Volume 44 | number 5 | Set . Out, 2018 -The September-October 2018 issue of the International Braz J Urol presents original contributions with a lot of interesting papers in different fields: R…
Partial nephrectomy: three dimensional (3D) models from preoperative computed tomography is the future to identify the exact loction of the tumor
Vol. 44 (5): 857-858, September – October, 2018
Luciano A. Favorito 1, 2, 3
1 Professor Titular, Unidade Urogenital da Univ. Est. do Rio de Janeiro – UERJ, RJ, Brasil; 2 Urologista do Hospital da Lagoa Federal, Rio de Janeiro , RJ, Brasil; 3 Editor Associado do International Braz J Urol
The September-October 2018 issue of the International Braz J Urol presents original contributions with a lot of interesting papers in different fields: Renal stones, Prostate Cancer, Renal Cell Carcinoma, Laparoscopy, Vaginal Prolapse, BPH, Varicocele, Testicular Torsion, Renal Cystis, Basic Research, HPV, Bladder Cancer, Bladder augmentation and Overactive bladder. The papers come from many different countries such as Brazil, USA, China, Turkey, Korea, Spain, Mexico, Iran and Israel, and as usual the editor ́s comment highlights some papers. We decided to comment the paper about a very interesting topic: Clinical applications of personalized 3D kidney model.
Vol. 44 (5): 859-861, September – October, 2018
DIFFERENCE OF OPINION
Brunno Raphael Iamashita Voris 1, Carolina Del Negro Visintin 2, Leonardo O. Reis 1, 3, 4
1 Departamento de Urologia, Universidade Estadual de Campinas, Unicamp, Campinas, SP, Brasil; 2 Departamento de Ginecologia, Pontifícia Universidade Católica de Campinas, PUC -Campinas, SP, Brasil; 3 UroScience, Campinas, SP, Brasil; 4 Departamento de Urologia, Pontifícia Universidade Católica de Campinas, PUC – Campinas, SP, Brasil
Keywords: Human papillomavirus 31; Penile Neoplasms; Vaccination, Male
Penile cancer is a rare tumor in developed countries; since its diagnosis is made usually in a late stage, it presents high morbidity and mortality. It is more prevalent in developing countries in Asia, Africa and South America, particularly in non-circumcised males (1). More common histology type is penile squamous cell carcinoma – PSCC (95%) related to the infection by the Human Papillomavirus (HPV) (2). HPV-DNA is found in more than 20% of patients with penile tumor and in 90% of anal cancers (3). The number of new patients with PSCC is increasing worldwide, including developed European countries (Denmark, Netherlands, England), and has been worried many health care professionals around the World (4).
Vol. 44 (5): 862-864, September – October, 2018
DIFFERENCE OF OPINION
Paulo Ornellas 1, Antonio Augusto Ornellas 2, 3
1 Departamento de Patologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; 2 Departamento de Urologia, Instituto Nacional do Câncer (INCA), Rio de Janeiro, RJ, Brasil; 3 Instituto de Pós-Graduação Médica Carlos Chagas, Rio de Janeiro, RJ, Brasil
Keywords: Human papillomavirus; Penile Neoplasms; Vaccination, Male
Human papillomavirus (HPV) is a DNA virus that presents tropism for epithelial cells, causing infections of the skin and mucous membranes. It is transmitted by direct contact of a healthy skin or mucosa with an affected skin or mucosa. Until now, more than 200 types of HPVs have been discovered (1). Approximately 30 types infect the anal and genital mucosa. Types that can also be detected in the oral mucosa are classified according to risk of causing lesions or their potential for malignancy. Such as “low risk” are included types 6 and 11 (more incidents) and as “high risk” the types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 66 (2). Human papillomavirus (HPV), a sexually transmitted infection, is responsible for 99.7% of cases of cervical cancer (3) and 530,000 new cases of cervical cancer globally every year (4). In addition, HPV is also responsible for some head and neck cancers, penile cancers and the majority of anal cancers (5). The incidence of these cancers is on the rise. Globally, HPV types 16 and 18 are responsible for 38,000 (85%) new cases of head and neck cancers and 35,000 (87%) cases of anal cancers (4).
Vol. 44 (5): 865-873, September – October, 2018
Jiamin Wang 1, Shankun Zhao 1, Lianmin Luo 1, Ermao Li 1, Xiaohang Li 1, ZhiGang Zhao 1
1 Department of Urology & Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of GuangZhou Medical University, Guangzhou, Guangdong, China
Objective: To assess the relationship between 5α-reductase inhibitors (5ARIs) and the risk of male breast cancer (MBC).
Material and Methods: We systematically searched Medline via PubMed, Embase and the Cochrane Library Central Register up to May 2017 to identify published articles related to 5ARIs and the risk of MBC.
Results: Summary effect estimates were calculated by a random-effect model, and tests for multivariable-unadjusted pooled risk ratios (RR) and heterogeneity, as well as the sensitivity analyses were conducted to assess publication bias. All four studies were conducted in a quality assessment according to the Newcastle Ottawa Scale system. The strength of association between 5ARIs and the prevalence of MBC was evaluated by using summarized unadjusted pooled RR with a 95% confidence interval [CI]. Four studies involving 595.776 participants, mean age range from 60 to 73.2 years old, were included in a meta-analysis, which produced a summary unadjusted RR of the risk of MBC for the treatment of 5ARIs of 1.16 (95% CI 0.85-1.58, P=0.36) and the multivariable-adjusted RR is 1.03, (95% CI 0.75-1.41, p=0.86). There was no heterogeneity among included studies (I2=0%, P=0.49). Estimates of total effects were generally consistent with the sensitivity.
Conclusion: We did not observe a positive association between the use of 5ARIs and MBC. The small number of breast cancer cases exposed to 5ARIs and the lack of na association in our study suggest that the development of breast cancer should not influence the prescribing of 5ARIs therapy.
Keywords: 5-alpha Reductase Inhibitors; Breast Neoplasms, Male; Meta-Analysis as Topic
Incidence and treatment of malignant tumors of the genitourinary tract in renal transplant recipients
Vol. 44 (5): 874-881, September – October, 2018
Juan Manuel Ochoa-Lopez 1, Bernardo Gabilondo-Pliego 1, Sylvain Collura-Merlier 1, Jaime O. Herrera-Caceres 1, Mariano Sotomayor de Zavaleta 1, Francisco Tomas Rodriguez-Covarrubias 1, Guillermo Feria-Bernal 1, Fernando Gabilondo-Navarro 1, Ricardo Alonso Castillejos-Molina 1
1 Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México
Purpose: To provide data of the incidence and management of common urological malignancies in renal transplant recipients.
Materials and Methods: We conducted a retrospective analysis of a prospective database from August 1967 to August 2015. A descriptive analysis of the sample was performed.
Results: Among 1256 consecutive RTR a total of 88 patients developed malignancies (7%). There were 18 genitourinary tumors in the 16 patients (20.45 % of all malignant neoplasms), incidence of 1.27%. The most common neoplasm encounter was renal cancer (38.8%), followed by urothelial carcinoma (33.3%). Median follow-up of transplantation was 197 months (R, 36-336). Mean time from RT to cancer diagnosis 89±70 months (R, 12-276). CsA and AZA was the most common immunosuppression regimen in 68.75%. Mean follow-up after diagnosis was 103±72 months (R 10-215). Recurrence free survival rate of 100%. Overall survival of 89.5% of the sample; there were two non-related cancer deaths during follow-up. Conclusions: The incidence of neoplasms in RTR was lower than in other series, with favorable functional and oncologic results after treatment. This suggests that actions to reduce the risk of these malignancies as well as a strict follow-up are mandatory for an early detection and treatment.
Keywords: Neoplasms; Urinary Tract; Kidney Transplantation
Objective value on ADC map to categorize the intensity of DWI restriction for prostate cancer detection on MRI
Vol. 44 (5): 882-891, September – October, 2018
Thais Caldara Mussi 1, Tatiana Martins 1, 2, Adriano Tachibana 1, Pedro Nogueira Mousessian 1, Ronaldo Hueb Baroni 1
1 Hospital Israelita Albert Einstein, São Paulo, SP, Brasil and 2 Ecoar Medicina Diagnostica, Belo Horizonte, MG, Brasil
Purpose: To identify objective and subjective criteria on multiparametric prostate MRI that can be helpful for prostate cancer detection.
Materials and Methods: Retrospective study, IRB approved, including 122 patients who had suspicious lesion on MRI and who underwent prostate biopsy with ultrasonography (US)/MRI imaging fusion. There were 60 patients with positive biopsies and 62 with negative biopsies. MRI of these patients were randomized and evaluated independently by two blinded radiologists. The following variables were analyzed in each lesion: morphology, contours, T2 signal, diffusion restriction (subjective impression and objective values), hyper-enhancement, contact with transition zone or prostatic contour, prostatic contour retraction, Likert and PIRADS classification.
Results: Apparent diffusion coefficient (ADC) value was the best predictor of positivity for prostate cancer, with mean value of 1.08 (SD 0.20) and 1.09 mm2/sec (SD 0.24) on negative biopsies and 0.81 (SD 0.22) and 0.84 mm2/sec (SD 0.22) on positive biopsies for readers 1 and 2, respectively (p < 0.001 in both analysis). For the others categorical variables evaluated the best AUC for reader 1 was subjective intensity of diffusion restriction (AUC of 0.74) and for reader 2 was hyper-enhancement (AUC of 0.65), all inferior comparing to the value of ADC map. Interobserver agreement ranged from 0.13 to 0.75, poor in most measurements, and good or excellent (kappa > 0.6) only in lesion size and ADC values.
Conclusions: Diffusion restriction with lower ADC-values is the best parameter to predict cancer on MRI prior to biopsy. Efforts to establish an ADC cutoff value would improve cancer detection, especially for less experience reader.
Keywords: Magnetic Resonance Imaging; Prostatic Neoplasms; Prostate
Impact of 68GA-PSMA PET / CT on treatment of patients with recurrent / metastatic high risk prostate cancer – a multicenter study
Vol. 44 (5): 892-899, September – October, 2018
Aline B. Mattiolli 1, Allan Santos1,2,3, Andreia Vicente 3, Marcelo Queiroz 3, Diogo Bastos 3, Daniel Herchenhorn 4, Miguel Srougi 3, Fabio A. Peixoto 5, Lisa Morikawa 4, 5, João Luiz Fernandes da Silva 3, Elba Etchebehere 1, 2, 3
1 Universidade Estadual de Campinas (UNICAMP), Campinas, Brasil; 2 Medicina Nuclear de Campinas, Campinas, SP, Brasil; 3 Hospital Sírio – Libanês, São Paulo, SP, Brasil; 4 Centro de Oncologia de D’Or, Rio de Janeiro, RJ, Brasil; 5 Grupo Américas Centro de Oncologia Integrado, Rio de Janeiro, RJ, Brasil
Purpose: The purpose of our study was to evaluate the clinical impact of 68Ga-PSMA PET / CT in the setting of biochemical recurrence of prostate cancer.
Materials and Methods: We retrospectively evaluated 125 prostate cancer patients submitted to the 68Ga-PSMA PET / CT due to biochemical recurrence. The parameters age, Gleason score, PSA levels, and the highest SUVmax were correlated to potential treatment changes. The highest SUVmax values were correlated with age and Gleason score. The median follow-up time was 24 months.
Results: 68Ga-PSMA PET / CT led to a treatment change in 66 / 104 (63.4%) patients (twenty-one patients were lost to follow-up). There was a significant change of treatment plan in patients with a higher Gleason score (P = 0.0233), higher SUVmax (p = 0.0306) and higher PSA levels (P < 0.0001; median PSA = 2.55 ng / mL).
Conclusion: 68Ga-PSMA PET / CT in prostate cancer patients with biochemical recurrence has a high impact in patient management.
Keywords: Prostatic Neoplasms; Tomography, X-Ray Computed; Positron-Emission Tomography
Vol. 44 (5): 900-905, September – October, 2018
Shay Golan 1, Meital Nidam 2, Hanna Bernstine 2, Jack Baniel 1, David Groshar 2
1 Institute of Urology, and 2 Department of Nuclear Medicine, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Israel
Objectives: To test the ability of dynamic 11C-PET / CT to discriminate cancerous tissue from background tissue in patients with localized prostate cancer.
Materials and Methods: Twenty-four consecutive patients with prostate cancer were prospectively evaluated with dynamic 11C-choline PET / CT prior to radical prostatectomy.
The PET / CT scan was divided into 18 sequences of 5 seconds each, followed by 9 sequences of 60 seconds each. Whole-mount sections of harvested prostates served as reference standards. Volumes of interest were positioned on the dynamic PET / CT images and the following quantitative variables were calculated: perfusion coefficient (K1), washout constant (K2), area under the curve (AUC) at 175 and 630 seconds, and average and maximum standardized uptake values (SUVavg, and SUVmax). Wilcoxon signed-ranks test was used to compare benign and cancerous areas of the prostate.
Results: Areas of cancerous tissue were characterized by higher SUVavg and SUVmax than areas of benign tissue (3.67 ± 2.7 vs. 2.08 ± 1.3 and 5.91 ± 4.4 vs. 3.71 ± 3.7, respectively, P < 0.001), in addition to a higher K1 (0.95 ± 0.58 vs. 0.43 ± 0.24, P < 0.001) and greater cumulative tracer uptake, represented by the AUC at 175 and 630 seconds (P <0.001). No associations were found between dynamic parameters and preoperative prostate specific antigen level or Gleason score.
Conclusions: In this pilot study, 11C-choline PET / CT demonstrated increased tracer uptake with higher values of static and dynamic parameters in areas of prostate cancer compared to areas of benign tissue. Larger studies are warranted to validate these results and examine the potential applicability of 11C-choline dynamic PET / CT for the diagnosis of prostate cancer.
Keywords: Positron-Emission Tomography; Tomography, X-Ray Computed; Prostatic Neoplasms
Analysis of the association between bladder carcinoma and arsenic concentration in soil and water in southeast Brazil
Vol. 44 (5): 906-913, September – October, 2018
Jonathan Doyun Cha 1, Danilo Budib Lourenço 2, Fernando Korkes 1, 2
1 Departamento de Urologia, Faculdade de Medicina do ABC, SP, Brasil; 2 Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
In approximately 50% of cases of bladder carcinoma, an associated predisposing factor can be established. The main factors are exposure to tobacco, arsenic (As) ore and aromatic compounds. Arsenic is a metalloid with a low average concentration in the earth’s crust, and one of the most dangerous substances for human health. The present study aims to evaluate the incidence of hospitalization and mortality from bladder neoplasia and its possible association with As concentration in water and soil in two of the most critical regions of Brazil: the states of São Paulo and Minas Gerais.
We have investigated bladder cancer hospitalization and mortality in the states of São Paulo and Minas Gerais during 2010-2014. Water and soil samples were analyzed and As concentrations were established. Data were obtained through the Department of Informatics of the Brazilian Unified Health System. Correlation was made with water samples from São Paulo and with data on soil analysis from Minas Gerais.
The results revealed no direct association in the distinctive municipalities. Areas with high environmental As concentration had a low bladder cancer rate, while areas with normal as levels had similar cancer rates. The quantitative variables did not present a normal distribution (p < 0.05).
In conclusion, we did not observe a correlation between as concentration in water or soil and bladder cancer’s hospitalization and mortality rates in the states of São Paulo and Minas Gerais.
Keywords: Arsenic; Urinary Bladder; Neoplasms
Vol. 44 (5): 914-919, September – October, 2018
Aloysio Floriano de Toledo 1, Carlos Eduardo Bastian da Cunha 1, Christian Heinz Steppe 1, Daniel Weissbluth de Toledo 1, Jorge Antonio Pastro Noronha 1, Gustavo Carvalhal 1
1 Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul – PUC, Porto Alegre, RS, Brasil
Introduction: We report on the surgical results of a series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers.
Materials and Methods: We report on a retrospective case series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers. Different techniques of gastric neobladders were employed from 1988 to 2013 at a university hospital in the South of Brazil.
Results: Initial outcomes utilizing Leong (Antral) and Nguyen-Mitchell (Wedge) technique were unsatisfactory, yielding high pressure, low capacity reservoirs. Further developments of these techniques, with the detubularized gastric neobladder and the “spherical” gastric neobladders resulted in low pressure, high capacity reservoirs, with better surgical and urodynamic outcomes. Complication and perioperative mortality rates of our series of gastric neobladders were significantly higher than historical results of techniques using ileum or colon.
Conclusions: Stomach is an exceptional option for the creation of neobladders after radical cystectomies, but due to the increased complication rates it should be reserved for specific situations (e.g., renal insufficiency, previous pelvic/abdominal radiotherapy, short bowel syndromes).
Keywords: Surgical Procedures, Operative; Urinary Diversion; Cystectomy
Vol. 44 (5): 920-921, September – October, 2018
1 Richard Hautmann
1 Department of Urology, University of Ulm, Germany
Localized chromophobe renal cell carcinoma: preoperative imaging judgment and laparoscopic simple enucleation for treatment
Vol. 44 (5): 922-932, September – October, 2018
Wenbiao Ren 1, Bichen Xue 1, Jiandong Qu 1, Longfei Liu 1, Chao Li 1, Xiongbing Zu 1
1 Department of Urology, Xiangya Hospital, Central South University, Changsha, China
Objective: To evaluate the preoperative imaging manifestation and therapeutic effect of laparoscopic simple enucleation (SE) for localized chromophobe renal cell carcinoma (chRCC).
Materials and Methods: Clinical data of 36 patients who underwent laparoscopic SE of localized chRCC at our institute were retrospectively analyzed. All patients underwent preoperative renal protocol CT (unenhanced, arterial, venous, and delayed images). CT scan characteristics were evaluated. After intraoperative occlusion of the renal artery, the tumor was free bluntly along the pseudocapsule and enucleated totally. The patients were followed up regularly after the operation.
Results: Mean tumor diameter was 3.9±1.0 cm, 80% of tumors were homogeneous and all the tumors had complete pseudocapsule. The attenuation values were slightly lower than normal renal cortex and degree of enhancement of the tumors were significantly lower than normal renal cortex. Mean operation time was 104.3±18.2 min. Mean warm ischemia time (WIT) was 21.3±3.5 min. Mean blood loss was 78.6±25.4 mL. No positive surgical margin was identified. Mean postoperative hospital stay was 5.3±1.5 d. Hematuria occurred in 3 patients and all disappeared within 3 days. After a mean follow-up of 32.1±20.6 months, no patient had local recurrence or metastatic progression.
Conclusion: Localized chRCCs have a great propensity for homogeneity and complete pseudocapsule. The attenuation values were slightly lower than normal renal cortex and small degree of enhancement. Laparoscopic SE is a safe and effective treatment for localized chRCC. The oncological results were satisfactory.
Keywords: Carcinoma, Renal Cell; Laparoscopy; Therapeutics
Prognostic role of preoperative albumin to globulin ratio in predicting survival of clear cell renal cell carcinoma
Vol. 44 (5): 933-946, September – October, 2018
Murat Yavuz Koparal 1, Fazlı Polat 2, Serhat Çetin 3, Ender Cem Bulut 4, Tevfik Sinan Sözen 2
1 Department of Urology, Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey; 2 Department of Urology, School of Medicine, Gazi University, Ankara, Turkey; 3 Urology Clinic, Viranşehir State Hospital, Şanliurfa, Turkey; 4 Department of Urology, Van Training and Research Hospital, Van, Turkey
Purpose: To investigate the prognostic role of preoperative albumin/globulin ratio (AGR) in predicting disease-free survival (DFS) and overall survival (OS) in localized and locally advanced clear cell renal cell carcinoma (RCC) patients.
Patients and Methods: 162 patients who met the criteria specified were included in the study. The DFS and OS ratios were determined using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the prognostic factors affecting DFS and OS.
Results: Median follow-up period was 27.5 (6-89) months. There was a statistically significant relationship between low AGR and high pathological tumor (pT) stage, presence of collecting system invasion, presence of tumor necrosis, and a high platelet count (p = 0.012, p = 0.01, p = 0.001, and p = 0.004, respectively). According to the Kaplan-Meier survival analysis, both OS and DFS were found to be significantly lower in the low AGR group (p = 0.006 and p = 0.012). In the multivariate Cox regression analysis, collecting system invasion and tumor necrosis were found to be independent prognostic factors in predicting OS and pT stage was found to be an independent prognostic factor in predicting DFS (HR: 4.08, p = 0.043; HR: 8.64, p = 0.003 and HR: 7.78, p = 0.041, respectively).
Conclusion: In our study, low AGR was found to be associated with increased mortality and disease recurrence in localized and locally advanced RCC.
Keywords: Albumins; Globulins; Carcinoma, Renal Cell
Vol. 44 (5): 947-951, September – October, 2018
Kyrollis Attalla 1, Shubha De 1, Carl Sarkissian 1, Manoj Monga 1
1 Glickman Urologic & Kidney Institute, Cleveland Clinic, OH, USA
Objectives: To investigate the seasonal variations in urinary calcium, serum vitamin D, and urinary volume in patients with a history of nephrolithiasis.
Materials and Methods: Patients included were those who completed a 24-hour urine metabolic evaluation on two occasions; one in summer (June-Aug) and one in winter (Nov-Jan), and who had not started any medications or been instructed on dietary modifications in the interval between the two tests that may have impacted the results. Patients were excluded if they were on thiazide diuretics or were taking calcium and / or Vitamin D supplementation. Welch’s t-test was used to compare the difference in average summer and winter values. Unpaired Student t-test was used to compare baseline parameters (age, BMI), and Paired Student t-test was used to compare average seasonal measurements in men vs. women.
Results: 136 patients were identified who were not taking calcium or vitamin D supplements or thiazide diuretics, and who were not instructed on dietary modifications in the interval between the two measured parameters. No significant differences were observed when comparing male to female baseline parameters of age or BMI (Table-1). Average 24-hour urine calcium was higher (226.60) in the winter than in summer (194.18) and was significant in males (p = 0.014) and females (p < 0.001). No significant seasonal difference was seen in 24-hour urine volume or serum vitamin D levels.
Conclusions: Urinary calcium is higher in winter months compared to summer months. As such, tailoring medical preventative strategies to the time of year may be helpful.
Keywords: Kidney; Calculi; Urinary Tract
Personalized 3D kidney model produced by rapid prototyping method and its usefulness in clinical applications
Vol. 44 (5): 952-957, September – October, 2018
Hakmin Lee 1, Ngoc Ha Nguyen 2, Sung Il Hwang 3, Hak Jong Lee 3, Sung Kyu Hong 1, Seok-Soo Byun 1
1 Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea; 2 Department of Urology, Cho Ray hospital, Ho Chi Minh city, Vietnam; 3 Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
Background: Three-dimensional (3D) printing has been introduced as a novel technique to produce 3D objects. We tried to evaluate the clinical usefulness of 3D-printed renal model in performing partial nephrectomy (PN) and also in the education of medical students.
Materials and Methods: We prospectively produced personalized renal models using 3D-printing methods from preoperative computed tomography (CT) images in a total of 10 patients. Two different groups (urologist and student group) appraised the clinical usefulness of 3D-renal models by answering questionnaires.
Results: After application of 3D renal models, the urologist group gave highly positive responses in asking clinical usefulness of 3D-model among PN (understanding personal anatomy: 8.9 / 10, preoperative surgical planning: 8.2 / 10, intraoperative tumor localization: 8.4 / 10, plan for further utilization in future: 8.3 / 10, clinical usefulness in complete endophytic mass: 9.5 / 10). The student group located each renal tumor correctly in 47.3% when they solely interpreted the CT images. After the introduction of 3D-models, the rate of correct answers was significantly elevated to 70.0% (p < 0.001). The subjective difficulty level in localizing renal tumor was also significantly low (52% versus 27%, p < 0.001) when they utilized 3D-models.
Conclusion: The personalized 3D renal model was revealed to significantly enhance the understanding of correct renal anatomy in patients with renal tumors in both urologist and student groups. These models can be useful for establishing the perioperative planning and also education program for medical students.
Keywords: Printing, Three-Dimensional; Kidney Neoplasms; Nephrectomy
Simultaneous treatment of parapelvic renal cysts and stones by flexible ureterorenoscopy with a novel four-step cyst localization strategy
Vol. 44 (5): 958-964, September – October, 2018
Ning Kang 1, Xing Guan 1, Liming Song 1, Xiaodong Zhang 1, Junhui Zhang 1
1 Department of Urology, Institute of Urology, Capital Medical University, University Beijing Chaoyang Hospital
Objective: To assess the safety, feasibility, and efficacy of simultaneous treatment of parapelvic renal cysts and stones by flexible ureterorenoscopy with a novel four-step cyst localization strategy in selected patients.
Patients and Methods: We retrospectively reviewed 11 consecutive cases of parapelvic renal cysts with concomitant calculi treated by flexible ureterorenoscopy and laser lithotripsy (FURSL). Marsupialization was performed subsequently with holmium: YAG laser in our institution. Fragmentation was used to manage renal stones and a novel four-step cyst localization strategy was applied in each case for marsupialization.
Results: There were no intraoperative complications. Two cases of cystitis were reported postoperatively. The mean operative times of FURSL and marsupialization were 23.6 ± 3.9 minutes and 29.1 ± 9.7 minutes, respectively. During marsupialization, seven patients underwent the first two steps of the new strategy, two patients underwent three steps and two patients underwent all four steps. The mean reduction in hemoglobin level was 4.7 ± 1.7 g / L (range 3-8 g / L). The mean length of hospital stay was 1.2 ± 0.4 days. During a mean follow-up duration of 18 months, all cases remained stonefree and there was no stone recurrence. Parapelvic cysts became undetectable in eight cases and decreased in size by at least half in three cases.
Conclusion: With appropriate patient selection, FURSL and marsupialization with a four-step cyst localization strategy is feasible, safe, and effective in treating parapelvic renal cysts with concomitant calculi.
Keywords: Calculi; Lithotripsy; Renal Colic
Vol. 44 (5): 965-971, September – October, 2018
Fabio Carvalho Vicentini 1, Rodrigo Perrella 1, Vinicius M. G. Souza 1, Marcelo Hisano 1, Claudio Bovolenta Murta 1, Joaquim Francisco de Almeida Claro 1
1 Departamento de Urologia, Setor de Endourologia e Litíase, Hospital Brigadeiro, São Paulo, SP, Brasil
Purpose: To evaluate the impact of the patient position on the outcomes of PCNL among patients with complex renal stones.
Material and Methods: From July 2011 to July 2014, we collected prospective data of consecutive patients who underwent PCNL. We included all patients with complex stones (Guy’s Stone Score 3 or 4 (GSS) based on a CT scan) and divided them based on the position used during PCNL (prone or supine). The variables analyzed were gender, age, body mass index, ASA score, stone diameter, GSS, number of punctures, calyx puncture site, intercostal access and patient positioning. Complications were graded according to the modified-Clavien Classification. Success was considered if fragments ≤ 4mm were observed on the first postoperative day CT scan.
Results: We analyzed 240 (46.4%) of 517 PCNL performed during the study period that were classified as GGS 3-4. Regarding patient positions, 21.2% were prone and 79.8% were supine. Both groups were comparable, although intercostal access was more common in prone cases (25.5% vs 10.5%; p=0.01). The success rates, complications, blood transfusions and surgical times were similar for both groups; however, there were significantly more visceral injuries (10.3% vs 2.6%; p=0.046) and sepsis (7.8% vs 2.1%; p=0.042) in prone cases.
Conclusion: Supine or prone position were equally suitable for PCNL with complex stones and did not impact the success rates. However, supine position was associated with fewer sepsis cases and visceral injuries.
Keywords: Kidney Calculi; Nephrolithotomy, Percutaneous; Supine Position; Prone Position
Vol. 44 (5): 972-980, September – October, 2018
Ahmet Salvarci 1, Mehmet Karabakan 2, Aliseydi Bozkurt 3, Erkan Hirik 3, Binhan Kagan Aktaş 4
1 Department of Urology, Novafertile IVF Centers and Konya Hospital, Konya, Turkey; 2 Department of Urology, Mersin Toros State Hospital, Mersin, Turkey; 3 Department of Urology, Erzincan University, Mengücek Gazi Research and Training Hospital, Erzincan, Turkey; 4 Department of Urology, Ankara Numune Research and Training Hospital, Ankara, Turkey
Purpose: To evaluate the impact of overactive bladder disorder on patients diagnosed with retrograde ejaculation.
Materials and Methods: Retrospective analysis of prospective collected database made.
Questionnaires conducted in urology polyclinics in five different centers. Main Outcome Measure(s): International Index of Erectile Function – 5 (IIEF – 5), Overactive Bladder 8 – Question Awareness Tool (OAB – V8), urodynamics, semen analysis. The participants of the study were n = 120 patients. There was retrograde ejaculation (RE) in only n = 47 patients (non / minimal symptomatic patients), n = 73 patients had RE and overactive (OAB) complaints (symptomatic patients) and received anticholinergic treatment (trospium), n = 37 control group patients who only had OAB and received an anticholinergic.
Results: While no difference was observed in overactive bladder examination and urodynamic values between the non / minimal symptomatic group and the symptomatic group (p > 0.05), sperm was detected and identified as fructose positive in post – ejaculation urine in the symptomatic group. Thus, it was possible to demonstrate the differences between symptomatic patients and non – symptomatic patients. Consequently, following three – month daily treatment with trospium 30 mg 2 x 1 in the control group and the symptomatic group, it was observed that an evident increase was observed in the sperm count and ejaculate volume in the symptomatic group and that no change was observed in the control group (p < 0.05).
Conclusion: This clinical study is the first of its kind in terms of revealing the coexistence of RE with OAB upon performing urodynamics and showing that treatment is possible in selected patients.
Keywords: Urinary Bladder, Overactive; Ejaculation; Urodynamics
Does total testicular volume predict testicular volume difference in adolescent males with varicocele?
Vol. 44 (5): 981-986, September – October, 2018
Ari P. Bernstein 1, Ethan B. Fram 1, 2, Amanda North 1, 2, Anthony Casale 1, 2, Beth A. Drzewiecki 1, 2
1 Albert Einstein College of Medicine, NY, USA and 2 Montefiore Medical Center, NY, USA
Introduction: We evaluated the relationship between total testicular volume (TTV) and testicular volume differential (TVD) in adolescent males with varicocele. Both low TTV and high TVD have been independently associated with higher incidences of infertility later in life, but a predictive relationship between TTV and TVD directly has yet to be described.
Materials and Methods: We retrospectively analyzed a database of Tanner 5 boys ages 16-21 who presented with varicocele at a single institution between 2009 and 2017. All patients had a scrotal sonogram prior to surgical intervention. TTV and TVD were calculated for each individual and four non-exclusive groupings of patients were cre¬ated for statistical analysis. We chose 30 cc as a cut off value for low TTV based on prior studies.
Results: 209 patients met our inclusion criteria. Mean age was 18.3 years (16-21, SD 1.7) with a mean total testicular volume of 36 cc (13.5-78.2, SD 11.1). Cut off points of TVD of 20% and TTV of 30 cc were used to separate patients. There were 65 boys (31%) with TTV < 30 cc and 58 boys (28%) with TVD ≥ 20%. Among males with TTV < 30 cc, 23 (35%) had a TVD ≥ 20%. Among males with TTV ≥ 30 cc, 35 (24%) had a TVD ≥ 20%. The relationship between TVD and TTV was found to be non-significant (p > 0.05).
Discussion: Adolescent varicoceles continue to pose a challenge to pediatric urologists. The dilemma of over-aggressive treatment has proven difficult to balance with the risk of infertility. We hoped that elucidating the relationship between TTV and TVD could be useful in identifying patients who are at greater risk for infertility while decreasing the need for more intrusive testing, such as semen analysis, in an adolescent popula¬tion. We looked at the direct relationship between low TTV and high TVD. In our popu¬lation, there was a non-significant relationship between TTV < 30 cc and TVD ≥ 20% (p > 0.05) indicating that in adolescents with varicocele, TTV and TVD are independent variables. Our study limitations include the inherent user dependent bias of ultrasound measurements and data collection at a single institution with high ethnic diversity, possibly not comparable to all patient populations.
Conclusions: Low TTV (< 30 cc) itself is not predictive of high TVD (≥ 20%) in ado¬lescent boys with varicocele, despite their reported independent associations with im¬paired fertility in other studies.
Keywords: Varicocele; Adolescent; Infertility
Is urotherapy alone as effective as a combination of urotherapy and biofeedback in children with dysfunctional voiding?
Vol. 44 (5): 987-995, September – October, 2018
Adem Altunkol 1, Deniz Abat 2, Nevzat Can Sener 1, Mehmet Gulum 3, Halil Ciftci 4, Murat Savas 5, Ercan Yeni 6
1 Department of Urology, Adana City Teaching and Research Hospital, University of Healthy Sciences, Adana, Turkey; 2 Department of Urology, Ministry of Health, Iskenderun State Hospital, Hatay, Turkey; 3 Department of Urology, Ankara Keçiören Teaching and Research Hospital, University of Healthy Sciences, Ankara, Turkey; 4 Department of Urology, Faculty of Medicine, Harran University, Şanliurfa, Turkey; 5 Department of Urology, Antalya Teaching and Research Hospital, University of Healthy Sciences, Antalya, Turkey; 6 Department of Urology, Ankara Numune Teaching and Research Hospital, University of Healthy Sciences, Ankara, Turkey
Objective: To compare standard urotherapy with a combination of urotherapy and biofeedback sessions and to determine the changes that these therapies promote in children with dysfunctional voiding.
Patients and Methods: The data of 45 patients who participated in the study from January 2010 to March 2013 were evaluated. All patients underwent urinary system ultrasonography to determine post-void residual urine volumes and urinary system anomalies. All patients were diagnosed using uroflowmetry – electromyography (EMG). The flow pattern, maximum flow rate, and urethral sphincter activity were evaluated in all patients using uroflowmetry – EMG. Each patient underwent standard urotherapy, and the results were recorded. Subsequently, biofeedback sessions were added for all patients, and the changes in the results were recorded and statistically compared.
Results: A total of forty – five patients were included, of which 34 were female and 11 were male and the average age of the patients was 8.4 ± 2.44 years (range: 5 – 15 years). After the standard urotherapy plus biofeedback sessions, the post-void residual urine volumes, incontinence rates and infection rates of patients were significantly lower than those with the standard urotherapy (p < 0.05). A statistically significant improvement in voiding symptoms was observed after the addition of biofeedback sessions to the standard urotherapy compared with the standard urotherapy alone (p < 0.05).
Conclusions: Our study showed that a combination of urotherapy and biofeedback was more effective in decreasing urinary incontinence rates, infection rates and post – void residual urine volumes in children with dysfunctional voiding than standard urotherapy alone, and it also showed that this combination therapy corrected voiding patterns significantly and objectively.
Keywords: Biofeedback, Psychology; Child; Urinary Tract Infections
Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, and laparoscopic pectopexy for apical prolapse
Vol. 44 (5): 996-1004, September – October, 2018
Alper Biler 1, I. Egemen Ertas 1, Gokhan Tosun 1, Ismet Hortu 2, Unal Turkay 3, Ozge E. Gultekin 4, Gulfem Igci 3
1 Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey; 2 Department of Obstetrics & Gynecology, Ege University School of Medicine, Izmir, Turkey; 3 Department of Obstetrics and Gynecology, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey; 4 Department of Statistics, Ege University, Izmir, Turkey
Objective: To investigate differences in perioperative complications and short-term outcomes of patients who underwent abdominal sacrocolpopexy / sacrohysteropexy, laparoscopic sacrocolpopexy / sacrohysteropexy, or laparoscopic pectopexy due to apical prolapse.
Materials and Methods: A retrospective cohort study was performed on 110 patients who underwent apical prolapse surgery between January 1, 2011, and July 31, 2017. Only symptomatic uterine or vaginal vault prolapse patients with stage 2-4, according to the pelvic organ prolapse quantification system, were included. Baseline and intraoperative variables of groups; perioperative complications, including hemorrhage, urinary, and wound complications, blood transfusion, ileus, and short-term outcomes were compared.
Results: A total of 68 abdominal sacrocolpopexies (44 sacrocolpopexies and 24 sacrohysteropexies), 14 laparoscopic sacrocolpopexies (10 sacrocolpopexies and 4 sacrohysteropexies), and 28 laparoscopic pectopexies (16 pectopexies and 12 pectohysteropexies) were analyzed. Baseline characteristics and intraoperative variables were similar. However, the mean operating time was significantly shorter in the laparoscopic pectopexy group (74.9 min) when compared with that of the other groups (p < 0.01). During the six-month follow-up period, no prolapse recurrence and mesh erosion / exposure were observed in any group. De-novo stress urinary incontinence, urgency, and defecation problems, as well as perioperative complication rates, were not statistically significantly different between the groups.
Conclusions: Although the complication rates and short-term outcomes were not significantly different between the groups, minimally invasive approaches were associated with reduced procedural-related morbidity. Laparoscopic pectopexy is a promising endoscopic prolapse surgery and can be an alternative technique to sacrocolpopexy.
Keywords: Laparoscopy; Pelvic Organ Prolapse; complications [Subheading]
Protective effects of Tadalafil and darbepoetin against ischemia – reperfusion injury in a rat testicular torsion model
Vol. 44 (5): 1005-1013, September – October, 2018
Caglar Yildirim 1, Ozgur H. Yuksel 1, Ahmet Urkmez 2, Aytac Sahin 1, Adnan Somay 3, Ayhan Verit 1
1 Department of Urology, Fatih Sultan Mehmet Research & Training Hospital, University of Health Sciences, Istanbul, Turkey; 2 Department of Urology, Haydarpasa Numune Research & Training Hospital, University of Health Sciences, Istanbul, Turkey; 3 Department of Pathology, Fatih Sultan Mehmet Research & Training Hospital, University of Health Sciences, Istanbul, Turkey
Objectives: to evaluate protective effects of darbepoetin and tadalafil against ischemiareperfusion injury in ipsilateral and contralateral testicle.
Materials and Methods: Thirty 3-month-old adult male Wistar-Albino rats were randomly divided into 5 groups (A-E). Sham operation was performed in the first group.
In Group B, rats did not received any medication after creating 720 degrees torsion of the left testis. The rats in Group C, D and E received darbepoetin, tadalafil, and darbepoetin/ tadalafil combination 30 minutes after creating 720 degrees torsion of the left testis, respectively. The testes of rats in these three groups were detorsioned at 90 minutes after drug administration. Both testes were removed at 30 minutes after detorsion.
Results: There were significant differences between the groups in terms of the degree of histopathological damage, Johnsen score, fibrosis score and caspase-3 immunoreactivity in the torsioned testes (p: 0.000). The results for each parameter in the left testes were significantly better in the darbepoetin / tadalafil combination group. Similarly, there were also significant differences in the contralateral testes (p: 0.000).
Conclusion: The active substances darbepoetin and tadalafil that were used as a combination had protective effects on both testes and produced out better results in preserving testicular histology. Especially in cases where it is not possible to rescue the torsioned testis, this result was more noticeable in the contralateral testis.
Keywords: Darbepoetin alfa; Tadalafil; Reperfusion Injury
Impact of intravesical hyaluronic acid treatment on bladder inflammation in interstitial cystitis rat model
Vol. 44 (5): 1014-1022, September – October, 2018
Ilker Fatih Sahiner 1, Hakan Soylu 2, Erhan Ates 3, Nuray Acar 2, Ismail Ustunel 2, Ahmet Danısman 1
1 Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey; 2 Department of Histology and Embryology, Akdeniz University School of Medicine, Antalya, Turkey; 3 Department of Urology, Adnan Menderes University School of Medicine, Aydin, Turkey
Objective: To evaluate the effect of intravesical hyaluronic acid (HA) treatment on inflammatory cells and the severity of inflammation in an interstitial cystitis rat model created with hydrogen chloride (HCL) via immunohistochemical studies and myeloperoxidase activity for the first time in the literature.
Materials and Methods: A total of 30 adult female white Rattus Norvegicus rats were divided into 3 groups as the HCL group, hyaluronic acid treatment (HCL-HA) group and control group. Chemical cystitis was created by administering HCL(400 microL,10 mM) except control group. A single dose of intravesical HA(0.5 mL,0.8 mg/mL) was administered to the treatment group. The bladder tissues of all subjects were immunohistochemically stained. The cell surface markers were used to evaluate inflammatory cell infiltration. Mast cell activation and IL-6 was evaluated to assess the inflammation and severity of inflammation, respectively. Myeloperoxidase activity was measured as it shows neutrophil density. Statistical significance was accepted as P<0.05.
Results: It was observed that there was rich monocyte, T lymphocyte, B lymphocyte, and Natural Killer cells infiltration and high IL-6 levels in the bladder tissue after the intravesical hydrogen chloride instillation, especially in the stroma layer(p<0.005). In the HCL-HA group, severity of inflammation had statistically significantly regressed to the levels of the control group(p<0.005). An increase was observed in the bladder myeloperoxidase activity of the HCL group compared to the other two groups(p<0.05).
Conclusions: Single dose intravesical hyluronic acid instillation reduces inflammatory cell infiltration and the severity of bladder inflammation in the rat model of bladder pain syndrome/interstitial cystitis.
Keywords: Interstitial cystitis; Inflammation; Hyaluronic Acid
Vol. 44 (5): 1023-1031, September – October, 2018
Hakan Türk 1, Sıtkı Ün 2, Erkan Arslan 3
1 Department of Urology, Evliya Celebi Training and Research Hospital, Kutahya, Turkey; 2 Department of Urology, Sivas State of Hospital, Sivas, Turkey; 3 Department of Urology, Harran University Medical School, Sanliurfa, Turkey
Objective: To protect the urethra from instrumentation related urethra injures and stricture, we developed a new surgical technique which can be defined as transvesical resection of prostate without using urethra.
Materials and Methods: Our study included 12 consecutive bladder outlet obstruction patients treated with transvesical prostate resection in our clinic between March 2016 and May 2016. Detailed anamnesis, results of physical examination, digital rectal examination, routine lab tests, international prostate symptoms score, transrectal ultrasound, measurement of prostate-specific antigen levels and uroflowmetry was performed in all patients prior to surgery.
Results: Hospitalization period following surgery was 1 day. Foley catheter and suprapubic cystostomy catheters were removed in a median period of 3.6 days and 1 day. Median mass of resected adenomas was measured as 21.8 gr. Median maximum flow rate was measured as 6mL/s. Median postvoid residual urine volume was 70.6 cc and median international prostate symptoms score and quality of life scores were 9 and 1.4, respectively.
Conclusion: In this study, we would like to show the possible practicality of transvesical resection of prostate technique in this patient group. However, we think that this technique is very useful in special patient groups such as patients with bladder stones, priapism and penile prosthesis.
Keywords: Transurethral Resection of Prostate; Urethra; Urinary Bladder Neck Obstruction
Vol. 44 (5): 1032-1035, September – October, 2018
CHALLENGING CLINICAL CASES
Mohammad Hadi Radfar 1, Behnam Shakiba 1, Amir Afyouni 1, Hassan Hoshyar 1
1 Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Introduction: Paraganglioma is an extremely rare catecholamine-producing tumor during pregnancy. Paraganglioma carries high risks of fetal and maternal mortality during pregnancy. We report a pregnant woman with paraganglioma in the second trimester.
Case Description: A 24-year-old pregnant woman presented with severe hypertension in the 17th week of gestation. Hormonal examination and Magnetic Resonance Imaging (MRI) confirmed the diagnosis of extra adrenal pheochromocytoma (paraganglioma). She underwent laparoscopic tumor excision successfully.
Conclusions: A high index of suspicion is needed to diagnose paraganglioma in a pregnant patient with hypertension. Laparoscopic tumor removal for paraganglioma seems to be a feasible and safe procedure during pregnancy.
Keywords: Laparoscopy; Paraganglioma; Pregnant Women
Neovagina construction and continent cutaneous urinary reservoir using a previous orthotopic ileal neobladder
Vol. 44 (5): 1036-1041, September – October, 2018
CHALLENGING CLINICAL CASES
Cinthia Alcántara-Quispe 1, Roberto Dias Machado 1, Wesley Justino Magnabosco 1, Alexandre Cesar Santos 1, Eliney Ferreira Faria 1
1 Departamento de Urologia, Hospital do Câncer de Barretos, Barretos, SP, Brasil
Standard radical cystectomy (RC) in women involves removal of the distal ureters, bladder, proximal urethra, uterus, ovaries, and adjacent vagina. Furthermore, pelvic organ-preserving RC to treat selected women has become an accepted technique and may confer better postoperative sexual and urinary functions than standard RC, avoid¬ing complications such as incontinence, prolapse, neobladder-vaginal fistula (NVF), and sexual dysfunction, without compromising oncological outcome.
This article reports a different surgical approach: a patient who underwent a cutane¬ous continent reservoir and neovagina construction using a previous ileal orthotopic neobladder after RC. Patient presented no complications and she has no evidence of recurrent disease and is sexually active, with a satisfactory continent reservoir. This case is the first report of this procedure that was able to treat concomitant dyspareunia caused by short vagina and neobladder-vaginal fistula.
In conclusion, standard radical cystectomy with no vaginal preservation can have a negative impact on quality of life. In the present case, we successfully treated neoblad¬der fistula and short vagina by transforming a previous ileal orthotopic neobladder into two parts: a continent reservoir and a neovagina. However, to establish the best approach in such patients, more cases with long-term follow-up are needed.
Keywords: Urinary Bladder Neoplasms; Cystectomy; Urinary Reservoirs, Continentx
Vol. 44 (5): 1042-1043, September – October, 2018
Yongquan Yu 1, Jiatong Li 2, Hongjun Hou 1
1 Department of Radiology, WeiHai Central Hospital, Affiliated Hospital of Qingdao University, China; 2 Taishan Medical University, China
Vol. 44 (5): 1044-1045, September – October, 2018
Pablo Garrido-Abad 1, Miguel Ángel Rodríguez-Cabello 1, Arturo Platas Sancho 1, Mairena Coronado Ruiz 2, Juan José Ortiz Zapata 3
1 Department of Urology, Hospital Sanitas La Moraleja, Madrid, Spain; 2 Department of Gynecology. Hospital Sanitas La Moraleja, Madrid, Spain; 3 LABCO (SYNLAB) Pathology. Madrid, Spain
Vol. 44 (5): 1046-1046, September – October, 2018
Fabio Carvalho Vicentini 1, Hugo Daniel Barone dos Santos 1, Carlos Alfredo Batagello 1, Julia Rothe Amundson 2, Evaristo Peixoto Oliveira Neto 1, Giovanni Scala Marchini 1, Miguel Srougi 1, Willian Carlos Nahas 1, Eduardo Mazzucchi 1
1 Divisão de Urologia, Grupo de Endourologia do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, USP, São Paulo, SP, Brasil; 2 University of Miami, Miller School of Medicine, Miami, EUA
Objective: To show a video of a complete supine Percutaneous Nephrolithotomy (csPCNL) performed for the treatment of a staghorn calculus, from the surgeon’s point of view. The procedure was recorded with a GoPro® camera, demonstrating the ten essential steps for a successful procedure.
Materials and methods: The patient was a 38 years-old woman with 2.4cm of left kidney lower pole stone burden who presented with 3 months of lumbar pain and recurrent urinary tract infections. She had a previous diagnosis of polycystic kidney disease and chronic renal failure stage 2. CT scan showed two 1.2cm stones in the lower pole (Guy’s Stone Score 2). She had a previous ipsilateral double J insertion due to an obstructive pyelonephritis. The csPCNL was uneventful with a single access in the lower pole. The surgeon had a Full HD GoPro Hero 4 Session® camera mounted on his head, controlled by the surgical team with a remote control. All of the mains steps were recorded. Informed consent was obtained prior to the procedure.
Results: The surgical time was 90 minutes. Hemoglobin drop was 0.5g/dL. A post-operative CT scan was stone-free. The patient was discharged 36 hours after surgery. The camera worked properly and didn’t cause pain or muscle discomfort to the surgeon. The quality of the recorded movie was excellent.
Conclusion: GoPro® camera proved to be a very interesting tool to document surgeries without interfering with the procedure and with great educational potential. More studies should be conducted to evaluate the role of this equipment.
Available at: http://www.intbrazjurol.com.br/video-section/20170337_Vicentini_et_al
Int Braz J Urol. 2018; 44 (Video #13): 1046-1046
Vol. 44 (5): 1047-1048, September – October, 2018
Marcelo Langer Wroclawski 1, 2, Guilherme Andrade Peixoto 2, Marcio Covas Moschovas 2, Arie Carneiro 1, Milton Borrelli Jr. 1, José Roberto Colombo Jr. 1
1 Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; 2 Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
Introduction: Renal ptosis is defined as the renal descent when there is a change from supine to orthostatic position, usually with a change of two vertebral bodies or more than five cm apart. Although rare, it is one of the causes of chronic flank pain or of upper abdomen. The typical patient of renal ptosis is young, female, thin, with complaint of pain when in an upright position (1, 2).
Objective: Demonstrate a robot-assisted nephropexy technique in a young woman diagnosed with symptomatic renal ptosis on the right kidney, confirmed by imaging tests.
Materials and Methods: A 29-year-old female patient with a history of chronic right-sided pain and palpable renal mobility on physical examination. The diagnosis of renal ptosis was confirmed by ultrasound imaging, excretory urography (Figure -1), and renal scintigraphy with 99mTc-DTPA (Figure-2). She was submitted to a robotic-assisted right nephropexy with a polypropylene mesh fixing the right kidney to the ipsilateral psoas muscle fascia.
Result: We reported a 96-minute surgical time. The patient was discharged in the first postoperative day. At the one-month follow-up, there was an important improvement of the symptoms, with normality renal function and imaging tests describing adequate renal positioning.
Conclusions: Robotic-assisted nephropexy is feasible and can be an excellent minimally invasive alternative technique for the proposed surgery. We reported a shorter hospital stay and a faster postoperative recovery compared with the opened procedure.
Available at: http://www.intbrazjurol.com.br/video-section/20170390_wroclawski_et_al
Int Braz J Urol. 2018; 44 (Video #14): 1047-1048
Vol. 44 (5): 1049-1049, September – October, 2018
Kaan Gokcen 1, Gokhan Gokce 1, Gokce Dundar 2, Resul Cicek 1, Halil Gulbahar 1, Emin Yener Gultekin 1
1 Department of Urology, Cumhuriyet University Faculty of Medine, Sivas, Turkey; 2 Department of Urology, Cizre State Hospital, Cizre, Turkey
Introduction: Ureteropelvic junction obstruction and concomitant calculus disease may coexist. We demonstrate our use of flexible renoscopy during laparoscopic pyeloplasty for caliceal stone removal.
Patient and methods: A 28-year-old female patient presented with recurrent attacks of flank pain of two years duration.
When noncontrast-CT and DTPA were performed, the patient was diagnosed with ureteropelvic junction stenosis and 3 stones with a total burden of 14mm in the lower pole of right kidney. After pneumoperitoneum was established in right flank position, three 10mm trocars were placed including one camera port. 5mm trocar was placed for convenience to retraction and dissection. The surgery was uneventful, with no operative complications or evidence of intra-abdominal bleeding.
Results: The duration of the surgery was 110 minutes. The amount of bleeding was 30ml. On the postoperative 2nd day, the urethral catheter was removed and the patient was discharged on the fourth day postoperatively. Stent removal was done on the 3rd postoperative week and retrograde pyelogram showed normal ureter. Post-operative follow-up with ultrasound showed that hydronephrosis had regressed.
Conclusıons: Laparoscopic pyeloplasty and concomitant flexible renoscopy through lowermost trocar with basket extraction is a simple, attractive alternative for the simultaneous treatment of ureteropelvic junction obstruction presenting with coexisting nephrolithiasis. This method is useful and feasible, with minimal invasiveness and an early post-operative recovery.
Available at: http://www.intbrazjurol.com.br/video-section/20170401_Gokcen_et_al
Int Braz J Urol. 2018; 44 (Video #15): 1049-1049
Vol. 44 (5): 1050-1050, September – October, 2018
Victor Espinheira Santos 1, Rafael Ribeiro Meduna 1, Wilson Bachega Jr. 1, Gustavo Cardoso Guimarães 1
1 Serviço de Urologia, Departamento de Cirurgia Pélvica, AC Camargo Cancer Center, São Paulo, SP, Brasil
Kidney cancer is the third most common urologic malignancy and a 2% annual increase in the incidence has occurred over the past two decades, largely because of the increased utilization of imaging. The majority of these tumors are small, so the indications for nephron-sparing surgery and for minimally invasive surgery are continually expanding. Complex kidney lesions, such as those completely endophytic, are still a challenge even for experienced surgeons.
Our objective is to demonstrate the operative technique for laparoscopic partial nephrectomy with the aid of intra-operative ultrasound in a man with a totally endophytic renal lesion.
Case: A 52 years old man, asymptomatic, with incidental renal mass of 2.9 cm, completely endophytic (R.E.N.A.L score 9p) submitted to partial laparoscopic nephrectomy. Surgical time was 2 hours, with 20 minutes of ischemia. Pathological anatomy confirmed tumor of clear cells T1a, free margins.
Available at: http://www.intbrazjurol.com.br/video-section/20170534_Santos_et_al
Int Braz J Urol. 2018; 44 (Video #16): 1050-1050
Vol. 44 (5): 1051-1051, September – October, 2018
Lessandro Curcio Gonçalves 1, Felipe Monnerat Lott 2, Rafael Rosa 1
1 Serviço de Urologia, Hospital Federal de Ipanema, Rio de Janeiro, RJ, Brasil; 2 Departamento de Urologia, Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brasil
Introduction: Only few reports are known about the use of robotic surgery for prostate benign enlargement. The robotic surgery can be improved by laparoscopic tricks. We show a video of robotic adenomectomy where a laparoscopic dissector is used to help create the plan between prostatic capsule and adenoma.
Materials and methods: A 62 years old male had severe urinary flow outlet obstruction. Medical therapy was not effective.
Ultrasound detected a 92gr enlarged prostate with a large middle lobe. Robotic assisted adenomectomy was scheduled.
The procedure followed this sequence: opening of Retzius space, superficial suture of the Dorsal vein complex, horizontal cistotomy. The plan was created with electrocautery and blunt dissection with the laparoscopic dissector. Haemostatic sutures were placed between prostate fossa and the posterior bladder neck and closure of the cistotomy.
Results: Whole operation time was 160 minutes, with a blood loss of 80cc. There was no perioperative or post-operative complication. Catheter was removed after 4 days. Post-operatory uroflowmetry shows a peak flow of 30ml/sec. Pathological examination is negative for tumor. After 60 days IPSS was 8.
Conclusion: Robotic prostate adenomectomy using the laparoscopic dissector is a safe and effective minimally invasive treatment for benign prostatic enlargement. It is a novel technique to find and dissect the plane between prostatic adenoma
and capsule. This could be one more use of laparoscopic technology to improve surgical outcomes in robotic field.
Available at: http://www.intbrazjurol.com.br/video-section/20170609_Goncalves_et_al
Int Braz J Urol. 2018; 44 (Video #17): 1051-1051