 , Yi-ping Lu 1
1 Department of Urology, Institute of Urology , West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China; 2 Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China

ABSTRACT

Aim: The role of low-intensity extracorporeal shock wave therapy (LI-ESWT) in erec­tile dysfunction (ED) is not clearly determined. The purpose of this study is to investi­gate the short-term efficacy and safety of LI-ESWT for ED patients.

Materials and Methods: Relevant studies were searched in Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), WANFANG and VIP databas­es. Effective rate in terms of International Index of Erectile Function-Erectile Function Domain (IIEF-EF) and Erectile Hardness Score (EHS) at about 1month after LI-ESWT was extracted from eligible studies for meta-analysis to calculate risk ratio (RR) of effective treatment in ED patients treated by LI-ESWT compared to those receiving sham-treatment.

Results: Overall fifteen studies were included in the review, of which four randomized controlled trials (RCTs) were for meta-analysis. Effective treatment was 8.31 [95% con­fidence interval (CI): 3.88-17.78] times more effective in the LI-ESWT group (n=176) than in the sham-treatment group (n=101) at about 1 month after the intervention in terms of EHS, while it was 2.50 (95% CI: 0.74-8.45) times more in the treatment group (n=121) than in the control group (n=89) in terms of IIEF-EF. Nine-week protocol with energy density of 0.09mJ/mm2 and 1500 pluses seemed to have better therapeutic ef­fect than five-week protocol. No significant adverse event was reported.

Conclusion: LI-ESWT, as a noninvasive treatment, has potential short-term therapeutic effect on patients with organic ED irrespective of sensitivity to PDE5is. Owing to the limited number and quality of the studies, more large-scale, well-designed and long-term follow-up time studies are needed to confirm our analysis.

Keywords: Erectile Dysfunction; Therapeutics; Meta-Analysis as Topic

[Full Text]


The prostate after castration and hormone replacement in a rat model: structural and ultrastructural analysis

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

doi: 10.1590/S1677-5538.IBJU.2016.0484


ORIGINAL ARTICLE

Bruno Felix-Patrício 1, Alexandre F. Miranda 2, Jorge L. Medeiros Jr. 3, Carla B. M. Gallo 2, Bianca M. Gregório 2, Diogo B. de Souza 2, Waldemar S. Costa 2, Francisco J. B. Sampaio 2
1 Instituto de Ciências Humanas e da Saúde, Universidade Federal Fluminense, Rio das Ostras, RJ, Brasil; 2 Urogenital Research Unit, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; 3 Fundação Educacional Dom André Arcoverde, Valença, RJ, Brasil

ABSTRACT

Purpose: To evaluate if late hormonal replacement is able to recover the prostatic tissue modified by androgenic deprivation.

Materials and Methods: 24 rats were assigned into a Sham group; an androgen deficient group, submitted to bilateral orchiectomy (Orch); and a group submitted to bilateral orchiectomy followed by testosterone replacement therapy (Orch+T). After 60 days from surgery blood was collected for determination of testosterone levels and the ventral prostate was collected for quantitative and qualitative microscopic analysis.

The acinar epithelium height, the number of mast cells per field, and the densities of collagen fibers and acinar lumen were analyzed by stereological methods under light microscopy. The muscle fibers and types of collagen fibers were qualitatively assessed by scanning electron microscopy and polarization microscopy.

Results: Hormone depletion (in group Orch) and return to normal levels (in group Orch+T) were effective as verified by serum testosterone analysis. The androgen deprivation promoted several alterations in the prostate: the acinar epithelium height diminished from 16.58±0.47 to 11.48±0.29μm; the number of mast cells per field presented increased from 0.45±0.07 to 2.83±0.25; collagen fibers density increased from 5.83±0.92 to 24.70±1.56%; and acinar lumen density decreased from 36.78±2.14 to 16.47±1.31%. Smooth muscle was also increased in Orch animals, and type I collagen fibers became more predominant in these animals. With the exception of the densities of collagen fibers and acinar lumen, in animals receiving testosterone replacement therapy all parameters became statistically similar to Sham. Collagen fibers density became lower and acinar lumen density became higher in Orch+T animals, when compared to Sham. This is the first study to demonstrate a relation between mast cells and testosterone levels in the prostate. This cells have been implicated in prostatic cancer and benign hyperplasia, although its specific role is not understood.

Conclusion: Testosterone deprivation promotes major changes in the prostate of rats. The hormonal replacement therapy was effective in reversing these alterations.

Keywords: Hormone Replacement Therapy; Prostate; Orchiectomy; Hypogonadism

[Full Text]


Management of prostate abscess in the absence of guidelines

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

doi: 10.1590/S1677-5538.IBJU.2016.0472


ORIGINAL ARTICLE

Haitham Abdelmoteleb 1, Fatima Rashed 1, Amr Hawary 1
1 Great Western Hospital, Swindon, United Kingdom

 ABSTRACT

 In contemporary practice, the number of patients presenting with prostatic abscess have significantly declined due to the widespread use of antibiotics. However, when faced with the pathology, prostatic abscess tends to pose a challenge to clinicians due to the difficulty of diagnosis and lack of guidelines for treatment. Treatment consists of an array of measures including parenteral broad-spectrum antibiotic administration and abscess drainage.

Keywords: Prostate; Disease Management; Guidelines as Topic

[Full Text]


Implantation of a biodegradable rectum balloon implant: tips, Tricks and Pitfalls

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

doi: 10.1590/S1677-5538.IBJU.2016.0494


ORIGINAL ARTICLE

Ben G.L. Vanneste 1, Kees van De Beek 2, Ludy Lutgens 1, Philippe Lambin 1
1 Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands; 2 Department of Urology, Maastricht University Medical Center+, Maastricht, Netherlands

 

ABSTRACT

Introduction: A rectum balloon implant (RBI) is a new device to spare rectal structures during prostate cancer radiotherapy. The theoretical advantages of a RBI are to reduce the high radiation dose to the anterior rectum wall, the possibility of a post-implant correction, and their predetermined shape with consequent predictable position.

Objective: To describe, step-by-step, our mini-invasive technique for hands-free transperineal implantation of a RBI before start of radiotherapy treatment.

Materials and Methods: We provide step-by-step instructions for optimization of the transperineal implantation procedure performed by urologists and/or radiation oncologists experienced with prostate brachytherapy and the use of the real-time bi-plane transrectal ultrasonography (TRUS) probe. A RBI was performed in 15 patients with localised prostate cancer. Perioperative side-effects were reported.

Results: We provide ‘tips and tricks’ for optimizing the procedure and proper positioning of the RBI. Please watch the animation, see video in https://vimeo.com/205852376/789df4fae4.

The side-effects included mild discomfort to slight pain at the perineal region in 8 out of 15 patients. Seven patients (47%) had no complaints at all. Two patients developed redness of the skin, where prompt antibiotic regimen was started with no further sequelae. One patient revealed a temporary urine retention, which resolved in a few hours following conservative treatment. Further no perioperative complicationsoccurred.

Conclusion: This paper describes in detail the implantation procedure for an RBI. It is a feasible, safe and very well-tolerated procedure.

Keywords: Prostatic Neoplasms; Radiotherapy; Biodegradable Plastics

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Prostate cancer in renal transplant recipients

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

doi: 10.1590/S1677-5538.IBJU.2016.0510


REVIEW ARTICLE

Benjamin A. Sherer 1, Krishnan Warrior 1, Karl Godlewski 1, Martin Hertl 2, Oyedolamu Olaitan 2, Ajay Nehra 1, Leslie Allan Deane 1
1 Department of Urology, Rush University Medical Center, Chicago, Illinois, United States; 2 Department of Surgery, Abdominal Transplant, Rush University Medical Center, Chicago, Illinois, United States

ABSTRACT

 

As patients with end-stage renal disease are receiving renal allografts at older ages, the number of male renal transplant recipients (RTRs) being diagnosed with prostate cancer (CaP) is increasing. Historically, the literature regarding the management of CaP in RTR’s is limited to case reports and small case series. To date, there are no stan­dardized guidelines for screening or management of CaP in these complex patients. To better understand the unique characteristics of CaP in the renal transplant popula­tion, we performed a literature review of PubMed, without date limitations, using a combination of search terms including prostate cancer, end stage renal disease, renal transplantation, prostate cancer screening, prostate specific antigen kinetics, immuno­suppression, prostatectomy, and radiation therapy. Of special note, teams facilitating the care of these complex patients must carefully and meticulously consider the altered anatomy for surgical and radiotherapeutic planning. Active surveillance, though gain­ing popularity in the general low risk prostate cancer population, needs further study in this group, as does the management of advance disease. This review provides a comprehensive and contemporary understanding of the incidence, screening measures, risk stratification, and treatment options for CaP in RTRs.

 

Keywords: Prostate cancer, familial [Supplementary Concept]; Kidney Transplantation; Prostatectomy; Radiotherapy; Prostate-Specific Antigen

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What is the quickest scoring system to predict percutaneous nephrolithotomy outcomes? A comparative study among S.T.O.N.E score, guy’s stone score and croes nomogram

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

doi: 10.1590/S1677-5538.IBJU.2016.0586


REVIEW ARTICLE

Fabio C. Vicentini 1, Felipe R. Serzedello 2, Kay Thomas 3, Giovanni S. Marchini 2, Fabio C. M. Torricelli 2, Miguel Srougi 2, Eduardo Mazzucchi 2
1 Seção de Endourologia, Departamento de Urologia, Hospital de Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil; 2 Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil; 3 Stone Unit, Guy’s and St. Thomas’ National Health services foundation Hospital, London, United Kingdom

ABSTRACT

Objective: To compare the application time and the capacity of the nomograms to predict the success of Guy’s Stone Score (GSS), S.T.O.N.E. Nephrolithometry (STONE) and Clinical Research Office of the Endourological Society nephrolithometric nomogram (CROES) of percutaneous nephrolithotomy (PCNL), evaluating the most efficient one for clinical use.

Materials and Methods: We studied 48 patients who underwent PCNL by the same surgeon between 2010 and 2011. We calculated GSS, STONE and CROES based on preoperative non-contrast computed tomography (CT) images and clinical data. A single observer, blinded to the outcomes, reviewed all images and assigned scores. We compared the application time of each nomogram. We used an analysis of variance for repeated measures and multiple comparisons by the Tukey test. We compared the area under the ROC curve (AUC) of the three nomograms two by two to determine the most predictive scoring system.

Results: The immediate success rate was 66.7% and complications occurred in 16.7% of cases. The average operative time was 122 minutes. Mean application time was significantly lower for the GSS (27.5 seconds) when compared to 300.6 seconds for STONE and 213.4 seconds for CROES (p<0.001). There was no significant difference among the GSS (AUC=0.653), STONE (AUC=0.563) and CROES (AUC=0.641) in the ability to predict immediate success of PCNL.

Conclusions: All three nomograms showed similar ability to predict success of PCNL, however the GSS was the quickest to be applied, what is an important issue for routine clinical use when counseling patients who are candidates to PCNL.

Keywords: Nomograms; Diagnosis; Calculi

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Update on complications of synthetic suburethral slings

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

doi: 10.1590/S1677-5538.IBJU.2016.0250


REVIEW ARTICLE

Cristiano Mendes Gomes 1, Fabrício Leite Carvalho 1, Carlos Henrique Suzuki Bellucci 1, Thiago Souto Hemerly 1, Fábio Baracat 1, Jose de Bessa Jr. 1, Miguel Srougi 1, Homero Bruschini 1
1 Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil

ABSTRACT

Synthetic suburethral slings have become the most widely used technique for the sur­gical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on pa­tients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings.

Keywords:  Urinary Incontinence; Polypropylenes; Postoperative Complications

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Efficacy and safety of Elevate® system on apical and anterior compartment prolapse repair with personal technique modification

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

doi: 10.1590/S1677-5538.IBJU.2016.0233


ORIGINAL ARTICLE

Daniele Castellani 1, Vikiela Galica 1, Pietro Saldutto 1, Giuseppe Paradiso Galatioto 1, Carlo Vicentini 1
1 Department of Life, Health & Environmental Sciences, University of L’Aquila, Urology Unit, “Giuseppe Mazzini” Hospital, Teramo, Italy

ABSTRACT

Aim: To evaluate the effectiveness and safety of Anterior Elevate® mesh kit system (AES) in woman with symptomatic stage 3 or 4 anterior and/or apical pelvic organ prolapse (POP).
Materials and Methods: This retrospective, monocentric, single surgeon study enrolled between May 2010 and January 2013 fifty-six woman experiencing symptomatic an¬terior vaginal prolapse with or without apical descent (POP-Q stage 3 or 4). All women received a AES and 7 (12.5%) received a concomitant transvaginal hysterectomy. Pri¬mary endpoint was anatomic correction of prolapse; success was defined as POP-Q stage ≤ 1 or asymptomatic stage 2. Secondary endpoints were quality-of-life (QOL) re¬sults and patients’ safety outcomes, which were assessed by 3 validated self-reporting questionnaires at baseline and annually: ICIQ-UI short form, ICIQ-VS and P-QOL. All patients completed 2-years and 28 women 3-years of follow-up. Surgical approach was modified in women with uterus, moving the two-propylene strips anteriorly around the cervix itself crossing one another, so the left will take place in the right side and the right on the opposite. This modification was made in order to better support the uterus.
Results: Vaginal mesh exposure was present in 3 (5,3%) patients. Very good anatomi¬cal outcomes were seen, with one (1,8%) failure at 6-months, 4 (7,1%) at 1-year, 6 at 2-years (10,7%). Statistically significant improvements were seen in the ICIQ-VS and P-QOL questionnaires throughout follow-up.
Conclusion: Our data suggest that AES is a minimally-invasive transvaginal procedure to repair anterior and apical POP, with good evidence related to mid-term safety and efficacy.

Keywords:  Pelvic Organ Prolapse; Surgical Mesh; Vagina; Surgical Procedures, Operative

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Urethral duplication type influences on the complications rate and number of surgical procedures

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

doi: 10.1590/S1677-5538.IBJU.2016.0269


ORIGINAL ARTICLE

Roberto Iglesias Lopes 1,2, Amilcar Martins Giron 1, Marcos Figueiredo Mello 1, Cristovao Machado Barbosa Neto 1, Joana dos Santos 2, Paulo Renato Marcelo Moscardi 1, Victor Srougi 1, Francisco Tibor Denes 1, Miguel Srougi 1
1 Unidade de Urologia Pediátrica, Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brasil; 2 Division of Urology, The Hospital for Sick Children, University of Toronto, Canada

ABSTRACT

Introduction: Urethral duplication is rare. Characterized by the presence of two urethral channels. This anomaly presents a great variety of clinical findings that depend on the type of duplication that often is associated with other anomalies.

Material and Methods: We report thirteen boys with urethral duplication managed in our institution between 1988-2015. Clinical findings, associated anomalies, treatment of urethral duplication and our results are described. Patients were classified according to Effmann classification.

Results: Mean patient’s age was 38.3±34.7 months (3-136 months). Mean follow-up was 7.7±3.4 years (3y8m-14y2m). Type II A2 was the most common pattern (8/13 patients, 61.5%), followed by type IA (3/13 patients, 23%) and IIA1 (2/13 patients, 15.3%). The most frequent clinical manifestations were urinary tract infections (UTI) observed in 11/13 patients (84.6%) and anal urinary leakage, found in 7/13 patients (53.8%). Associated anomalies were found in 9/13 patients (69.2%).

Required surgeries were 3.53±2.84 procedures per patient. Considering groups: Type IIA2 4.25±3.28, type IIA1 4±1.41 and type IA 1.33±0.57 needed procedures per patient. Complications rate were 0% for type IA, 50% for type IIA1 and 75% for type IIA2.

Conclusions: Patients with incomplete duplication (type I A or I B) can totally be as­ymptomatic, with no need of surgical correction. Type IIA2 is the most complex form of duplication to correct and multiple procedures might be required because of the very hypoplastic orthotopic dorsal urethral tissue. Surgical treatment should be individual­ized and parents should be advised on complications and need of multiple surgeries according to urethral duplication type.

Keywords:  Surgical Procedures, Opera­tive; Urethra; complications [Subheading]

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Attenuation of partial unilateral ureteral obstruction -induced renal damage with hyperbaric oxygen therapy in a rat model

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

doi: 10.1590/S1677-5538.IBJU.2016.0565


ORIGINAL ARTICLE

Eyup Burak Sancak 1, Yusuf Ziya Tan 2, Hakan Turkon 3, Coskun Silan 4
1 Department of Urology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey; 2 Department of Nuclear Medicine, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey; 3 Department of Biochemistry, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey; 4 Department of Pharmacology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey

ABSTRACT

Objective: The objective of the present study was to evaluate the effectiveness of HBO therapy on biochemical parameters, renal morphology and renal scintigraphy in rats undergoing chronic unilateral partial ureteral obstruction (UPUO).

Material and methods: Thirty-five rats were divided into five equal groups: Control group; Sham group; HBO group; UPUO group and UPUO/HBO group. The effects of HBO therapy were examined using biochemical parameters and histopathological changes. After calculating the score for each histopathological change, the total histopathological score was obtained by adding all the scores. In addition, dynamic renal scintigraphy findings were evaluated.

Results: Serum parameters indicating inflammation, serum tumor necrosis factoralpha, ischemia modified-albumin, IMA/albumin ratio and Pentraxin-3 levels, were observed to be high in the UPUO group and low in the UPUO/HBO treatment group. Similarly, in the treatment group, the reduction in malondialdehyde, total oxidant status and oxidative stress index levels and increase in total antioxidant capacity values were observed to be statistically significant compared to the UPUO group (p<0.001, p=0.007, p<0.001, p=0.001, respectively). The total score and apoptosis index significantly decreased after administration of HBO treatment. Dynamic 99mTc-MAG3 renal scintigraphy also showed convincing evidence regarding the protective nature of HBO against kidney injury. In the UPUO/HBO therapy group, the percentage contribution of each operated kidney increased significantly compared to the UPUO group (41.73% versus 32.72%).

Conclusion: The findings of this study indicate that HBO therapy had a reno-protective effect by reducing inflammation and oxidative stress, and preserving renal function after renal tissue damage due to induction of UPUO.

Keywords: Hyperbaric Oxygenation; Ureteral Obstruction; Apoptosis

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Full-thickness skin mesh graft vaginoplasty: a skin sparing technique

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

doi: 10.1590/S1677-5538.IBJU.2016.0259


VIDEO SECTION

Guilherme Lang Motta 1, Patric Machado Tavares 1, Gabriel Veber Moisés da Silva 1, Milton Berger 1, Brasil Silva Neto 1, Tiago Elias Rosito 1
1 Departamento de Urologia do Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil

ABSTRACT

Introduction: The ideal vaginoplasty method should promote good cosmetic and functional results with low morbidity. We describe a new technique for congenital vaginal agenesis using a full-thickness perforated skin graft.

Materials and Methods: We report an 18 year old patient with vaginal agenesis (Morris syndrome) that undergone a modified version of McIndoe vaginoplasty. Patient is set in a low lithotomy position and lateral traction sutures are placed in labia and a 16Fr urethral catheter inserted. An inverted “V”-shaped incision is made in the mucosal plaque below the urethra. Blunt dissection in a cephalic posterior direction forms a space between the rectum and urethra. Special care is taken to avoid rectal tear during this maneuver. A full-thickness skin graft is removed from the lower abdomen measuring 12.0×6.0cm as an aesthetic abdominoplasty. The fat tissue is removed, remaining epidermis and dermis and the graft is perforated, allowing a great surface increase. After suturing over a mold, the graft is fixed in the created space. The donor site is closed with intradermal transversal suture.

Results: From January 2009 to August 2015, seven patients diagnosed with vaginal agenesis underwent this technique. There were no major complications or need for blood transfusions. At the six-month follow-up, all patients reportedsatisfactory sexual intercourse. There were no significant complications at donor site or neovagina that needed surgical intervention.

Conclusion: Vaginal reconstruction using the perforated graft is viable with excellent functional results. Applying this modification, we yielded the good results of a classic McIndoe technique with lower donor site morbidity.

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Robotic Assisted Radical Cystoprostatectomy and Intracorporeal Ileal Conduit Urinary Diversion for a Kidney Transplant Recipient

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

doi: 10.1590/S1677-5538.IBJU.2016.0227


VIDEO SECTION

Peter A. Caputo 1, Daniel Ramirez 1, Matthew Maurice 1, Ryan Nelson 1, Onder Kara 1, Ercan Malkoc 1, David Goldfarb 1, Jihad Kaouk

1 Departament of Urology Cleveland Clinic, Cleveland, Ohio, United States

ABSTRACT

Introduction and Objectives: Robotic assisted radical cystectomy (RARC) is an alternative to open radical cystectomy. As experience is gained with the RARC approach the technique is being applied to more complex surgical cases. We describe here our technique for RARC with intracorporeal ileal conduit urinary diversion for a renal transplant recipient.

Materials and Methods: The patient is a 60-year old man with high-grade muscle invasive bladder cancer.  He has a history of renal failure due to polycystic kidney disease and received a deceased donor renal transplant in 2008. His hospital course at time of transplant was complicated by low-level BK virus viremia. Interestingly his trans-urethral bladder tumor resection specimen at time of bladder cancer diagnosis stained positive for SV40.  His native kidneys were anuric so bilateral laparoscopic nephrectomy was performed in a staged fashion 2 weeks prior to RARC.  Our surgical technique utilizes 6 trocars, of note a 12-mm assistant trocar is placed 1 cm superior to the pubic symphysis, and this trocar is solely used to pass a laparoscopic stapler to facilitate the excision of the ileal segment and the stapled enteric anastomosis. Surgical steps include: identification of native ureters bilaterally (removed en bloc with the bladder specimen); identification of the transplanted ureter at the right bladder dome; posterior bladder and prostate dissection along Denonvilliers’ fascia; development of the space of Retzius; ligation and transection of the bladder and prostate vascular bundles; apical prostate dissection and transection of urethra; left pelvic lymphadenectomy; ilium resection for creation of the ileal conduit; stapled enteric anastomosis; ureteroileal anastomosis; maturation of the ileal conduit stoma.

Results: The surgery had no intraoperative complications. Operative time was 443 minutes (7.4 hours). Estimated blood loss was 250 cc. Length of hospital stay was 5 days. The patient did not experience any postoperative complications. The patient maintained good renal graft function with no decline in eGFR to date.

Conclusions: As surgeon comfort and experience with robotic assisted surgery grows, robotic surgery can successfully be applied to less frequently performed procedures. Here we successfully performed a robotic assisted radical cystoprostatectomy with intracorporeal ileal conduit urinary diversion for a renal transplant recipient.

[Full Text]


 

Robotic Assisted Laparoscopic Augmentation Ileocystoplasty

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

doi: 10.1590/S1677-5538.IBJU.2016.0205


VIDEO SECTION

Peter A. Caputo 1, Daniel Ramirez 1, Matthew Maurice 1, Onder Kara 1, Ryan Nelson 1, Ercan Malkoc 1, Jihad Kaouk 1

1 Department of Urology, Cleveland Clinic, Cleveland, Ohio, USA

 

ABSTRACT

Introduction: Augmentation ileocystoplasty is a common treatment in adults with low capacity bladders due to neurogenic bladder dysfunction. We describe here our technique for robotic assisted laparoscopic augmentation ileocystoplasty in an adult with a low capacity bladder due to neurogenic bladder dysfunction.

Materials and Methods: The patient is a 35 years-old man with neurogenic bladder due to a C6 spinal cord injury in 2004. Cystometrogram shows a maximum capacity of 96cc and Pdet at maximum capacity of 97cmH2O. He manages his bladder with intermittent catheterization and experiences multiple episodes of incontinence between catheterizations.

He experiences severe autonomic dysreflexia symptoms with indwelling urethral catheter. He has previously failed non operative management options of his bladder dysfunction. Our surgical technique utilizes 6 trocars, of note a 12mm assistant trocar is placed 1cm superior to the pubic symphysis, and this trocar is solely used to pass a laparoscopic stapler to facilitate the excision of the ileal segment and the enteric anastomosis. Surgical steps include: development of the space of Retzius/dropping the bladder; opening the bladder from the anterior to posterior bladder neck; excision of a segment of ileum; enteric anastomosis; detubularizing the ileal segment; suturing the ileal segment to the incised bladder edge.

Results: The surgery had no intraoperative complications. Operative time was 286 minutes (4.8 hours). Estimated blood loss was 50cc. Length of hospital stay was 8 days. He did experience a postoperative complication on hospital day 3 of hematemesis, which did not require blood transfusion. Cystometrogram at 22 days post operatively showed a maximum bladder capacity of 165cc with a Pdet at maximum capacity of 10cmH2O.

Conclusions: As surgeon comfort and experience with robotic assisted surgery grows, robotic surgery can successfully be applied to less frequently performed procedures. In this case we successfully performed a robotic assisted laparoscopic augmentation ileocystoplasty displaying improvement in measurable functional outcomes.

[Full Text]


 

Unilateral extravesical ureteral reimplantation via inguinal incision for the correction of vesicoureteral reflux: a 10-year experience

Vol. 42 (x): 2016 November 6.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0179


ORIGINAL ARTICLE

Michael Yap 1, Unwanabong Nseyo 1, Hena Din 1, Madhu Alagiri 1

1 Rady Children’s Hospital, San Diego, CA, USA

ABSTRACT

Introduction and Objective: Multiple options exist for the surgical management of vesicoureteral reflux (VUR). We report on our 10-year experience using the inguinal approach to extravesical ureteral reimplantation (EVR).

Materials and Methods: Patient characteristics of age, gender, and reflux grade were obtained and outcomes of operative time, hospital stay, and radiographic resolution were assessed.

Results: 71 girls and 20 boys with a mean age of 74 months (range 14-164) underwent inguinal EVR via a 3.5-cm inguinal mini-incision. Mean follow up was 10.9 months (range 0.4-69.7). Average grade of reflux was 2.80. Average operative time was 91 minutes (range 51-268). The procedure was successful in 87 of 91 patients (95.6%). The 3 cases of reflux that persisted were all grade 1 and managed expectantly. Contralateral reflux developed in 9 cases, all of which resolved after treatment with either Deflux or ureteral reimplant. There were 4 case of urinary retention that resolved after a brief period of CIC or indwelling catheterization. There were no cases of ureteral obstruction.

Most patients were discharged on post-operative day 1 (85/91) and no hospitalization extended beyond 3 days.

Conclusions: The inguinal approach to extravesical ureteral reimplantation should be considered as a potentially minimally invasive alternative to endoscopic and robotic treatment of VUR with a success rate more comparable to traditional open approaches. We feel it is the method of choice in cases of unilateral VUR requiring surgical correction.

Keywords: Urinary Incontinence; Minimally Invasive Surgical Procedures; Vesico-Ureteral Reflux

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Ultrasound detection of prostatic calculi as a parameter to predict the appearance of hematospermia after a prostate biopsy

Vol. 42 (x): 2016 November 6.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0005


ORIGINAL ARTICLE

Lucio Dell’Atti 1

1 Department of Urology, University Hospital “St.Anna”, Ferrara, Italy

ABSTRACT

Purpose: We evaluated the correlation between prostate calculi and hematospermia in patients undergoing prostate biopsy, and its impact on sexual activity of patients.

Materials and Methods: A single-center prospective randomized study of 212 patients referred for transrectal ultrasound-guided prostate biopsy (TRUSBx) was performed. All patients were divided into two groups: Group A (GA), 106 patients with moderate/ marked presence of prostatic calculi visualized by TRUS; Group B (GB), 106 patients with absence/scarce of prostatic calcifications. Patients were handed questionnaires to obtain a validated data on the duration and impact of hematospermia on sexual activ­ity. The anxiety scores were recorded using a visual analogue scale.

Results: No significant difference was noted between the two groups when comparing age, preoperative PSA level, prostate volume, and biopsy number, except for digital rectal examination (DRE) findings. Post-biopsy results of patients included in GA re­vealed that the complication of hematospermia was present in 65.1%, while in GB was present in 39.7% (p<0.001).

On multivariate analysis for identifying significant preoperative predictors of hemato­spermia, which included variables of age, PSA, prostate volume, and prostate cancer were not shown to be significant predictors of hematospermia, except DRE and pros­tate calculi (p<0.001).

The mean anxiety score was 3.7±2.8 in GA and 2.3±1.9 in GB, respectively (p<0.001).

Conclusions: Prostatic calculi are an independent predictive factor of severe hemato­spermia after TRUSBx on the basis of multivariate analysis, but don’t affect the posi­tive rate of prostate cancer. Patients should be adequately counselled before TRUSBx to avoid undue anxiety and alterations in sexual activity.

Keywords: Prostate; Ultrasound, High- Intensity Focused, Transrectal; Biopsy; Hemospermia

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