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Stage effect of chronic kidney disease in erectile function

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

doi: 10.1590/S1677-5538.IBJU.2017.0228


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

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Saphenous-sparing laparoscopic inguinal lymphadenectomy

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

doi: 10.1590/S1677-5538.IBJU.2017.0120


VIDEO SECTION

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

ABSTRACT

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

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

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

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

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

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

doi: 10.1590/S1677-5538.IBJU.2016.0119


VIDEO SECTION

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

ABSTRACT

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

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

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

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

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

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

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

doi: 10.1590/S1677-5538.IBJU.2017.0071


CHALLENGING CLINICAL CASES

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

ABSTRACT

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

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

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

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

Keywords: Prostatic Neoplasms; Vas Deferens; Therapeutics

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

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

doi: 10.1590/S1677-5538.IBJU.2016.0652


ORIGINAL ARTICLE

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

ABSTRACT  

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

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

Keywords:  Infertility; Hypogonadism; Testosterone

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

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

doi: 10.1590/S1677-5538.IBJU.2016.0611


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

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

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

doi: 10.1590/S1677-5538.IBJU.2016.0347


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

Keywords: Urinary Bladder; Sarcoma; Carcinoma

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Biochemical recurrence after radical prostatectomy: what does it mean?

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

doi: 10.1590/S1677-5538.IBJU.2016.0656


REVIEW ARTICLE

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

ABSTRACT

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

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

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

 

Keywords: Prostatic Neoplasms; Prostate-Specific Antigen; Prostatectomy

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Transition to adulthood with a bladder augmentation: histopathologic concerns

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

doi: 10.1590/S1677-5538.IBJU.2016.0548


ORIGINAL ARTICLE

Emil Mammadov 1, Sergulen Dervisoglu 2, Mehmet Elicevik 3, Haluk Emir 3, Yunus Soylet 3, S. N. Cenk Buyukunal 3
1 Department of Pediatric Surgery, Near East University Medical Faculty, Turkey; 2 Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey; 3 Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey

ABSTRACT

Aim: To investigate the histopathologic changes in native bladder and gastrointestinal segment, the relation between histopathologic changes, type of operation and the period passed over operation in patients with bladder augmentation.

Materials and methods: Twenty consecutive patients were enrolled in this study.

Histopathologic evaluation of the cystoscopic mucosal biopsies from native bladder and enteric augment was performed in all patients.

Results: Active or chronic non-specific inflammation of various degrees was found in all specimens except two. Metaplastic changes were detected in 3 patients. Two patients had squamous metaplasia (one focal, one extensive) and one patient had intestinal metaplasia. All metaplastic changes were found in native bladder specimens.

The type of augmentation in patients with metaplastic changes were ileocystoplasty and sigmoidocystoplasty. No signs of malignancy were detected in any patient.

Conclusion: The complexity of the disorders requiring bladder augmentation does not let the surgeons to draw a clear line between different groups of complications including malignancy formation. However, due to challenging course of the augmentation procedure itself, surgeons should be well aware of the possibility of malignancy development.

Keywords: Urinary Bladder; Neoplasms; Pediatrics

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

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

doi: 10.1590/S1677-5538.IBJU.2017.0143


ORIGINAL ARTICLE

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

ABSTRACT

 

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

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

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

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

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

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Ureteral orifice involvement by urothelial carcinoma: long term oncologic and functional outcomes

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

doi: 10.1590/S1677-5538.IBJU.2017.0218


ORIGINAL ARTICLE

Muammer Altok 1, Ali F. Sahin 2, Mehmet I. Gokce 3, Gokhan R. Ekin 4, Rauf Taner Divrik 5
1 Department of Urology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA; 2 Department of Urology, Sivas Numune Hospital, Sivas, Turkey; 3 Department of Urology, School of Medicine, Ankara University, Ankara, Turkey; 4 Department of Urology, Tepecik Education and Research Hospital, Izmir, Turkey; 5 Department of Urology, Private Ege City Hospital, Izmir, Turkey

ABSTRACT

Purpose: Bladder cancer (BC) may involve the ureteral orifice, and the resection of the orifice has oncological and functional consequences such as development of up­per tract urothelial carcinoma (UTUC), vesicoureteral reflux or ureteral stenosis. The aim of this study was to investigate the oncological and functional outcomes of the ureteral orifice resection in BC patients and determine the predictive factors for UTUC development.

Materials and methods: A total of 1359 patients diagnosed with BC, between 1992 and 2012, were reviewed retrospectively. Patients were grouped with respect to orifice resection and compared for development of UTUC, survival and functional outcomes. Kaplan-Meier method was used to compare survival outcomes. Logistic regression analysis was performed to determine predictors of UTUC development.

Results: Ureteral orifice involvement was detected in 138 (10.2%) patients. The rate of synchronous (10.1% vs. 0.7%, p=0.0001) and metachronous (5.3% vs. 0.9%, p=0.0001) UTUC development was found to be higher in patients with ureteral orifice involve­ment. Orifice involvement and tumor stage were found to be associated with develop­ment of UTUC in the regression analysis. Overall (p=0.963) and cancer specific survival rates (p=0.629) were found to be similar. Hydronephrosis was also significantly higher in patients with orifice involved BC, due to the orifice obstruction caused by the tumor (33.3% vs. 13.9%, p<0.05).

Conclusions: BC with ureteral orifice involvement has significantly increased the risk of having synchronous or metachronous UTUC. However, orifice involvement was not found to be associated with survival outcomes. Development of stricture due to resec­tion is a very rare complication.

Keywords: Urinary Bladder Neoplasms; Hydronephrosis; Therapeutics

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Open radical prostatectomy reproducing robot-assisted radical prostatectomy: Involving antegrade nerve sparing and continuous anastomosis

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

doi: 10.1590/S1677-5538.IBJU.2016.0627


ORIGINAL ARTICLE

Se Yun Kwon 1, Jun Nyung Lee 2, Yun-Sok Ha 2, Seock Hwan Choi 2, Tae-Hwan Kim 2, Tae Gyun Kwon 2
1 Department of Urology, Dongguk University College of Medicine, Gyeongju, Korea; 2 Department of Urology, Kyungpook National University Medical Center, Daegu, Korea

ABSTRACT

Purpose: To present modified RRP using the same method as RALP and compare its surgical outcomes with RALP.

Materials and Methods: Demographics, perioperative and functional outcomes of the 322 patients that underwent RRP (N=99) or RALP (N=223) at our institution from January 2011 through June 2013 were evaluated retrospectively. Postoperative inconti­nence and erectile dysfunction are involved functional outcomes. During the modified procedure, the bladder neck was dissected first as for RALP. After dissection of vas deference and seminal vesicle, the prostate was dissected in an antegrade fashion with bilateral nerve saving. Finally, the urethra was cut at the prostate apex. After a Rocco suture was applied, and then urethrovesical anastomosis was performed with continu­ous suture as for RALP.

Results: Perioperative characteristics and complication rates were similar in the RRP and RALP groups except for mean estimated blood loss (p<0.001) and operative time (p<0.001). Incontinence rates at 3 and 12 months after RRP decreased from 67.6% to 10.1 and after RALP decreased from 53.4% to 5.4%. Positive surgical margin rates were non-significantly different in the RRP and RALP groups (30.3% and 37.2%, respec­tively). Overall postoperative potency rate at 12 months was not significant different in RRP and RALP groups (34.3% and 43.0%).

Conclusions: RRP reproducing RALP was found to have surgical outcomes comparable to RALP. This technique might be adopted by experienced urologic surgeons as a stan­dard procedure.

Keywords: Prostatectomy; Anastomosis, Surgical

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Step by step male to female transsexual surgery

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

doi: 10.1590/S1677-5538.IBJU.2017.0044


VIDEO SECTION

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

 

ABSTRACT

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

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

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

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

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

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

doi: 10.1590/S1677-5538.IBJU.2017.0043


VIDEO SECTION

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

No Abstract available

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

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

doi: 10.1590/S1677-5538.IBJU.2017.0016


VIDEO SECTION

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

No Abstract available

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

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

doi: 10.1590/S1677-5538.IBJU.2016.0560


VIDEO SECTION

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

ABSTRACT

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

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

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

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

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

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Which is best method for instillation of topical therapy to the upper urinary tract? An in vivo porcine study to evaluate three delivery methods

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

doi: 10.1590/S1677-5538.IBJU.2016.0258


ORIGINAL ARTICLE

Zhenbang Liu 1, Junxiang Ng 2, Arianto Yuwono 1, Yadong Lu 1, Yung Khan Tan 1
1 Department of Urology, Tan Tock Seng Hospital, Singapore, TW; 2 Clinical Research Unit, Tan Tock Seng Hospital, Singapore, TW

 

ABSTRACT

Purpose: To compare the staining intensity of the upper urinary tract (UUT) urothelium among three UUT delivery methods in an in vivo porcine model.

Materials and methods: A fluorescent dye solution (indigo carmine) was delivered to the UUT via three different methods: antegrade perfusion, vesico-ureteral reflux via in­dwelling ureteric stent and retrograde perfusion via a 5F open-ended ureteral catheter. Twelve renal units were tested with 4 in each method. After a 2-hour delivery time, the renal-ureter units were harvested en bloc. Time from harvesting to analysis was also standardised to be 2 hours in each arm. Three urothelium samples of the same weight and size were taken from each of the 6 pre-defined points (upper pole, mid pole, lower pole, renal pelvis, mid ureter and distal ureter) and the amount of fluorescence was measured with a spectrometer.

Results: The mean fluorescence detected at all 6 predefined points of the UUT urothe­lium was the highest for the retrograde method. This was statistically significant with p-value less than <0.05 at all 6 points.

Conclusions: Retrograde infusion of UUT by an open ended ureteral catheter resulted in highest mean fluorescence detected at all 6 pre-defined points of the UUT urothe­lium compared to antegrade infusion and vesico-ureteral reflux via indwelling ureteric stents indicating retrograde method ideal for topical therapy throughout the UUT uro­thelium. More clinical studies are needed to demonstrate if retrograde method could lead to better clinical outcomes compared to the other two methods.

Keywords: Urinary tract; carcinoma; transitional cell; adjuvant; instillation

[Full Text]


 

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

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

doi: 10.1590/S1677-5538.IBJU.2017.0193


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

[Full Text]


Spermatozoa retrieval for cryopreservation after death

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

doi: 10.1590/S1677-5538.IBJU.2017.0249


CHALLENGING CLINICAL CASES

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

1 Centro de Reprodução Humana Curitiba, PR, Brasil

ABSTRACT

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

Keywords: Cryopreservation; Spermatozoa; Vas Deferens; Testis

[Full Text]


Incidentally detected tuberculous prostatitis with microabscess

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

doi: 10.1590/S1677-5538.IBJU.2017.0190


RADIOLOGY PAGE

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

ABSTRACT  

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

Keywords: Prostate; Tuberculosis; MRI; Radiology

[Full Text]


Re: Unusual intravesical foreign body in a young female migrated from the vagina due to autoerotism

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

doi: 10.1590/S1677-5538.IBJU.2017.0306


LETTER TO THE EDITOR

Michael S. Floyd Jr. 1, Ahmad M. Omar 1, Altaf Q. Khattak 1
1 Department of Reconstructive Urology, St Helens & Knowsley Hospital NHS Trust, Whiston Hospital, United Kingdom, UK

No abstract available

[Full Text]


 

A Safe teaching protocol of LRP (laparoscopic radical prostatectomy)

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

doi: 10.1590/S1677-5538.IBJU.2017.0137


ORIGINAL ARTICLE

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

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

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

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

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

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

Keywords: Prostatectomy; Education; Surgical Procedures, Operative

[Full Text]


 

Magnetic resonance imaging and clinical findings in seminal vesicle pathologies

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

10.1590/S1677-5538.IBJU.2017.0153


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Seminal Vesicles; Pathology; Magnetic Resonance Imaging

 

[Full Text]


 

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

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

doi: 10.1590/S1677-5538.IBJU.2017.0221


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

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

[Full Text]


 

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

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

doi: 10.1590/S1677-5538.IBJU.2016.0638


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Acute Kidney Injury; Kidney; Lithotripsy

[Full Text]


 

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

[Full Text]


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

[Full Text]


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

[Full Text]


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]

[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]


 

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]


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]


 

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]


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]


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]


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]


 

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

[Full Text]


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

[Full Text]


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

[Full Text]


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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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.

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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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