Ahead of print

Effect of Mitomycin – C and Triamcinolone on Preventing Urethral Strictures

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

doi: 10.1590/S1677-5538.IBJU.2016.0191


ORIGINAL ARTICLE

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

ABSTRACT

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

 

Keywords: Endoscopy; Mitomycin; Triamcinolone; Urethral Stricture

[Full Text]


 

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

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

doi: 10.1590/S1677-5538.IBJU.2017.0049


VIDEO SECTION

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

ABSTRACT

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

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

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

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

ARTICLE INFO

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

[Full Text]


 

Alternative approach of a Fibroepithelial polyp

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

doi: 10.1590/S1677-5538.IBJU.2016.0471


VIDEO SECTION

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

ABSTRACT

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

ARTICLE INFO

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

[Full Text]


 

Does index tumor predominant location influence prognostic factors in radical prostatectomies?

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

doi: 10.1590/S1677-5538.IBJU.2016.0335


ORIGINAL ARTICLE

Athanase Billis 1, Leandro L. L. Freitas 1, Larissa B. E. Costa 1, Camila M. de Angelis 1, Kelson R. Carvalho 1, Luis A. Magna 2, Ubirajara Ferreira 3
1 Departamento de Patologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil; 2 Departamento de Genética Médica/Bioestatística, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil; 3 Departamento Urologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil

ABSTRACT

Purpose: To find any influence on prognostic factors of index tumor according to predominant location.

Materials and Methods: Prostate surgical specimens from 499 patients submitted to radical retropubic prostatectomy were step-sectioned. Each transverse section was sub­divided into 2 anterolateral and 2 posterolateral quadrants. Tumor extent was evalu­ated by a semi-quantitative point-count method. The index tumor (dominant nodule) was recorded as the maximal number of positive points of the most extensive tumor area from the quadrants and the predominant location was considered anterior (antero­lateral quadrants), posterior (posterolateral quadrants), basal (quadrants in upper half of the prostate), apical (quadrants in lower half of the prostate), left (left quadrants) or right (right quadrants). Time to biochemical recurrence was analyzed by Kaplan-Meier product-limit analysis and prediction of shorter time to biochemical recurrence using univariate and multivariate Cox proportional hazards model.

Results: Index tumors with predominant posterior location were significantly associ­ated with higher total tumor extent, needle and radical prostatectomy Gleason score, positive lymph nodes and preoperative prostate-specific antigen. Index tumors with predominant basal location were significantly associated with higher preoperative prostate-specific antigen, pathological stage higher than pT2, extra-prostatic exten­sion, and seminal vesicle invasion. Index tumors with predominant basal location were significantly associated with time to biochemical recurrence in Kaplan-Meier estimates and significantly predicted shorter time to biochemical recurrence on univariate analy­sis but not on multivariate analysis.

Conclusions: The study suggests that index tumor predominant location is associated with prognosis in radical prostatectomies, however, in multivariate analysis do not of­fer advantage over other well-established prognostic factors.

Keywords: Neoplasms; Prostate; Prostatectomy; Prostate-Specific Antigen

[Full Text]


Ten cases with 46,XX testicular disorder of sex development: single center experience

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

doi: 10.1590/S1677-5538.IBJU.2016.0505


CHALLENGING CLINICAL CASES

Akinsal, Emre Can 1, Baydilli, Numan 1, Demirtas, Abdullah 1, Saatci, Cetin 2, Ekmekcioglu, Oguz 1
1 Department of Urology, Erciyes University Medical Faculty, Kayseri, Turkey; 2 Department of Genetics, Erciyes University Medical Faculty Medical, Kayseri, Turkey

Objective: To present clinical, chromosomal and hormonal features of ten cases with SRY-positive 46,XX testicular disorder of sex development who were admitted to our infertility clinic.

Cases and Methods: Records of the cases who were admitted to our infertility clinic between 2004 and 2015 were investigated. Ten 46,XX testicular disorder of sex development cases were detected. Clinical, hormonal and chromosomal assessments were analized.

Results: Mean age at diagnosis was 30.4, mean body height was 166.9cm. Hormonal data indicated that the patients had a higher FSH, LH levels, lower TT level and normal E2, PRL levels. Karyotype analysis of all patients confirmed 46,XX karyotype, and FISH analysis showed that SRY gene was positive and translocated to Xp. The AZFa, AZFb and AZFc regions were absent in 8 cases. In one case AZFb and AZFc incomplete deletion and normal AZFa region was present. In the other one all AZF regions were present.

Conclusion: Gonadal development disorders such as SRY-positive 46,XX testicular disorder of sex development can be diagnosed in infertility clinics during infertility workup. Although these cases had no chance of bearing a child, they should be protected from negative effects of testosterone deficiency by replacement therapies.

Keywords: Chromosomal abnormality, infertility, 46,XX testicular disorder of sex development

[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]


 

Towards development and validation of an intraoperative assessment tool for robot-assisted radical prostatectomy training: results of a Delphi study

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

doi: 10.1590/S1677-5538.IBJU.2016.0420


ORIGINAL ARTICLE

Christopher Morris 1, Jen Hoogenes 1, Bobby Shayegan 1, Edward D. Matsumoto 1
1 Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada

ABSTRACT

Introduction: As urology training shifts toward competency-based frameworks, the need for tools for high stakes assessment of trainees is crucial. Validated assessment metrics are lacking for many robot-assisted radical prostatectomy (RARP). As it is quickly becoming the gold standard for treatment of localized prostate cancer, the development and validation of a RARP assessment tool for training is timely.

Materials and methods: We recruited 13 expert RARP surgeons from the United States and Canada to serve as our Delphi panel. Using an initial inventory developed via a modified Delphi process with urology residents, fellows, and staff at our institution, panelists iteratively rated each step and sub-step on a 5-point Likert scale of agreement for inclusion in the final assessment tool. Qualitative feedback was elicited for each item to determine proper step placement, wording, and suggestions.

Results: Panelist’s responses were compiled and the inventory was edited through three iterations, after which 100% consensus was achieved. The initial inventory steps were decreased by 13% and a skip pattern was incorporated. The final RARP stepwise in­ventory was comprised of 13 critical steps with 52 sub-steps. There was no attrition throughout the Delphi process.

Conclusions: Our Delphi study resulted in a comprehensive inventory of intraoperative RARP steps with excellent consensus. This final inventory will be used to develop a valid and psychometrically sound intraoperative assessment tool for use during RARP training and evaluation, with the aim of increasing competency of all trainees.

Keywords:  Delphi Technique; Prostatectomy; Robotic Surgical Procedures

[Full Text]


Laparoscopic donor nephrectomy in unusual venous anatomy – donor and recepient implications

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

doi: 10.1590/S1677-5538.IBJU.2016.0309


ORIGINAL ARTICLE

Avinash Bapusaheb Patil 1,Tarun Dilip Javali 1,Harohalli K. Nagaraj 1, S. M. L. Prakash Babu 1, Arvind Nayak 1
1 Department of Urology, M.S. Ramaiah Hospital, Bangalore

ABSTRACT

Objectives: Laparoscopic donor nephrectomy is now a commonly performed procedure in most of renal transplantation centers. However, the suitability of laparoscopy for donors with abnormal venous anatomy is still a subject of debate.

Materials and methods: Between August 2007 and August 2014, 243 laparoscopic donor nephrectomies were performed in our institution. All donors were evaluated with preoperative three-dimensional spiral computed tomography (CT) angiography Thirteen (5.35%) donors had a left renal vein anomaly. A retrospective analysis was performed to collect donor and recipient demographics and perioperative data.

Results: Four donors had a type I retroaortic vein, seven had type II retroaortic vein and a circumaortic vein was seen in three donors. The mean operative time was 114±11 minutes and mean warm ischemia time was 202±12 seconds. The mean blood loss was 52.7±18.4mL and no donor required blood transfusion. Mean recipient creatinine at the time of discharge was 1.15±0.18mg/dL, and creatinine at six months and one year follow-up was 1.12±0.13mg/dL and 1.2±0.14mg/dL, respectively. There were no significant differences in operative time, blood loss, warm ischemia time, donor hospital stay or recipient creatinine at 6 months follow-up, following laparoscopic donor nephrectomy in patients with or without left renal vein anomalies.

Conclusion: Preoperative delineation of venous anatomy using CT angiography is as important as arterial anatomy. Laparoscopic donor nephrectomy is safe and feasible in patients with retroaortic or circumaortic renal vein with good recipient outcome.

Keywords: Laparoscopy; Veins; Kidney Transplantation

[Full Text]


SCUBE1: a promising biomarker in renal cell cancer

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

doi: 10.1590/S1677-5538.IBJU.2016.0316


ORIGINAL ARTICLE

Ersagun Karagüzel 1, Ahmet Menteşe 2, İlke O.Kazaz 1, Selim Demir 3, Asım Örem 4, Ali Ertan Okatan 1, Diler Us Altay 5, Serap Özer Yaman 4
1 Department of Urology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey; 2 Program of Medical Laboratory Techniques, Karadeniz Technical University, Vocational School of Health Sciences, Trabzon, Turkey; 3 Department of Nutrition and Dietetics, Karadeniz Technical University, Faculty of Health Sciences, Trabzon, Turkey; 4 Department of Medical Biochemistry, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey 5 Department of Chemistry and Chemical Processing Technology, Ordu University, Ulubey Vocational School, Ordu, Turkey

 

ABSTRACT

Purpose: To investigate the efficacy of signal peptide-CUB-EGF domain-containing protein 1 (SCUBE-1) as a novel biomarker of renal tumors.

Materials and Methods: 48 individuals were included in the study. The patient group (Group-1) consisted of 23 subjects diagnosed with renal tumor, and the control group (Group-2) of 25 healthy individuals. Patients diagnosed with renal tumor received surgical treatment consisting of radical or partial nephrectomy. Blood specimens were collected following overnight fasting. Signal peptide-CUB-EGF domain-containing protein 1 (SCUBE-1), soluble urokinase plasminogen activator receptor (suPAR) and carbonic anhydrase IX (CA IX) levels were measured from plasma samples. Patients in groups 1 and 2 were compared in terms of these biochemical parameters.

Results: The 23-member renal tumor group was made up of 17 (73.91%) male and 6 (26.08%) female patients with a mean age of 58.5±15.7 years (range 25 to 80). The 24-member healthy control group was made up of 16 (64%) male and 9 (36%) female subjects with a mean age of 52.4±9.12 years (range 40 to 67). Analysis revealed sig­nificant elevation in SCUBE-1 levels in the renal tumor group (p=0.005). No significant differences were detected between the groups with regard to CA IX or suPAR measure­ments (p=0.062 vs. p=0.176).

Conclusions: SCUBE-1 appears to represent a promising biomarker in the diagnosis and follow-up of patients with renal tumor.

Keywords: Carcinoma, Renal Cell; Biomarkers

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2016.0245


REVIEW ARTICLE

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

ABSTRACT

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

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

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

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

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

[Full Text]


Histopathological analysis of the non – tumour parenchyma following radical nephrectomy: can it predict renal functional outcome?

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

doi: 10.1590/S1677-5538.IBJU.2016.0417


ORIGINAL ARTICLE

Rana Birendra 1, Nirmal Thampi John 2, Neelaveni Duhli 2, Antony Devasia 1, Nitin Kekre 1, Ramani Manojkumar 2
1 Department of Urology, Christian Medical College, Vellore; 2 Department of Pathology, Christian Medical College, Vellore

ABSTRACT

Introduction: Radical nephrectomy (RN), a recommended treatment option for patients with Renal cell carcinoma (RCC) leads to an inevitable decline in global renal function. Pathological changes in the non-tumour parenchyma of the kidney may help predict the function of the remaining kidney.

Materials and Methods: Aim of this prospective, observational study was to find histo­pathological factors in the non-tumor renal parenchyma that could predict the decline in global renal function postoperatively and its association with co-morbidities like diabetes (DM). Data of consecutive patients undergoing RN from December-2013 to January-2015 was collected. Non-tumor parenchyma of the specimen was reported by a dedicated histopathologist. eGFR was calculated using Cockcroft-Gault formula before the surgery and at last follow up of at least 12 months.

Results: 73 RN specimens were analyzed. Mean follow up was 12.3 months. The mean decrease in eGFR was 22% (p=.0001). Percent decrease in eGFR did not show asso­ciation with any of the histopathological parameters studied. DM was significantly associated with decrease in percent eGFR (p<0.05) and increase in arteriolar hyali­nosis (p=0.004), Glomerulosclerosis (p=0.03) and Interstitial fibrosis/ Tubular atrophy (p=.0001). Maximum size of the tumor showed a negative correlation with percentage change in eGFR (p=.028).

Conclusion: Histological parameters in the non-tumour portion of the RN specimen may not be able to predict renal function outcome over a short follow up. However, presence of DM was associated with adverse pathological changes and significant de­crease in renal function postoperatively.

Keywords: Nephrectomy; Arteriosclerosis; Glomerulosclerosis, Focal Segmental

[Full Text]


 

Erectile dysfunction in ankylosing spondylitis patients

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

doi: 10.1590/S1677-5538.IBJU.2016.0378


ORIGINAL ARTICLE

Thiago Santana 1, Thelma Skare 1, Vitor Steil Delboni 1, Juliana Simione 1, Ana Paula B. Campos 1 , Renato Nisihara 1,2
1 Unidade de Reumatologia, Hospital Evangélico, Padre Anchieta, Curitiba, PR, Brasil; 2 Departamento de Medicina, Universidade Positivo, Curitiba, PR, Brasil

ABSTRACT

Background: Rheumatic diseases such as ankylosing spondylitis (AS) may be associ­ated with sexual dysfunction.

Aim: To study erectile function of a group of Brazilian AS patients comparing them with controls.

Materials and Methods: This was a cross sectional study approved by the local Com­mittee of Ethics in Research. The questionnaire IIEF (International Index of Erectile Function) was applied to 40 AS patients and 40 healthy controls. AS patients had de­termination of disease activity (through BASDAI or Bath Ankylosing Spondylitis Dis­ease activity index), ASDAS (Ankylosing Spondylitis Disease Activity Score, MASES or Maastricht Ankylosing Spondylitis Score and SPARCC or Spondyloarthritis Research Consortium of Canada), function (through BASFI or Bath Ankylosing Spondylitis Functional Index and HAQ or Health Assessment Questionnaire) and BASMI (Bath Ankylosing Spondylitis Metrological Index).

Results: AS patients had a median score on IIEF of 22.0 (IQR=18-25) while controls had 29 (IQR=27-30) with p<0.0001 Only 17.5% of the AS patients had no erectile dysfunc­tion, in opposite to 87.5% of controls (p<0.0001). IIEF scores had a negative association with BASDAI (p<0.0001), HAQ (p=0.05), body mass index (P=0.03), MASES (P=0.02) and SPARCC (P=0.02) in a univariate analysis. Multiple regression showed that BAS­DAI was the only variable independently associated with IIEF.

Conclusion: There is a high prevalence of erectile dysfunction among AS patients that is associated with disease activity measured by BASDAI.

Keywords: Erectile Dysfunction; Spondylitis, Ankylosing; Disease

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2016.0484


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

Keywords: Hormone Replacement Therapy; Prostate; Orchiectomy; Hypogonadism

[Full Text]


Management of prostate abscess in the absence of guidelines

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

doi: 10.1590/S1677-5538.IBJU.2016.0472


ORIGINAL ARTICLE

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

 ABSTRACT

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

Keywords: Prostate; Disease Management; Guidelines as Topic

[Full Text]


Quality of Life after post-prostatectomy intensity modulated radiation therapy to the prostate bed with or without the use of gold fiducial markers for image guidance or higher total radiotherapy doses

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

doi: 10.1590/S1677-5538.IBJU.2016.0189


ORIGINAL ARTICLE

Yazan A. Abuodeh 1, Arash O. Naghavi 1, Tzu-Hua Juan 1, Zhenjun Ma 1, Richard B. Wilder 2
1 Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA; 2 Cancer Treatment Centers of America, Newnan, Georgia, USA

ABSTRACT

Purpose: To evaluate quality of life (QoL) after post-prostatectomy intensity modulated radiation therapy (IMRT) in the “adjuvant” setting starting within 4 months of radical prostatectomy for adverse features; and “salvage” setting for a PSA≥0.2ng/mL.

Materials and Methods: Retrospective review of 130 patients who underwent IMRT to the prostate bed±gold fiducial marker placement for image guidance to 64.8-72.0Gy (median, 70.2Gy) between 2004 and 2013. Higher doses were defined as 70.2-72.0Gy and lower doses were defined as 64.8-68.4Gy. Androgen deprivation therapy (ADT) was given to 4/48 (8%) adjuvant patients and 9/82 (11%) salvage patients. International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), and Expanded Prostate Cancer Index Composite-26-bowel (EPIC-26-bowel) questionnaires were used to assess urinary, sexual, and bowel QoL, respectively.

Results: Median follow-up was 46 months. There were better urinary (p=0.03) and sexual (p=0.002) QoL scores with adjuvant IMRT relative to salvage IMRT. The use of prostate bed fiducial markers did not significantly affect urinary, sexual, or bowel QoL (p=0.39, p=0.49, and p=0.40, respectively). Higher total radiotherapy doses did not significantly affect urinary, sexual, or bowel QoL (p=0.21, p=0.61, and p=0.36, respectively).

Conclusions: There was no significant change in urinary, sexual, and bowel sexual QoL with post-prostatectomy IMRT regardless of whether prostate bed fiducial markers or higher total radiotherapy doses were used. QoL with IMRT in the present study compares favorably with prior reports for three-dimensional conformal radiation therapy.

Keywords: Prostate; Postoperative Care; Radiotherapy; Quality of Life

[Full Text]


Penile alterations at early stage of type 1 diabetes in rats

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

doi: 10.1590/S1677-5538.IBJU.2016.0454


ORIGINAL ARTICLE

Mingfang Tao 1, Cemal Tasdemir 1,2, Seda Tasdemir 1,3, Ali Shahabi 1,4, Guiming Liu 1,4
1 Department of Urology, Case Western Reserve University School of Medicine, Cleveland, OH, USA; 2 Department of Urology, Inonu University, Medical Faculty, Malatya, Turkey; 3 Department of Pharmacology, Inonu University, Medical Faculty, Malatya, Turkey; 4 Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA

ABSTRACT

Objective: Diabetes affects the erectile function significantly. However, the penile alterations in the early stage of diabetes in experimental animal models have not been well studied. We examined the changes of the penis and its main erectile components in diabetic rats.

Materials and methods: Male Sprague-Dawley rats were divided into 2 groups: streptozotocin (STZ)-induced diabetics and age-matched controls. Three or nine weeks after diabetes induction, the penis was removed for immunohistochemical staining of smooth muscle and neuronal nitric oxide synthase (nNOS) in midshaft penile tissues.

The cross-sectional areas of the whole midshaft penis and the corpora cavernosa were quantified. The smooth muscle in the corpora cavernosa and nNOS in the dorsal nerves were quantified.

Results: The weight, but not the length, of the penis was lower in diabetics. The crosssectional areas of the total midshaft penis and the corpora cavernosa were lower in diabetic rats compared with controls 9 weeks, but not 3 weeks after diabetes induction.

The cross-sectional area of smooth muscle in the corpora cavernosa as percentage of the overall area of the corpora cavernosa was lower in diabetic rats than in controls 9 weeks, but not 3 weeks after diabetes induction. Percentage change of nNOS in dorsal nerves was similar at 3 weeks, and has a decreased trend at 9 weeks in diabetic rats compared with controls.

Conclusions: Diabetes causes temporal alterations in the penis, and the significant changes in STZ rat model begin 3-9 weeks after induction. Further studies on the reversibility of the observed changes are warranted.

 

Keywords: Diabetes Mellitus; Penis; Erectile Dysfunction

[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]


Use of the Uro Dyna-CT in endourology – the new frontier

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

doi: 10.1590/S1677-5538.IBJU.2016.0413


SURGICAL TECHNIQUE

Fabio C. Vicentini 1, Luiz A. A. Botelho 1, José L. M. Braz 2, Ernane de S. Almeida 3, Marcelo Hisano 1
1 Departamento de Urologia, Centro do Cálculo Renal do Hospital 9 de Julho, São Paulo, Brasil; 2 Departamento de Anestesia, Hospital 9 de Julho, São Paulo, Brasil; 3 Departamento de Enfermagem, Centro Cirúrgico do Hospital 9 de Julho, São Paulo, Brasil

ABSTRACT

We describe the use of the Uro Dyna-CT, an imaging system used in the operating room that produces real-time three-dimensional (3D) imaging and cross-sectional image reconstructions similar to an intraoperative computerized tomography, during a percutaneous nephrolithotomy and a contralateral flexible ureteroscopy in a complete supine position. A 65 year-old female patient had an incomplete calyceal staghorn stone in the right kidney and a 10mm in the left one. The procedure was uneventful and the intraoperative use of the Uro Dyna-CT identified 2 residual stones that were not found by digital fluoroscopy and flexible nephroscopy at the end of surgery, helping us to render the patient stone-free in one procedure, which was confirmed by a postoperative CT scan. Prospective studies will define the real role of the Uro Dyna-CT for endourological procedures, but its use seems to be a very promising tool for improving stone free rates and decreasing auxiliary procedures, especially for complex cases.

Keywords: Nephrostomy, Percutaneous; Radiation; Ureteroscopy

[Full Text]


Minimally Invasive Radiologic Uretero-calycostomy; a salvage procedure for late transplant rejection ureter necrosis

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

doi: 10.1590/S1677-5538.IBJU.2016.0386


RADIOLOGY PAGE

Erich K. Lang 1
 1 Department of Radiology, Tulane School Medicine, New Orleans, LA, USA

No abstract available

[Full Text]


Update on complications of synthetic suburethral slings

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

doi: 10.1590/S1677-5538.IBJU.2016.0250


REVIEW ARTICLE

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

ABSTRACT

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

Keywords:  Urinary Incontinence; Polypropylenes; Postoperative Complications

[Full Text]


Antioxidant enzyme profile and lipid peroxidation products in semen samples of testicular germ cell tumor patients submitted to orchiectomy

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

doi: 10.1590/S1677-5538.IBJU.2016.0323


ORIGINAL ARTICLE

Camila Sposito 1, Mariana Camargo 1,Danielle Spinola Tibaldi 1, Valéria Barradas 1, Agnaldo Pereira Cedenho 1, Marcílio Nichi 2, Ricardo Pimenta Bertolla 1, Deborah Montagnini Spaine 1
1 Departamento de Cirurgia, Divisão de Urologia, Setor de Reprodução Humana, Universidade Federal de São Paulo, SP, Brasil; 2 Departamento de Reprodução Animal, Faculdade de Medicina Veterinária, Universidade de São Paulo, SP, Brasil

ABSTRACT

Purpose: To determine enzymatic antioxidant and lipid peroxidation levels in seminal plasma of patients orchiectomized for testicular tumors.

Materials and Methods: The study included 52 patients: 26 control men and 26 orchi­ectomized patients for testicular tumor, of which 12 men had seminoma tumor and 14 men non-seminoma tumor. After semen analysis performed according to the WHO guidelines, an aliquot of semen was centrifuged and the seminal plasma was collected. Lipid peroxidation was performed by thiobarbituric acid reactive substances(TBARS) assay and antioxidant profile was assessed by analyzing catalase, glutathione per­oxidase (GPx) and superoxide anion (SOD) activities using colorimetric assays with a standard spectrophotometer. Data were tested for normality and compared using one-way ANOVA (p<0.05).

Results: Seminoma and non-seminoma groups presented lower sperm concentration and morphology when compared to control group (p=0.0001). Both study groups (sem­inoma and non-seminoma) presented higher TBARS levels when compared to con­trol group (p=0.0000013). No differences were observed for SOD (p=0.646) andGPx (p=0.328). It was not possible to access the enzymatic activity of catalase in any group.

Conclusion: Patients with testicular tumor present increased semen oxidative stress, but no differences were observed in antioxidant levels, even after orchiectomy. This indicates that most likely an increased generation of oxidative products takes place in these patients.

Keywords: Antioxidants; Oxidative Stress; Testicular Germ Cell Tumor; Orchiectomy; Semen

[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

[Full Text]


Generation of potent cytotoxic T lymphocytes against in male patients with non-muscle invasive bladder cancer by dendritic cells loaded with dying T24 bladder cancer cells

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

doi: 10.1590/S1677-5538.IBJU.2016.0274


ORIGINAL ARTICLE

Eu Chang Hwang 1,2, Seung Il Jung 2, Hyun-Ju Lee 1, Je-Jung Lee 1,3,4,5, Dong Deuk Kwon 2
1 Research Center for Cancer Immunotherapy, Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo, Republic of Korea; 2 Department of Urology and 3 Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo, Republic of Korea; 4 Vaxcell-Bio Therapeutics, Hwasun, Jeollanamdo, Republic of Korea; 5 The Brain Korea 21 Project, Center forBiomedical Human Resources at Chonnam National University, Gwangju, Republic of Korea

ABSTRACT

Background: In order to induce a potent cytotoxic T lymphocyte (CTL) response in dendritic cell (DC)-based immunotherapy for bladder cancer, various tumor antigens can be loaded onto DCs.
Objective: The aim of this study was to establish a method of immunotherapy for male patients with non-muscle invasive bladder cancer (NMIBC), using bladder cancer-spe¬cific CTLs generated in vitro by DCs.
Materials and Methods: Monocyte-derived DCs from bladder cancer patients were in¬duced to mature in a standard cytokine cocktail (IL-1β, TNF-α, IL-6, and PGE2: standard DCs, sDCs) or anα-type 1-polarized DC (αDC1) cocktail (IL-1β, TNF-α, IFN-α, IFN-γ, and polyinosinic:polycytidylic acid) and loaded with the UVB-irradiated bladder cancer cell line, T24. Antigen-loaded αDC1s were evaluated by morphological and functional assays, and the bladder cancer-specific CTL response was analyzed by cytotoxic assay.
Results: The αDC1s significantly increased the expression of several molecules pertain¬ing to DC maturation, regardless of whether or not the αDC1s were loaded with tumor antigens, relative to sDCs. The αDC1s demonstrated increased production of interleukin-12 both during maturation and after subsequent stimulation with CD40L that was not significantly affected by loading with tumor antigens as compared to that of sDCs. Bladder cancer-specific CTLs targeting autologous bladder cancer cells were success¬fully induced by αDC1s loaded with dying T24 cells.
Conclusion: Autologous αDC1s loaded with an allogeneic bladder cancer cell line re¬sulted in increased bladder cancer-specific CTL responses as compared to that with sDCs, and therefore, may provide a novel source of DC-based vaccines that canbe used in immunotherapy for male patients with NMIBC.

Keywords: Dendritic Cells; Urinary Bladder Neoplasms; T-Lymphocytes, Cytotoxic

 

[Full Text]


Skin to calyx distance is not a predictive factor for miniaturized percutaneous nephrolithotomy outcomes

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

doi: 10.1590/S1677-5538.IBJU.2016.0291


ORIGINAL ARTICLE

Faruk Ozgor 1, Onur Kucuktopcu 1, Burak Ucpinar 1, Fatih Yanaral 1, Murat Binbay 1
1 Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey

ABSTRACT

Objective: To evaluate the predictive value of the distance from skin to calyx (SCD) on the outcome and complication rates of patients undergoing mPNL.

Materials and Methods: Patient’s charts, who had undergone mPNL between June 2012 and June 2015, were analyzed retrospectively. Patients who had a preoperative computerized tomography (CT) were enrolled into the study. Two separateurologists evaluated the CT scans and calculated the SCD defined as the distance between the skin and surface/lateral edge of the calyx, which was the preferred site of entry for percutaneous access. The average value of the two measurements was included inthe final analysis to avoid bias. The mean SCD was 75mm. According to the median SCD value, patients were divided into two groups: group 1 (SCD ≤75) and group 2 (SCD >75).

Results: A total of 140 patients and 130 patients were enrolled in groups 1 and 2, respectively.

The mean operation time and the mean fluoroscopy time was significantly longer in group 2 (p:0.004 vs. p:0.021). The rate of blood transfusion was significantly higher in group 1 (6 patients). None of patientsin group 2required blood transfusion (p:0.017). Stone-free status after a single session of mPNL was 67.1% in group 1 and 75.4% in group 2 (p:0.112). After additional procedures, stone-free rates increased to 84.3% and 85.4% in group 1 and group 2, respectively (p:0.802).

Conclusion: Our study demonstrated that longer SCD was not a predictive factor for stone-free rates after mPNL. However, SCD over 75mm was associated with longer operation time and fluoroscopy time with lower rates of transfusion.

Keywords: Obesity; Nephrostomy, Percutaneous; Kidney Calculi

[Full Text]


The effect of extended release tolterodine used for overactive bladder treatment on female sexual function

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

doi: 10.1590/S1677-5538.IBJU.2016.0303


ORIGINAL ARTICLE

Athanasios Zachariou 1, Maria Filiponi 2
1 Department of Urology, Elpis Hospital, Volos, Greece; 2 Laboratory of Endocrinology and Metabolic Disorders, Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece

ABSTRACT

Introduction: Overactive bladder (OAB) is a common condition, especially in middle aged women, requiring long term therapy with anticholinergics to maintain symptoms relief. The aim of the study was to determine the effect of tolterodine extended release (ER) used for OAB treatment on the sexual function of women.

Materials and Methods: Between August 2010 and August 2014, 220 women with confirmed OAB, attended Urogynecology Outpatient Clinic and were prospectively en­rolled in this study. 158 women were evaluated, with a comprehensive history, physical examination, urodynamic studies and Female Sexual Function Index (FSFI) question­naire. 73 patients of group A (control group) received no treatment and 85 patients of group B received an anticholinergic regimen – tolterodine ER 4mg once daily. Data were evaluated again in accordance with FSFI after three months, using SPSS software.

Results: A statistically significant increase was noted in group B in domains of desire (pre-treatment 2.5±0.2 to 4.5±0.2 post-treatment), arousal (3.1±0.2 to 3.1±0.2 respec­tively), lubrication (3.4±0.3 to 4.3±0.3 respectively), orgasm (3.5±0.3 to 4.5±0.3 re­spectively), satisfaction (2.6±0.2 to 4.2±0.3 respectively) and pain (2.4±0.2 to 4.6±0.4 respectively) after three months treatment with tolterodine ER. In group A there were no statistically significant changes in pre and post treatment values (p>0.05). Total FSFI score for group B was significantly higher after tolterodine treatment (26.5±1.5) compared to pre-treatment values (17.4±1.4, p<0.01) and to control group A (17.7±1.2 and 17.9±1.5, p>0,05) respectively.

Conclusions: This preliminary study demonstrates that treatment of OAB with toltero­dine ER was found to have positive effect on sexual function of patients with OAB.

Keywords: Urinary Bladder, Overactive; Tolterodine Tartrate; Female

[Full Text]


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]

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2016.0565


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Hyperbaric Oxygenation; Ureteral Obstruction; Apoptosis

[Full Text]


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.

[Full Text]


Vaginal evisceration related to genital prolapse in premenopausal woman

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

doi: 10.1590/S1677-5538.IBJU.2016.0249


CHALLENGING CLINICAL CASES

Lucas Schreiner 1, Thais Guimarães dos Santos 1, Christiana Campani Nygaard 2, Daniele Sparemberger Oliveira 2
1 Departamento de Obstetrícia e Ginecologia do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, RS, Brasil; 2 Serviço de Uroginecologia do Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, RS, Brasil

ABSTRACT

Background: Vaginal evisceration is a rare problem, usually related to a previous hys­terectomy. We report a case of spontaneous rupture of the cul-de-sac in a premeno­pausal woman under treatment with glucocorticoids to treat Systemic Lupus Erythe­matosus (SLE), with uterine prolapse that occurred during evacuation.

Case Report: A 40-year-old woman with SLE, using glucocorticoids, with uterine pro­lapse grade 4 (POP-Q), awaiting surgery presented at the emergency room with vaginal bleeding after Valsalva during defaction. Uterine prolapse associated with vaginal evis­ceration was identified. Under vaginal examination, we confirmed the bowel viability and performed a vaginal hysterectomy and sacrospinous fixation.

Case hypothesis: This case draws attention to the extreme risk of untreated uterine prolapse, as well as the importance of multidisciplinary care of patients with vaginal prolapse and chronic diseases.

Keywords:  Prolapse; Vagina; Lupus Erythematosus, Systemic

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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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Robotic Assisted Laparoscopic Augmentation Ileocystoplasty

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

doi: 10.1590/S1677-5538.IBJU.2016.0205


VIDEO SECTION

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

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

 

ABSTRACT

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

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

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

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

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

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Step-by-step Laparoscopic Vesiculectomy for Hemospermia

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

doi: 10.1590/S1677-5538.IBJU.2016.0127


VIDEO SECTION

Marcos Figueiredo Mello 1, Hiury Silva Andrade 1, Victor Srougi 1, Marco Antonio Arap 1, Anuar Ibrahim Mitre 1, Ricardo Jordão Duarte 1, Miguel Srougi 1

1 Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil

ABSTRACT

Hemospermia has been considered as a benign and self-limiting condition. It usually has an inflammatory or infectious cause. However, recurrent or persistent hemospermia may indicate a more serious underlying pathology, especially over 40 years of age.

Biopsy or surgical excision is indicated in cases of suspicious findings during investigation, such as cysts or masses. Open surgery has been considered the definitive form of treatment, however, it can be associated with significant morbidity. With growing experience in laparoscopics, this approach is becoming the preferable way to access the seminal vesicles.

Our objective is to demonstrate a step-by-step operative technique for laparoscopic unilateral vesiculectomy approach in a man with hemospermia.

Case: A 61 year-old man presented with 1 year of hemospermia. He was treated empirically with a fluoroquinolone plus a nonsteroidal anti-inflammatory without resolution of symptoms. Ultrasonography and MRI showed a solid-cystic mass in the right seminal vesicle. The patient was submitted to a laparoscopic unilateral vesiculectomy. Histopathological analysis showed intraluminal dilatation with blood content. During follow-up, complete resolution of symptoms was seen.

Results: Three patients composed our cohort. Mean age was 53 years-old (range 45-61 years), the right side was more commonly affected (two unilateral on the right and bilateral). Mean operative time was 55 minutes (range 40-120min). One patient presented amyloidosis in the histopathological analysis. All cases presented complete resolution of symptoms.

Conclusions: Laparoscopic vesiculectomy is a safe and feasible approach in cases of hemospermia. This technique showed good outcomes and minimal morbidity.

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

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

doi: 10.1590/S1677-5538.IBJU.2016.0179


ORIGINAL ARTICLE

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

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

ABSTRACT

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

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

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

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

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

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

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Effect of platelet-rich plasma on polypropylene meshes implanted in the rabbit vagina: histological analysis

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

doi: 10.1590/S1677-5538.IBJU.2016.0177


ORIGINAL ARTICLE

Natália Gomes Parizzi 1, Oscar Ávila Rubini 2, Silvio Henrique Maia de Almeida 1, Lais Caetano Ireno 1, Roger Mitio Tashiro 1, Victor Hugo Tolotto de Carvalho 1

1 Departamento de Cirurgia, Universidade Estadual de Londrina, Londrina, PR, Brasil; 2 Departamento de Cirurgia, Universidade do Oeste Paulista, Presidente Prudente, SP, Brasil

 

ABSTRACT

Purpose: The polypropylene mesh (PPM) is used in many surgical interventions because of its good incorporation and accessibility. However, potential mesh-related complications are common. Platelet-rich plasma (PRP) improves the healing of wounds and is inexpensive. Thus, the purpose of this study was to analyze the effect of the PRP-gel coating of a PPM on inflammation, production of collagen, and smooth muscle in the rabbit vagina.

Materials and Methods: The intervention consisted of a 1.5cm incision and divulsion of the vaginal mucosa for the implantation of a PRP-coated PPM. The PRP-coated mesh was implanted in 15 rabbits, and in the second group, the same implant was used without the PRP coating. In the sham group, the intervention consisted of the incision, divulsion, and suture. The rabbits were euthanized at 7, 30 and 90 days, and full-thickness sagittal sections of the posterior vaginal wall and rectum were scored.

The inflammatory infiltrate was evaluated using hematoxylin and eosin staining. The Sirius Red stain was used to examine deposition of collagen I and III, and Masson’s trichrome staining was used to visualize the smooth muscle.

Results: The group with PRP-coated meshes had a lower inflammatory infiltrate count at 30 days. Deposition of collagen III increased with the use of PRP-coating at 90 days.

Conclusions: The area of inflammatory infiltrate was significantly increased in the group without the PRP-coated mesh at 30 days but not in the group with the PRPcoated mesh, indicating a less intense inflammatory response. In addition, a significant increase in collagen III occurred at 90 days.

 

Keywords: Platelet-Rich Plasma; Collagen; Rabbits; Inflammation

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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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Novel penile circumcision suturing devices versus the shang ring for adult male circumcision: a prospective study

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

doi: 10.1590/S1677-5538.IBJU.2016.0204


ORIGINAL ARTICLE

Hu Han 1, Da-wei Xie 1, Xiao-guang Zhou 1, Xiao-dong Zhang 1

1 Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China

ABSTRACT

Introduction: To evaluate the safety and efficacy of a novel penile circumcision sutur­ing devices PCSD and Shang ring (SR) for circumcision in an adult population.

Materials and Methods: A total of 124 outpatients were randomly assigned to receive PCSD (n=62) or SR (n=62). Patient characteristics, operative time, blood loss, return to normal activities time (RNAT), visual analogue scale (VAS), scar width, wound healing time, cosmetic result, and complications were recorded.

Results: There were no significant differences in blood loss, RNAT, or complications between the two groups. There were no significant differences in the VAS scores at theduring operation, and 6 or 24 hours after surgery (P>0.05). The wound scar width was wider in the SR group than in the PCSD group (P<0.01). Patients in the SR group had significantly longer wound healing time compared with those in the PCSD group (P<0.01). Patients who underwent PCSD wereere significantly more satisfied with the cosmetic results (P<0.01).

Conclusions: SR and PCSD are safe and effective minimally invasive techniques for adult male circumcision. Compared with SRs, PCSDs have the advantages of faster postoperative incision healing and a good effect on wound cosmetics.

Keywords:  Circumcision, Male; Penis; Surgical Procedures, Operative

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Impact of local treatment on overall survival of patients with metastatic prostate cancer: systematic review and meta-analysis

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

doi: 10.1590/S1677-5538.IBJU.2016.0483


REVIEW ARTICLE

Arie Carneiro 1,2, Willy Baccaglini 2, Felipe P.A. Glina 3, Paulo P. Kayano 1, Victor M. Nunes 4, Oren Smaletz 5, Wanderley Marques Bernardo 4, Icaro Thiago de Carvalho 6, Gustavo Caserta Lemos 1

1 Departamento de Urologia, Hospital Israelita Albert Einstein, SP, Brasil; 2 Departamento de Urologia, Faculdade de Medicina do ABC, SP, Brasil; 3 Faculdade de Ciências Médicas, Universidade Metropolitana de Santos, SP, Brasil; 4 Centro Universitário Lusiada, Faculdade de Ciências Médicas de Santos, SP, Brasil; 5 Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, Brasil; 6 Departamento de Radioterapia, Hospital Israelita Albert Einstein, São Paulo, Brasil

 

ABSTRACT

Context: Currently, standard treatment of metastatic prostatic cancer (MPCa) is androgen-deprivation therapy (ADT). Recent studies suggested that local treatment of MPCa is related to increase of survival of those patients, as observed in other tumors.

Objective: To evaluate the impact of local treatment on overall survival and cancer specific survival in 3 and 5 years in patients with MPCa.

Materials and Methods: Systematic review and meta-analysis of population studies published at PubMed, Scielo, Lilacs, Cochrane and EMBASE databases until June 2016. Several large cohorts and Post-Roc studies were included, that evaluated patients with MPCa submitted to local treatment (LT) using radiotherapy (RDT), surgery (RP) or brachytherapy (BCT) or not submitted to local treatment (NLT).

Results: 34.338 patients were analyzed in six included papers, 31.653 submitted to NLT and 2.685 to LT. Overall survival in three years was significantly higher in patients submitted to LT versus NLT (64.2% vs. 44.5%; RD 0.19, 95% CI, 0.17-0.21; p<0.00001; I²=0%), as well as in five years (51.9% vs. 23.6%; RD 0.30, 95% CI, 0.11-0.49; p<0.00001; I²=97%). Sensitive analysis according to type of local treatment showed that surgery (78.2% and 45.0%; RD 0.31, 95% CI, 0.26-0.35; p<0.00001; I²=50%) and radiotherapy (60.4% and 44.5%; RD 0.17, 95% CI, 0.12-0.22; p<0.00001; I²=67%) presented better outcomes.

Conclusion: LT using RDT, RP or BCT seems to significantly improve overall survival and cancer-specific survival of patients with metastatic prostatic cancer. Prospective and randomized studies must be performed in order to confirm our results.

Keywords: Prostate; Survival; Radiation Oncology; Prostatic Neoplasms

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Robot-assisted laparoscopic radical prostatectomy with early retrograde release of the neurovascular bundle and endopelvic fascia sparing

Vol. 42 (x): 2016 May 4.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2015.0349


VIDEO SECTION

George Augusto Monteiro Lins de Albuquerque 1,2, Giuliano Betoni Guglielmetti 1,2, Maurício Dener Cordeiro 1,2, William Carlos Nahas 1,2, Rafael Ferreira Coelho 1,2

1 Instituto do Câncer de São Paulo, SP. Brasil; 2 Divisão de Urologia, Faculdade de Medicina, Universidade de São Paulo, SP, Brasil

ABSTRACT

Introduction: Robotic-assisted radical prostatectomy (RAP) is the dominant minimally invasive surgical treatment for patients with localized prostate cancer. The introduction of robotic assistance has the potential to improve surgical out­comes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. The purpose of this video is to demonstrate the early retrograde release of the neurovascular bundle without open the endopelvic fascia during RAP.

Materials and Methods: A 51-year old male, presenting histological diagnosis of prostate adenocarcinoma, Gleason 6 (3+3), in 4 cores of 12, with an initial PSA=3.41ng/dl and the digital rectal examination demonstrating a prostate with hardened nodule in the right lobe of the prostate base (clinical stage T2a). Surgical treatment with the robot-assisted technique was offered as initial therapeutic option and the critical technical point was the early retrograde release of the neurovascular bundle with endopelvic fascia preservation, during radical prostatectomy.

Results: The operative time was of 89 minutes, blood loss was 100ml. No drain was left in the peritoneal cavity. The patient was discharged within 24 hours. There were no intraoperative or immediate postoperative complications. The pathological evaluation revealed prostate adenocarcinoma, Gleason 6, with free surgical margins and seminal vesicles free of neoplastic involvement (pathologic stage T2a). At 3-month-follow-up, the patient lies with undetectable PSA, continent and potent.

Conclusion: This is a feasible technique combining the benefits of retrograde release of the neurovascular bundle, the preservation of the pubo-prostatic collar and the preservation of the antero-lateral cavernous nerves.

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Feasibility of Robot – assisted Segmental Ureterectomy and Ureteroureterostomy in Patient with High Medical Comorbidity

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

doi: 10.1590/S1677-5538.IBJU.2016.0026


VIDEO SECTION

Ali Abdel Raheem 1, Atalla Alatawi 2, Dae Keun Kim 3, Abulhasan Sheikh 2, Koon Ho Rha 2

1 Department of Urology, Tanta University Medical School, Egypt; 2 Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea; 3 Department of Urology, CHA Seoul Station Medical Center, CHA University Medical School, Seoul, Republic of Korea

 

ABSTRACT

Introduction and objectives: Nephroureterectomy remains the gold standard treatment option for upper tract tumors.

However, segmental ureterectomy may be another option in patients with single kidney, borderline renal function or high medical comorbidities. The aim of this video is to assess the feasibility of robotic surgery as a minimally invasive technique in treatment of a high comorbid patient with ureteric tumor.

Materials and Methods: Eighty-year old male patient, with a medical history of chronic hypertensive and uncontrolled Diabetes Mellitus, was referred to our department for treatment of ureteric tumor. Patient underwent robot-assisted radical prostatectomy 5 years ago. Patient’s Charlson comorbidity index score was 9. Computed tomography showed a 2.5cm right ureteral luminal filling enhancing lesion at lower part of upper 1/3 ureter. We performed diagnostic flexible cystoscopy under local anesthesia to exclude associated lower urinary tract carcinoma, and bladder wash was negative for malignancy. Under general anesthesia patient underwent diagnostic flexible ureteroscopy to confirm mass location, and a retrograde pyelography to rule out additional tumors on the right collecting system. Then, the patient was placed in the full lateral flank position without Table flexion. Ports placement were inserted as follow: a “12mm” optical trocar at pararectal line superior and lateral to umbilicus, two “8mm” robotic trocars cranial and caudal to optical trocar (8cm distance), a “8mm” robotic trocar towards anterior superior ischial spine, and a “12mm” assistant trocar was inserted between umbilicus and pubic bone. The surgical steps are shown in the video.

Results: The procedure was performed easily. The total operative time and consol time were 100 and 60 minutes, respectively. Blood loss was 50ml. No reported intraoperative or postoperative complications. Notably, we took full precautions in case of intraoperative failure to complete the procedure successfully, nephroureterectomy was our second option.

Postoperative serum creatinine was 1.2mg/dL and length of hospital stay was 2 days. The frozen biopsy showed that the tumor was resected with safe proximal and distal surgical margins. Final histopathology revealed high grade (G3) urothelial carcinoma (pT3), measures (1.3×1.2×0.2cm), associated with carcinoma in situ.

Conclusion: We affirm that robotic segmental ureterectomy and ureteroureterostomy could be offered safely as a minimally invasive treatment for patients with ureteric tumors and high-risk medical comorbidities. It provides excelente perioperative outcomes and early oncological safety with regard to surgical margins.

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