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Volume 44 | number 6 | Nov . Dec, 2018 -The current status of renal cell carcinoma and prostate carcinoma grading…

The current status of renal cell carcinoma and prostate carcinoma grading

Vol. 44 (6): 1057-1062, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.06.01


EDITORIAL In this issue

Brett Delahunt 1, Lars Egevad 2, 3, John Yaxley 4, 5, Hemamali Samaratunga 5, 6
1 Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, Wellington, New Zealand; 2 Department of Pathology, Karolinska Institute, Stockholm, Sweden; 3 Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden; 4 Wesley Hospital, Brisbane, Queensland, Australia; 5 University of Queensland School of Medicine, Brisbane, Queensland, Australia; 6 Aquesta Uropathology , Brisbane, Queensland, Australia

INTRODUCTION

Grading is an important prognostic indicator for tumors and for most malignancies provides information additional to staging. As with staging, grading criteria for individual tumors are subject to change, with developments reflecting contemporary advances in our understanding of the behavior of tumors. In the field of urological pathology, the grading classifications most commonly utilized for both renal cell carcinoma (RCC) and prostate adenocarcinoma (PCa) have undergone radical change. This evolution has, most recently, led to the establishment of novel grading systems for both of these tumors, under the auspices of the International Society of Urological Pathology (ISUP) (1, 2). The release of the Fourth Edition of the World Health Organization (WHO) Bluebook on the Classification of Tumours of the Urinary Tract and Male Genital Organs in 2016 (3), followed on from the development of these contemporary grading classifications. In this publication these novel classifications, relating to the two most common morphotypes of RCC and for PCa, were endorsed for international implementation. Subsequently both grading classifications have been incorporated into the reporting datasets issued by the International Collaboration on Cancer Reporting (4, 5).

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Related Post

Microdissection is the best way to perform sperm retrieval in men with non-obstructive azoospermy? | Opinion: Yes

Vol. 44 (6): 1063-1066, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.06.02


DIFFERENCE OF OPINION

Renato Fraietta 1
1 Setor Integrado de Reprodução Humana, Universidade Federal de São Paulo, São Paulo, SP, Brasil

 Keywords: Azoospermia; Microdissection; Sperm Retrieval; Fertility


Non-obstructive azoospermia (NOA) is the diagnosis of one percent of all men and 10% of men complaining about infertility (1, 2). All NOA patients should be evaluated with complete history and physical examination, with genetic testing (karyotype analysis and Y chromosome microdeletion testing) being offered and performed, which will identify the causes of NOA in up to 17% of men (3, 4). Hormonal profile is also important as up to 47% of men that have impaired spermatogenesis with NOA were found to have hypogonadism (4,5).

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Related Post

Microdissection is the best way to perform sperm retrieval in men with non-obstructive azoospermy? | Opinion: No, there are other options

Vol. 44 (6): 1067-1070, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.06.03


DIFFERENCE OF OPINION

Marcelo Vieira 1, 2
1 Membro Titular da Sociedade Brasileira de Urologia, Rio de Janeiro, RJ, Brasil; 2 Urologista do Projeto ALFA, Sao Paulo, SP, Brasil

Keywords: Azoospermia; Microdissection; Sperm Retrieval; Fertility


In the last 23 years, Intracitoplasmic Sperm Injection (ICSI) has given non-obstructive azoospermic man the opportunity to become biological fathers, if sperm could be found in their testicles. These men present the biggest challenge in the routine of infertility clinics around the World, since there are no positive, clinical or laboratory, prognostic factors for sperm recovery.

Once testicular sperm has been regularly used for ICSI, discussion about which technique for testicular sperm retrieval has been done. Sperm can be harvest from testicular parenchyma by: open biopsy (Testicular Sperm Extraction-TESE), percutaneous aspiration (Testicular Sperm Aspiration), open guided biopsy by previous cytology (Testicular fine-needle Aspiration) and open biopsy using microsurgery technique (Testicular Microdissection). The proposed techniques have the same objective, to find sperm with minimal testicular damage and in a reproducible way (1).

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Related Post

A review of the possibility of adopting financially driven live donor kidney transplantation

Vol. 44 (6): 1071-1080, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0693


REVIEW ARTICLE

Aline Adour Yacoubian 1, 2, Rana Abu Dargham 1, 2, Raja B. Khauli 1, 2
1 Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon; 2 Division of Urology and Renal Transplantation, American University of Beirut Medical Center, Beirut, Lebanon

ABSTRACT

Kidney transplantation for end-stage renal disease remains the preferred solution due to its survival advantage, enhanced quality of life and cost-effectiveness. The main obstacle worldwide with this modality of treatment is the scarcity of organs. The de­mand has always exceeded the supply resulting in different types of donations. Kidney donation includes pure living related donors, deceased donors, living unrelated do­nors (altruistic), paired kidney donation and more recently compensated kidney dona­tion. Ethical considerations in live donor kidney transplantation have always created a debate especially when rewarding unrelated donors. In this paper, we examine the problems of financially driven kidney transplantation, the ethical legitimacy of this practice, and propose some innovative methods and policies that could be adopted to ensure a better practice with accepted ethical guidelines.

Keywords:  Kidney Transplantation; Kidney Diseases; Review [Publication Type]

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Related Post

Lowering positive margin rates at radical prostatectomy by color coding of biopsy specimens to permit individualized preservation of the neurovascular bundles: is it feasible? a pilot investigation

Vol. 44 (6): 1081-1088, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0328


ORIGINAL ARTICLE

Leslie A. Deane 1, Wei Phin Tan 1, Andrea Strong 1, Megan Lowe 1, Nency Antoine 1, Ritu Ghai 1, Shahid Ekbal 1
1 Department of Urology, Rush University Medical Center, Chicago, IL, USA

 

ABSTRACT

Objective: To evaluate whether color-coding of prostate core biopsy specimens aids in preservation of the neurovascular bundles from an oncological perspective.

Materials and Methods: MRI guided transrectal ultrasound and biopsy of the prostate were performed in 51 consecutive patients suspected of being at high risk for harboring prostate cancer. Core specimens were labeled with blue dye at the deep aspect and red dye at the superficial peripheral aspect of the core. The distance from the tumor to the end of the dyed specimen was measured to determine if there was an area of normal tissue between the prostate capsule and tumor.

Results: Of the 51 patients undergoing prostate biopsy, 30 (58.8%) were found to have cancer of the prostate: grade group 1 in 13.7%, 2 in 25.5%, 3 in 7.8%, 4 in 7.8% and 5 in 3.9% of the cohort. A total of 461 cores were analyzed in the cohort, of which 122 showed cancer. Five patients opted to undergo robotic assisted laparoscopic radical prostatectomy. No patients had a positive surgical margin (PSM) or extra prostatic ex­tension (EPE) on radical prostatectomy if there was a margin of normal prostatic tissue seen between the dye and the tumor on prostate biopsy.

Conclusion: Color-coding of prostate biopsy core specimens may assist in tailoring the approach for preservation of the neurovascular bundles without compromising early oncological efficacy. Further study is required to determine whether this simple modi­fication of the prostate biopsy protocol is valuable in larger groups of patients.

Keywords: Robotic Surgical Procedures; Prostatectomy; Laparoscopy

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Related Post

Predictive factors for prolonged hospital stay after retropubic radical prostatectomy in a high-volume teaching center

Vol. 44 (6): 1089-1105, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0339


ORIGINAL ARTICLE

Rafael F. Coelho 1, Mauricio D. Cordeiro 1, Guilherme P. Padovani 1, Rafael Localli 1, Limirio Fonseca 1, José Pontes Junior 1, Giuliano B. Guglielmetti 1, Miguel Srougi 1, William Carlos Nahas 1
1 Divisão de Urologia, Instituto do Câncer de Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil

ABSTRACT

Objective: To evaluate the length hospital stay and predictors of prolonged hospitaliza­tion after RRP performed in a high-surgical volume teaching institution, and analyze the rate of unplanned visits to the office, emergency care, hospital readmissions and perioperative complications rates.

Materials and Methods: Retrospective analysis of prospectively collected data in a standardized database for patients with localized prostate cancer undergoing RRP in our institution between January/2010 – January/2012.

A logistic regression model including preoperative variables was initially built in order to determine the factors that predict prolonged hospital stay before the surgical pro­cedure; subsequently, a second model including both pre and intraoperative variables was analyzed.

Results: 1011 patients underwent RRP at our institution were evaluated. The median hospital stay was 2 days, and 217 (21.5%) patients had prolonged hospitalization. Predictors of prolonged hospital stay among the preoperative variables were ICC (OR. 1.40 p=0.003), age (OR 1.050 p<0.001), ASA score of 3 (OR. 3.260 p<0.001), pros­tate volume on USG-TR (OR, 1.005 p=0.038) and African-American race (OR 2.235 p=0.004); among intra and postoperative factors, operative time (OR 1.007 p=0.022) and the presence of any complications (OR 2.013 p=0.009) or major complications (OR 2.357 p=0.01) were also correlated independently with prolonged hospital stay. The complication rate was 14.5%.

Conclusions: The independent predictors of prolonged hospitalization among preop­erative variables were CCI, age, ASA score of 3, prostate volume on USG-TR and African-American race; amongst intra and postoperative factors, operative time, pres­ence of any complications and major complications were correlated independently with prolonged hospital stay.

Keywords: rostatectomy; Therapeutics; Retrospective Studies

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Related Post

Comparison of Gleason upgrading rates in transrectal ultrasound systematic random biopsies versus US-MRI fusion biopsies for prostate cancer

Vol. 44 (6): 1106-1113, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0552


ORIGINAL ARTICLE

Paulo Priante Kayano ¹, Arie Carneiro ¹, Tiago Mendonça Lopez Castilho 1, Arjun Sivaraman ², Oliver Rojas Claros ¹, Ronaldo Hueb Baroni ¹, Rodrigo Gobbo Garcia ¹, Guilherme Cayres Mariotti ¹, Oren Smaletz ¹, Renne Zon Filippi ¹, Gustavo Caserta Lemos 1
1 Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; 2 Memorial Sloan Kettering Cancer Center – USA, New York, NY, EUA

ABSTRACT

Purpose: Ultrasound-magnetic resonance imaging (US-MRI) fusion biopsy (FB) im­proves the detection of clinically significant prostate cancer (PCa).

We aimed to compare the Gleason upgrading (GU) rates and the concordance of the Gleason scores in the biopsy versus final pathology after surgery in patients who underwent transrectal ultrasound (TRUS) systematic random biopsies (SRB) versus US-MRI FB for PCa.

Materials and Methods: A retrospective analysis of data that were collected prospec­tively from January 2011 to June 2016 from patients who underwent prostate biopsy and subsequent radical prostatectomy. The study cohort was divided into two groups: US-MRI FB (Group A) and TRUS SRB (Group B).

US-MRI FB was performed in patients with a previous MRI with a focal lesion with a Likert score ≥3; otherwise, a TRUS SRB was performed.

Results: In total, 73 men underwent US-MRI FB, and 89 underwent TRUS SRB. The GU rate was higher in Group B (31.5% vs. 16.4%; p=0.027). According to the Gleason grade pattern, GU was higher in Group B than in Group A (40.4% vs. 23.3%; p=0.020). Analyses of the Gleason grading patterns showed that Gleason scores 3+4 presented less GU in Group A (24.1% vs. 52.6%; p=0.043).

The Bland-Altman plot analysis showed a higher bias in Group B than in Group A (-0.27 [-1.40 to 0.86] vs. -0.01 [-1.42 to 1.39]).

In the multivariable logistic regression analysis, the only independent predictor of GU was the use of TRUS SRB (2.64 [1.11 – 6.28]; p=0.024).

Conclusions: US-MRI FB appears to be related to a decrease in GU rate and an increase in concordance between biopsy and final pathology compared to TRUS SRB, sug­gesting that performing US-MRI FB leads to greater accuracy of diagnosis and better treatment decisions.

Keywords: Prostatic Neoplasms; Magnetic Resonance Spectroscopy; Image-Guided Biopsy

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Related Post

PSA kinetics before 40 years of age

Vol. 44 (6): 1114-1121, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0710


ORIGINAL ARTICLE

Cristiano Linck Pazeto 1, Thiago Fernandes Negris Lima 1, José Carlos Truzzi 2, Nairo Sumita 2, José de Sá 2, Fernando R. Oliveira3, Sidney Glina 1
1 Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil; 2 Fleury Medicina e Saúde São Paulo, SP, Brasil; 3 Departamento de Epidemiologia, Universidade de São Paulo, São Paulo, SP, Brasil

ABSTRACT

Purpose: The baseline PSA has been proposed as a possible marker for prostate cancer.

The PSA determination before 40 years seems interesting because it not suffers yet the drawbacks related to more advanced ages. Considering the scarcity of data on this topic, an analysis of PSA kinetics in this period seems interesting.

Materials and Methods: A retrospective assay in a database of a private diagnostic center was performed from 2003 to 2016. All subjects with a PSA before 40 years were included.

Results: 92995 patients performed PSA between the ages of 21 – 39. The mean value ranged from 0.66 ng / mL (at age 22) to 0.76 ng / mL (at age 39) and the overall mean was 0.73 ng / mL. As for outliers, 3783 individuals presented a baseline PSA > 1.6 ng / mL (p95). A linear regression model showed that each year there is a PSA increase of 0.0055 ng / mL (β = 0.0055; r² = 0.0020; p < 0.001). A plateau in PSA between 23 and 32 years was found and there were only minimal variations among the ages regardless of the evaluated percentile.

Conclusion: It was demonstrated that PSA kinetics before 40 years is a very slow and progressive phenomenon regardless of the assessed percentile. Considering our results, it could be suggested that any PSA performed in this period could represent the baseline value without significant distortions.

Keywords: Prostate-Specific Antigen; Kinetics, Prostatic Neoplasms

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Related Post

Adequate rectal preparation reduces hospital admission for urosepsis after transrectal ultrasound – guided prostate biopsy

Vol. 44 (6): 1122-1128, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.0181


ORIGINAL ARTICLE

Yu-Chen Chen 1, 2, Hao-Wei Chen 1, 2, Shu-Pin Huang 2, Hsin-Chin Yeh 3, Ching-Chia Li 2
1 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 2 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 3 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

ABSTRACT

Objectives: Previous studies have compared infectious outcomes on the basis of whether rectal preparation was performed; however, they failed to evaluate the quality of each rectal preparation, which may have led to confounding results. This study aimed to com­pare hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy between patients with adequate and traditional rectal preparations.

Materials and Methods: Between January 2011 and December 2016, a total of 510 patients who underwent transrectal ultrasound – guided prostate biopsy at our in­stitutions and were orally administered prophylactic antibiotics (levofloxacin) were included. Two rectal preparations were performed: (1) adequate rectal preparation con­firmed by digital rectal examination and transrectal ultrasound (Group A, n = 310) and (2) traditional rectal preparation (Group B, n = 200). All patient characteristics were recorded. A logistic regression model was used to assess the effects of the two different rectal preparations on urosepsis, adjusted by patient characteristics.

Results: There were a total of three and nine hospitalizations for urosepsis in Groups A and B, respectively. Differences in the demographic data between the two groups were insignificant. Logistic regression showed that adequate rectal preparation before biopsy significantly decreased the risk for urosepsis after biopsy (adjusted odds ratio: 0.2; 95% confidence interval: 0.05 – 0.78; P = 0.021).

Conclusions: Adequate rectal preparation could significantly reduce hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy. The quality of rectal preparation should be evaluated before biopsy. If adequate rectal preparation is not achieved, postponing the biopsy and adjusting the rectal preparation regimen are suggested.

Keywords: Prostate; Prostatic Neoplasms; Ultrasound, High-Intensity Focused, Transrectal

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Related Post

Comparison between multiparametric MRI with and without post – contrast sequences for clinically significant prostate cancer detection

Vol. 44 (6): 1129-1138, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.0102


ORIGINAL ARTICLE

Thais Caldara Mussi 1,Tatiana Martins 1, 2, George Caldas Dantas 1, Rodrigo Gobbo Garcia 3, Renee Zon Filippi 4, Gustavo Caserta Lemos 5, Ronaldo Hueb Baroni 1
1 Departamento de Radiologia e Diagnóstico por Imagem, Hospital Israelita Albert Einstein, SP, Brasil; 2 Ecoar Medicina Diagnóstica, Lourdes, Belo Horizonte, MG, Brasil; 3 Departamento de Intervenção Guiada por Imagens, Hospital Israelita Albert Einstein, SP, Brasil; 4 Departamento de Patologia, Hospital Israelita Albert Einstein, SP, Brasil; 5 Departamento de Urologia, Hospital Israelita Albert Einstein, SP, Brasil

ABSTRACT

 

Background: Dynamic-contrast enhanced (DCE) sequence is used to increase detection of small lesions, based on increased vascularization. However, literature is controversy about the real incremental value of DCE in detection of clinically significant (CS) prostate cancer (PCa), since absence of enhancement does not exclude cancer, and enhancement alone is not definitive for tumor. Purpose: To test the hypothesis that DCE images do not increase CS PCa detection on MRI prior to biopsy, comparing exams without and with contrast sequences. Material and Materials and Methods: All men who come to our institution to perform MRI on a 3T scanner without a prior diagnosis of CS PCa were invited to participate in this study. Reference standard was transrectal prostate US with systematic biopsy and MRI/US fusion biopsy of suspicious areas. Radiologists read the MRI images prospectively and independently (first only sequences without contrast, and subsequently the entire exam) and graded them on 5-points scale of cancer suspicion.

Results: 102 patients were included. Overall detection on biopsy showed CS cancer in 43 patients (42.2%), clinically non-significant cancer in 11 (10.8%) and negative results in 48 patients (47%). Positivities for CS PCa ranged from 8.9% to 9.8% for low suspicion and 75.0% to 88.9% for very high suspicion. There was no statistical difference regarding detection of CS PCa (no statistical difference was found when compared accuracies, sensitivities, specificities, PPV and NPV in both types of exams). Inter-reader agreement was 0.59. Conclusion: Exams with and without contrast-enhanced sequences were similar for detection of CS PCa on MRI.

 Keywords: Magnetic Resonance Imaging; Prostatic Neoplasms; Men

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Related Post

Prospective Evaluation of Chondroitin Sulfate, Heparan Sulfate and Hyaluronic Acid in Prostate Cancer

Vol. 44 (6): 1139-1146, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0569


ORIGINAL ARTICLE

Matheus Neves Ribeiro da Silva 1, 2, Aline Mendes 1, João Roberto Maciel Martins 2, Marcos Tobias Machado 2, Maria Aparecida da Silva Pinhal 1
1 Departamento de Bioquímica, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil; 2 Departmento de Urologia Faculdade de Medicina do ABC, Santo André, SP, Brasil

ABSTRACT

Purpose: The present study evaluates chondroitin sulfate (CS) and heparan sulfate (HS) in the urine and hyaluronic acid (HA) in the plasma of patients with prostate cancer before and after treatment compared to a control group.
Materials and Methods: Plasma samples were used for HA dosage and urine for quantification of CS and HS from forty-four cancer patients and fourteen controls. Clinical, laboratory and radiological information were correlated with glycosaminoglycan
quantification by statistical analysis.
Results: Serum HA was significantly increased in cancer patients (39.68 ± 30.00 ng/ mL) compared to control group (15.04 ± 7.11 ng/mL; p=0.004) and was further increased in high-risk prostate cancer patients when compared to lower risk patients (p = 0.0214). Also, surgically treated individuals had a significant decrease in seric levels of heparan sulfate after surgical treatment, 31.05 ± 21.01 μg/mL (before surgery) and 23.14 ± 11.1 μg/mL (after surgery; p=0.029). There was no difference in the urinary CS and HS between prostate cancer patients and control group. Urinary CS in cancer patients was 27.32 ± 25.99 μg/mg creatinine while in the men unaffected by cancer it was 31.37 ± 28.37 μg/mg creatinine (p=0.4768). Urinary HS was 39.58 ± 32.81 μg/ mg creatinine and 35.29 ± 28.11 μg/mg creatinine, respectively, in cancer patients and control group (p=0.6252).
Conclusions: Serum HA may be a useful biomarker for the diagnosis and prognosis of prostate cancer. However, urinary CS and HS did not altered in the present evaluation.
Further studies are necessary to confirm these preliminary findings.

Keywords: Biomarkers; Glycosaminoglycans; Prostatic Neoplasms

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Related Post

Prognostic significance of Body Mass Index in patients with localized renal cell carcinoma

Vol. 44 (6): 1147-1155, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0629


ORIGINAL ARTICLE

Chengtao Wang 1, Zebin Chen 2, Jun Dong 1, Bixiu Wen 1, Yong Fang 2
1 Department of Radiation Oncology, First Affiliated Hospital of Sun Yat – Sen University, Guangzhou, China; 2 Department of Urology, First Affiliated Hospital of Sun Yat – Sen University, Guangzhou, China

 

ABSTRACT

Objective: To investigate the relationship between the pretreatment body mass index (BMI) and the clinical outcomes in patients with localized stage I – III renal cell carcinoma (RCC) surgically treated.

Materials and Methods: From January 2000 to December 2012, 798 patients with stage I – III RCC were recruited from First Affiliated Hospital and Cancer Center of Sun Yat – Sen University. Patients were divided into two groups of BMI < 25 kg / m2 or BMI ≥ 25 kg / m2 according to the World Health Organization classifications for Asian populations. The differences in the long-term survival of these two BMI groups were analyzed.

Results: The 5 – year failure – free survival rates for BMI < 25 kg / m2 and BMI ≥ 25 kg / m2 groups were 81.3% and 93.3%, respectively (P = 0.002), and the 5 – year overall survival rates were 82.5% and 93.8%, respectively (P = 0.003). BMI was a favored prognostic factor of overall survival and failure – free survival in a Cox regression model.

Conclusions: Pretreatment body mass index was an independent prognostic factor for Chinese patients surgically treated, localized stage I – III RCC.

Keywords: Body Mass Index; Carcinoma, Renal Cell; Prognosis

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Related Post

Surgical techniques for facilitating laparoscopic intracorporeal orthotopic neobladder: initial experience

Vol. 44 (6): 1156-1165, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0505


ORIGINAL ARTICLE

Lianchao Jin 1,2, Mingshuai Wang 1, Feiya Yang 1, Yinong Niu 1, Nianzeng Xing 1
1 Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China; 2 Department of Urology, Peking University Shougang Hospital, Beijing, China

ABSTRACT

 

Purpose: To describe our technique and outcomes for laparoscopic intracorporeal ileal neobladder (ICNB) reconstruction.

Materials and Methods: From April 2014 to November 2016, 21 patients underwent laparoscopic ICNB at our tertiary referral centre. ICNB with bilateral isoperistaltic af­ferent limbs and several technique improvements were introduced. Demographics, clinical, and pathological data were collected. Perioperative, 1-year oncologic, 1-year Quality of life and 1-year functional outcomes were reported.

Results: ICNB was successfully performed in all 21 patients without open conversion and transfusion. Mean operative time was 345.6±66.9 min, including 106±22 min for LRC and PLND and 204±46.4 min for ICNB, respectively. Mean established blood loss was 192±146 mL. The overall incidence of 90-d complication was 33.3%, while major complication occurred in 4.8%. One-year daytime and night-time continence rates were 85.7% and 57.1%, respectively. One patient died from myocardial infarction six months postoperatively, and two patients had lung metastasis five months and six months respectively.

Conclusions: We described our experience of 3D LRC with a novel intracorporeal or­thotopic ileal neobladder, and the technique improvements facilitate the procedure. However, further studies are required to evaluate long-term outcomes of the intracor­poreal neobladder with bilateral isoperistaltic afferent limbs.

 Keywords: Laparoscopy; Quality of Life; Cystectomy

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Related Post

Retroperitoneoscopic resection of retroperitoneal nonadrenal ganglioneuromas: our technique and clinical outcomes

Vol. 44 (6): 1166-1173, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0460


ORIGINAL ARTICLE

Changjin Shi 1, Feng Li 1, Yanchao Wang 1, Long Pei 1, Tao Wang 2
1 Department of Urology, the Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China; 2 Department of Nephrology, Hebei Provincial General Hospital, Shijiazhuang, China

ABSTRACT

Objective: To report our experience of retroperitoneoscopic technique in semi-lateral decubitus position for the retroperitoneal nonadrenal ganglioneuromas in 18 patients, and to evaluate its clinical outcomes.

Materials and Methods: From January 2012 to May 2016, 18 patients with retroperitoneal nonadrenal ganglioneuromas underwent retroperitoneoscopic resection. With the patients in semi-lateral decubitus position, a 4-port retroperitoneal approach was used. Data were collected on the tumor size, tumor location, perioperative outcomes, pathology, and lastknown disease status. We reviewed the operative videos to identify surgical tips and tricks.

Results: All procedures were carried out successfully without converting to open surgery.

The tumors had an average size of 5.2cm. The mean operative time was 86.5 min, with a mean estimated blood loss of 85.4mL. There were three patients suffering from intraoperative complications. Postoperatively, all patients achieved an uneventful recovery; the mean postoperative hospital stay was 5.5 days. The postoperative pathology revealed to be retroperitoneal ganglioneuromas. With a mean follow-up of 39.5 months, all patients were recurrence free. The review of the operative videos revealed several tips and tricks, including keeping peritoneum and posterior Gerota fascia intact to provide a favorable operative exposure of tumors, and placing the harmonic scalpel through different ports during tumor dissection.

Conclusions: With the patient in semi-lateral decubitus position and a 4-port retroperitoneal approach, retroperitoneoscopic resection of retroperitoneal nonadrenal ganglioneuroma is a feasible, effective, and safe procedure. This approach has distinct advantages including direct access to the tumor, optimal exposure of tumor and less intraperitoneal interference.

Keywords: Retroperitoneal Neoplasms; Ganglioneuroma; Pathology

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Related Post

Retroperitoneal laparoscopic nephroureterectomy with distal and intramural ureter resection for a tuberculous non – functional kidney

Vol. 44 (6): 1174-1181, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0326


ORIGINAL ARTICLE

Canqiang Li 1, Yi Yang 1, Le Xu 1, Minjie Qiu 1
1 Department of Urology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, Guangdong, China

 

ABSTRACT

 

Objective: To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection for a tuberculous non-functional kidney.

Materials and Methods: A total of 27 individuals diagnosed with unilateral non-functional kidney secondary to tuberculosis were treated between June 2011 and June 2015. All patients had normal renal function on the contralateral side and underwent the standard four-drug anti-tuberculosis treatment for at least four weeks before surgery. Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients, and the urinary-bladder junction of distal ureter was managed using different auto-suture techniques.

Results: Nineteen male and 8 female patients with an average age of 47.3 years (range, 36-64 years) underwent surgery. All the operations were successfully performed with­out conversion. The median operative time was 109.3 min (range, 75-138 min), the median blood loss was 157.5 mL (range, 70-250 mL), and the median hospitalization time was 3.7 days (range, 3-6 days). No serious perioperative complications occurred. Anti-tuberculosis chemotherapy was prescribed to all patients, with the entire course of treatment lasting six months. No recurrence of tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of 26.7 months (range, 6-54 months).

Conclusion: Retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection is a safe and feasible approach for the treatment of tuberculous non-functional kidneys.

Keywords: Tuberculosis, Renal; Nephroureterectomy; Nephrectomy

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Related Post

Oxidative stress in the bladder of men with LUTS undergoing open prostatectomy: a pilot study

Vol. 44 (6): 1182-1193, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.0127


ORIGINAL ARTICLE

Marcio Augusto Averbeck 1, 2, 3, Nelson Gianni de Lima 4, Gabriela Almeida Motta 1, Lauro Beltrão 2, Nury Jafar Abboud Filho 2, Clarice Pereira Rigotti 2, William Nascimento dos Santos 2, Steven Kitzberger Jaeger dos Santos 2, Luis Fernando Batista da Silva 2, Ernani Luis Rhoden 2, 3, 5
1 Departamento Pós-graduação em Ciências da Saúde da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil; 2 Serviço de Urologia, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brasil; 3 Serviço de Urologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil; 4 Serviço de Urologia, Hospital de Nossa Senhora dos Navegantes, Torres, RS, Brasil; 5 Disciplina de Urologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil

ABSTRACT

Purpose: This study aims to evaluate the link between preoperative parameters and oxida­tive stress (OS) markers in the bladder wall of men undergoing open prostatectomy.

Materials and Methods: From July 2014 to August 2016, men aged ≥ 50 years and presenting with LUTS were prospectively enrolled. Preoperative assessment included validated questionnaires (IPSS and OAB – V8), lower urinary tract ultrasound and uro­dynamics. Bladder biopsies were taken during open prostatectomy for determination of OS markers. Increased OS was defined by increased concentration of malondialdehyde (MDA) and / or decreased concentration of antioxidant enzymes (superoxide dismutase and / or catalase). P<0.05 was regarded as statistically significant.

Results: Thirty – eight consecutive patients were included. Mean age was 66.36 ± 6.44 ye­ars, mean prostate volume was 77.7 ± 20.63 cm3, and mean IPSS was 11.05 ± 8.72 points. MDA concentration was increased in men with severe bladder outlet obstruction (BOO gra­de V – VI according to the Schaefer’s nomogram) in comparison with BOO grade III – IV (p = 0.022). Patients with severe LUTS also had higher MDA concentration when compared to those with mild LUTS (p = 0.031). There was a statistically significant association between increased post – void residual urine (cut off ≥ 50 mL) and not only higher levels of MDA, but also reduced activity of SOD and catalase (p < 0.05).

Conclusions: This pilot study showed that severity of LUTS and BOO were associated with increased MDA concentration in the bladder wall of men undergoing open prosta­tectomy. Further studies are still needed to assess the role of non – invasive biomarkers of OS in predicting bladder dysfunction in men with LUTS.

Keywords: Urinary Bladder; Lower Urinary Tract Symptoms; Urinary Bladder Neck Obstruction; Oxidative Stress

[Full Text]


 

Related Post

Changing bulking agent may require change in injection volume for endoscopic treatment of vesicoureteral reflux

Vol. 44 (6): 1194-1199, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.0033


ORIGINAL ARTICLE

Ali Tekin 1,2, Ismail Yagmur 1,2, Sibel Tiryaki 1,2, Zafer Dokumcu 1, Ibrahim Ulman 1,2, Ali Avanoglu 1,2
1 Department of Pediatric Surgery, Ege University Faculty of Medicine, Izmir, Turkey; 2 Division of Pediatric Urology, Ege University Faculty of Medicine, Izmir, Turkey

ABSTRACT

Introduction: Various bulking agents were utilized for endoscopic correction of VUR. A study reviewing multi-institutional data showed that the amount of injection material has increased over time with the purpose of improving success rates, which also resul­ted in costs. We noticed an opposite trend in our center since we started using a new bulking agent. The aim of this study was to evaluate evolution of our practice with different bulking agents.

Patients and Methods: Records of VUR patients who underwent subureteric injection with polyacrylate polyalcohol copolymer (PPC) and dextronomere hyaluronic aci­de (DxHA) between 2005 and 2014 were reviewed. Variation of different parameters throughout the study period was evaluated along with the success rate. Success was defined as complete resolution of reflux.

Results: A total of 260 patients with 384 refluxing units were included. The success rate was higher in PPC group compared to DxHA group. There was no statistically significant difference between years regarding distribution of VUR grade, body weight, patient height, and age in PPC group. Despite significant reduction in injection volu­me, success rate did not decrease through the years with PPC.

Conclusion: Different bulking agents may require different injection volumes to achieve the same success rate in endoscopic treatment of vesicoureteral reflux. Habits gained with previous experience using other materials should be revised while using a new agent.

Keywords: Vesico-Ureteral Reflux; Endoscopy; Cakut [Supplementary Concept]

[Full Text]


 

Related Post

The learning curve of sting method for endoscopic injection treatment of vesicoureteral reflux

Vol. 44 (6): 1200-1206, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0465


ORIGINAL ARTICLE

Ayhan Dalkiliç 1, Göksel Bayar 2, Hasan Demirkan 3, Kaya Horasanli 3
1 Department of Urology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey; 2 Department of Urology, Martyr Prof Dr. Ilhan Varank Sancaktepe Training and Research Hospital, Turkey; 3 Department of Pediatric Urology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey

ABSTRACT

Objective: To identify how many endoscopic injection (EI) procedures, STING method, must be performed before reaching an ideal success rate when simulation training has not been received.

Materials and Methods: The EI procedures performed by two pediatric urology fellows were investigated. The study excluded patients without primary VUR and those with previous EI or ureteroneocystostomy, lower urinary tract dysfunction, and/or duplicate ureters. The EIs used dextranomer hyaluronate and the STING method, as described by O’Donnell and Puri. Groups number was determined by multiple statistical trials. Statistically significance differences were achieved with one combination that had 35 EI procedures each and with 3 different combination of patients, having 12, 24, and 36 patients, respectively. Therefore, groups were established 12 patients. The first fellow performed 54 EIs, and the second performed 51. Therefore, each of the first fellow’s three groups contained 18 EI procedures, and each of the second fellow’s 17.

Results: The study included 72 patients and 105 ureter units. When the data from both fellows were combined, each of the three groups contained 35 procedures. For the first fellow, the success rates in the first, second, and third groups were 38.3%, 66.6%, and 83.3% (p = 0.02), respectively, and for the second fellow, the success rates were 41.2%, 64.7%, and 82.3% (p = 0.045), respectively. The increased success rates for both fellows were very similar.

Conclusions: An acceptable rate of success for EI may be reached after about 20 pro­cedures and a high success rate after about 35-40 procedures.

Keywords: Learning Curve; Endoscopy; Vesico-Ureteral Reflux

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Pelvic floor electromyography and urine flow patterns in children with vesicoureteral reflux and lower urinary tract symptoms

Vol. 44 (6): 1207-1214, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.0401


ORIGINAL ARTICLE

Lida Sharifi-Rad 1, 2, Seyedeh-Sanam Ladi-Seyedian 1, Hossein Amirzargar 1, Abdol-Mohammad Kajbafzadeh 1
1 Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran; 2 Department of Physical Therapy, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran

ABSTRACT

Objective: To determine the different urine flow patterns and active pelvic floor electromyography (EMG) during voiding in children with vesicoureteral reflux (VUR) as well as presenting the prevalence of lower urinary tract symptoms in these patients.

Materials and Methods: We retrospectively reviewed the charts of children diagnosed with VUR after toilet training from Sep 2013 to Jan 2016. 225 anatomically and neurologically normal children were included. The reflux was diagnosed with voiding cystourethrography. The study was comprised an interview by means of a symptom questionnaire, a voiding diary, uroflowmetry with EMG and kidney and bladder ultrasounds. Urine flow patterns were classified as bell shape, staccato, interrupted, tower and plateau based on the current International Children’s Continence Society guidelines.

Results: Of 225 children with VUR (175 girls, 50 boys), underwent uroflowmetry + EMG, 151 (67.1%) had an abnormal urine flow pattern. An active pelvic floor EMG during voiding was confirmed in 113 (50.2%) children. The flow patterns were staccato in 76 (33.7 %), interrupted in 41 (18.2%), Plateau in 26 (11.5%), tower in 12 (5.3%) and a bell shape or normal pattern in 70 (31.5%). Urinary tract infection, enuresis and constipation respectively, were more frequent symptoms in these patients.

Conclusions: Bladder/bowel dysfunction is common in patients with VUR that increases the risk of breakthrough urinary tract infections in children receiving antibiotic prophylaxis and reduces the success rate for endoscopic injection therapy. Therefore investigation of voiding dysfunction with primary assessment tools can be used prior to treating VUR.

Keywords: Vesico-Ureteral Reflux; Lower Urinary Tract Symptoms; Urinary Bladder

[Full Text]


 

Related Post

Artificial sphincter “BR – SL – AS 904” in the treatment of urinary incontinence after radical prostatectomy: efficacy, practicality and safety in a prospective and multicenter study

Vol. 44 (6): 1215-1223, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.0128


ORIGINAL ARTICLE

Salvador Vilar Correia Lima 1, 2, Evandilson Guenes Campos de Barros 1, Fabio de Oliveira Vilar 1, Flavia Cristina Morone Pinto 2, Thomé Décio Pinheiro Barros 1, 2, José Carlos Truzzi 3, Luiz Gustavo M. de Toledo 4, Francisco Kanasiro 5, João Luiz Amaro 6
1 Serviço de Urologia, Hospital das Clínicas, Universidade Federal de Pernambuco, UFPE, Recife, PE, Brasil; 2 Departamento de Cirurgia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, UFPE, Recife, PE, Brasil; 3 Departamento de Urologia, Instituto do Câncer Dr. Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil; 4 Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil; 5 Serviço de Urologia, Hospital Santa Marcelina, Porto Velho, RO, Brasil; 6 Disciplina de Urologia, Unesp – Universidade Estadual Paulista, São Paulo, SP, Brasil

ABSTRACT

Purpose: The objective of the present study is to test the efficiency and practicality of a new artificial sphincter “BR – SL – AS – 904” in the control of urinary incontinence in post – PR patients and to evaluate their complications.

Patients and Methods: Fifteen patients with incontinence after one year of radical prostatectomy were included prospectively. All patients underwent artificial urethral sphincter (AUS) implant “BR – SL – AS – 904” according to established technique. Inde­pendent variables such as free urinary flow, PAD weight test, ICIQ – SF score and uri­nary symptoms through the IPSS score were compared in different follow-up moments.

Results: Patients submitted to AUS implantation did not present trans – operative or post – operative complications related to the surgical act such as: infection, hematoma, erosion or urinary retention. Device was inert to the body during the follow-up, sho­wing an excellent adaptation of the patients, besides the easy handling. The mean age was 68.20 years 40% of the patients had systemic arterial hypertension, 6.7% diabetes mellitus, 6.7% were hypertensive and diabetic, 13.4% were hypertensive, had diabetes and hypercholesterolemia and 26.7% patients had no comorbidities. It was evidenced that the urinary flow peak during the follow-up remained stable. Decreased averages and median PAD weight test were 135.19 to 75.72 and 106.00 to 23.50, respectively. The IPSS score decreased and the quality of life increased (12.33 to 3.40 and 2.50 to 3.20 respectively). The ICQF – SF questionnaire score also showed a decrease, ranging from 16, 71 to 7.33.

Conclusion: The artificial sphincter implant “BR – SL – AS 904” was reproducible, safe and effective in the control of urinary incontinence in post – PR patients.

Keywords: Urinary Incontinence; Urinary Sphincter, Artificial; Prostatic Neoplasms

[Full Text]


 

Related Post

Simplified method using kidney / ureter / bladder x-ray to determine the appropriate length of ureteral stents

Vol. 44 (6): 1224-1233, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0620


ORIGINAL ARTICLE

Makoto Taguchi 1, Kenji Yoshida 1, Motohiko Sugi 1, Hidefumi Kinoshita 1, Tadashi Matsuda 1
1 Department of Urology and Andrology, Kansai Medical University, Osaka, Japan

ABSTRACT

Purpose: To investigate a method to determine the appropriate length of ureteral stents, given that the stent length may lead to exacerbation of urinary symptoms if the stent crosses the bladder midline.

Materials and Methods: We retrospectively reviewed the position of the distal curl of the ureteral stent using kidney/ureter/bladder (KUB) radiographs after ureteroscopic lithotripsy in 165 patients who underwent placement of 24- or 26-cm ureteral stents.

According to the KUB findings, we categorized the position of the distal curl of the ureteral stent into two groups. In Group 1, the stents did not cross the midline (appropriate length); in Group 2, the stents crossed the midline (inappropriate length). We assessed several patient parameters (sex, height, body mass index, and stone side) and the index of ureteral length using KUB radiographs (“C-P”) and computed tomography (CT, “PV”).

Multivariate analysis was performed to identify the most significant factors affecting the position of ureteral stents. We also calculated the cutoff points of the receiver operating characteristic (ROC) curve of C-P and P-V for the position of ureteral stents.

Results: The multivariate analysis showed that C-P was the most significant factor affecting the position of ureteral stents (p < 0.001) in patients with 24- and 26-cm ureteral stents. Comparison of the ROC curves of C-P and P-V showed that C-P was superior to P-V (p < 0.01) in patients with 24- and 26-cm stents.

Conclusion: The use of KUB radiographs was effective and simple in determining the appropriate length of ureteral stents.

Keywords: Kidney; Ureter; Urinary Bladder

[Full Text]


 

Related Post

Vitamin C inhibits crystallization of struvite from artificial urine in the presence of Pseudomonas aeruginosa

Vol. 44 (6): 1234-1242, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0656


ORIGINAL ARTICLE

Muhammed A. P. Manzoor 1, Surya Ram Duwal 2, M. Mujeeburahiman 3, Punchappady-Devasya Rekha 1
1 Yenepoya Research Centre, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India; 2 Department of Biochemistry, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India; 3 Department of Urology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India

ABSTRACT  

Background: Formation of struvite stones is associated with urinary tract infection by urease-producing bacteria. Biogenic crystal growth in natural and synthetic materials is regulated by the action of inhibitors, ranging from small ions, molecules to large macromolecules.

Materials and Methods: We report the dynamics of in vitro crystallization of struvite in presence of vitamin C in synthetic urine using single diffusion gel growth technique. Sodium metasilicate gel of specific gravity 1.05 and the aqueous solution of ammo­nium dihydrogen phosphate were used as the medium for growing the struvite crystals. The crystallization process was induced by a urease positive struvite stone associated Pseudomonas aeruginosa to mimic the infection leading to stone formation. The grown crystals were characterized by ATR-FTIR and powder XRD. The surface morphology was analysed through FE-SEM for comparison between treatments.

Results: We observed decrease in number, dimension, and growth rate of struvite crys­tals with the increasing concentrations of vitamin C. Crystals displayed well-defined faces and dendritic morphology of struvite in both control and biogenic systems.

Conclusion: The results strongly suggest that, vitamin C can modulate the formation of struvite crystals in the presence of uropathogenic bacteria.

 

Keywords: Struvite; Pseudomonas aeruginosa; Ascorbic Acid

[Full Text]


Related Post

Beneficial effects of oltipraz, nuclear factor – erythroid – 2 – related factor 2 (Nrf2), on renal damage in unilateral ureteral obstruction rat model

Vol. 44 (6): 1243-1251, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.0232


ORIGINAL ARTICLE

Emre Can Polat 1, Huseyin Besiroglu 2, Levent Ozcan 3, Alper Otunctemur 1, Ahmet Tugrul Eruyar 4, Adnan Somay 5, Nurver Ozbay 5, Mustafa Cekmen 6, Ceyla Eraldemır 7, Emin Ozbek 8
1 Department of Urology, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey; 2 Department of Urology, Catalca Ilyas Cokay State Hospital, Istanbul, Turkey; 3 Department of Urology, Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey; 4 Department of Pathology, Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey; 5 Department of Pathology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey; 6 Department of Biochemistry, Istanbul Medeniyet University, Istanbul, Turkey; 7 Department of Biochemistry, Kocaeli University, Kocaeli, Turkey; 8 Department of Urology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey

ABSTRACT

Introduction: We investigated whether Oltipraz (OPZ) attenuated renal fibrosis in a unilateral ureteral obstruction (UUO) rat model.

Materials and Methods: We randomly divided 32 rats into four groups, each consisting of eight animals as follows: Rats in group 1 underwent a sham operation and received no treatment. Rats in group 2 underwent a sham operation and received OPZ. Rats in group 3 underwent unilateral ureteral ligation and received no treatment. Group 4 rats were subjected to unilateral ureteral ligation plus OPZ administration. Transforming growth factor beta-1 (TGF-β1), E-cadherin, nitric oxide (NO) and hydroxyproline levels were measured. Histopathological and immunohistochemical examinations were carried out.

Results: TGF-β1, NO and E-cadherin levels in the UUO group were significantly higher than the sham group and these values were significantly different in treated groups compared to the UUO group. In rats treated with UUO + OPZ, despite the presence of mild tubular degeneration and less severe tubular necrosis, glomeruli maintained a better morphology when compared to the UUO group. Expressions of αSMA in immunohistochemistry showed that the staining positivity decreased in the tubules of the OPZ-treated group.

Conclusions: While the precise mechanism of action remains unknown, our results demonstrated that OPZ exerted a protective role in the UUO-mediated renal fibrosis rat model highlighting a promising therapeutic potency of Nrf2-activators for alleviating the detrimental effects of unilateral obstruction in kidneys.

 

Keywords: Oltipraz [Supplementary Concept]; Renal Insufficiency; Ureter

[Full Text]


 

Related Post

Encrusted cystitis caused by corynebacterium urealyticum: a case report with novel treatment strategy of intravesical dimethyl sulfoxide

Vol. 44 (6): 1252-1255, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0588


CHALLENGING CLINICAL CASES

Tayyar Alp Ozkan 1, Mustafa Savas Yalcin 2, Ozdal Dillioglugil 2, Ibrahim Cevik 3
1 Department of Urology, Kocaeli Derince Traning and Research Hospital, Kocaeli, Tukey; 2 Department of Urology, Kocaeli University, School of Medicine, Kocaeli, Tukey; 3 Department of Urology, Okan University, School of Medicine, Istanbul, Tukey

ABSTRACT

Encrusted cystitis (EC) was first described as chronic cystitis with mucosal calcification in 1914 (1). It is a very rare chronic inflammatory disease presenting with dysuria, pelvic pain and gross hematuria. Voided urine contains mucus or calcified mucopurulent stone like particles. Urinalysis always reveals alkaline pH. It may be present in healthy individuals with no predisposing etiological factors (2-4). Etiologically, previous urological diseases, immunosuppression, urinary infection with urea splitting bacteria, or urological interventions resulting in bladder mucosa trauma may also be present (5, 6). In the present case report, we describe a novel treatment for EC with intravesical dimethyl sulfoxide.

Keywords: Corynebacterium; Cystitis; Dimethyl Sulfoxide

[Full Text]


 

Related Post

Neurofibromas of the bladder in a child with neurofibromatosis type 1

Vol. 44 (6): 1256-1257, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0199


RADIOLOGY PAGE

Gulec Mert Dogan 1, Ahmet Siğirci 1, Leyla Karaca 1
1 Department of Radiology Pediatric, Inonu University Malatya, Turkey
No abstract available

[Full Text]


Related Post

Recto-urethral fistula presenting as fever of unknown origin: a rare complication of prostatic abscess

Vol. 44 (6): 1258-1260, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0468


RADIOLOGY PAGE

Sun Hwa Lee 1, Seong Jong Yun 2, Seokyong Ryu 1
1 Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea; 2 Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea

ABSTRACT

Not available

[Full Text]


Related Post

Robotic excision of complex adrenal mass with retrocaval extension and encasement of renal hilum with renal preservation

Vol. 44 (6): 1261-1261, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0384


VIDEO SECTION

Vishnu Raveendran 1, Ramaprasad Manasseri Koduveli 1, Kishore Thekke Adiyat 1
1 Aster Medcity, Kochi, Kerala, India

ABSTRACT

Objective: The purpose of this video is to present robotic excision of a complex adrenal mass with retrocaval extension and encasement of renal hilum in a 16 year old boy. Biochemical screening was negative for metabolically active compo­nent. Computerized tomographic scan with contrast revealed a homogenous mass of approximately 10.8 cm x 6.2 cm x 4.2 cm in the suprarenal area on right side that was extend-ing behind inferior vena cava and encasing renal hilar vessels. Imaging findings were that of a classical ganglioneuroma.

Material and methods: Robot assisted laparoscopic adrenalectomy with sparing of renal hilar vasculature was performed. With patient in lateral position, five ports were used, including one for liver retraction. Da Vinci® system with four arms was docked from over the right shoulder. The displaced renal hilar structures were identified by opening Gerota’s fascia. Mass was dissected completely and removed through Pfan-nensteil incision.

Results: Duration of procedure was 345 minutes and console time was 290 minutes. Blood loss was 250 mL. Post-opera­tive renal doppler showed normal blood flow. He was discharged on post-operative day three. Histopathologic examina­tion of specimen revealed ganglioneuroma arising from adrenal gland.

Conclusion: Ganglioneuroma is a rare adrenal tumor with good prognosis on surgical removal. The advent of robotic surgery has made complex surgical procedures involving vital structures like inferior vena cava be performed using minimally invasive techniques without compromising oncologic principles.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20170384_Raveendran_et_al

Int Braz J Urol. 2018; 44 (Video #18): 1261-1

[Full Text]


Related Post

The Lithocatch (TM) by Boston Scientific: how to use it and how to solve a common problem

Vol. 44 (6): 1262-1262, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.0105


VIDEO SECTION

Giuseppe Giusti 1, Marco Lucci Chiarissi 1, Antonello De Lisa 1
1 Department of Urology, University of Cagliari, Cagliari , Italy

ABSTRACT

Introduction: The LithocatchTM basket is a immobilization device commercialized by Boston Scientific. It allows to col­lect multiple stone fragments from the ureter. The ability of the basket to capture a large number of stone fragments, is however responsible for a problem connected to its usage: the entrapment of the basket inside the ureter. In this video we explain how to use it and how to solve this problem.

Material and Methods: After positioning the LithocatchTM over the fragments, the basket is opened and it is rotated through a special handle to collect stones. One frequent problem occurs when too many fragments are collected at once, preventing the extraction of the device. We research our archives to extrapolate the total number of procedures carried out with the LithocatchTM in the last two years and the total number of complications occurred.

Results: We experienced the above mentioned complication in 16 procedures (14% of the total) of 114 surgeries per­formed. The way described to solve this complication was efficient and did not produce any damage to the ureter or to the basket.

Conclusion: The LithocatchTM has an excellent ability to capture small stones so it allows to reduce the length of the pro­cedure. Paying attention to limit the amount of fragments collected, it is possible to avoid the entrapment of the basket. If this complication occurs, the problem can be solved by reducing the size of the stone fragments. The preferable type of energy is the ballistic one.

 

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20180105_Giusti_et_al

nt Braz J Urol. 2018; 44 (Video #19): 1262-2

[Full Text]


Related Post

Addressing the challenges of reoperative robotic-assisted sacrocolpopexy

Vol. 44 (6): 1263-1264, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.0037


VIDEO SECTION

Wilson Lin 1, Nitya Abraham 2
1 Yeshiva University Albert Einstein College of Medicine, NY, USA ; 2 Department of Urology, Montefiore Medical Center, NY, USA

ABSTRACT

Sacrocolpopexy is the gold-standard repair for apical pelvic organ prolapse (POP). However, over half of women with POP who undergo the surgery experience recurrence, particularly those with higher preoperative stage, younger age, and greater body weight. We address the challenges of repairing recurrent POP in a patient with a prior transabdominal mesh sacrohysteropexy.

ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20180037_Lin_et_al

Int Braz J Urol. 2018; 44 (Video #20): 1263-4

[Full Text]


 

Related Post

A martius flap in the treatment of iatrogenic distal urogenital fistula

Vol. 44 (6): 1265-1265, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0444


VIDEO SECTION

Ivan Ignjatovic 1, 2, Dragoslav Basic 1, 2, Milan Potic 1, 2, Ljubomir Dinic 1, Aleksandar Skakic 1
1 Clinical Center Nis, Serbia; 2 University in Nis, Faculty of Medicine Nis, Serbia

ABSTRACT

Introduction: Distal urogenital fistulas (DUF) are usually iatrogenic and are uncommon in Europe. They occur in the ure­thra or near the bladder neck, and can be caused by vaginal hysterectomy, para-urethral cyst surgery, or erosion of the bladder or urethra from tension-free slings or meshes. The psychological and physical health consequences of DUF are devastating because most patients consider themselves “healthy” before surgery. Incontinence can appear after success­ful DUF closure due to previously occult incontinence or urethral incompetence. Additional surgery for incontinence is sometimes necessary to achieve satisfactory outcome.

Materials and Methods: A Martius flap was used in 23 patients between 2000 and 2015. Patient age range was 38-75 years (mean, 58.7). DUF was due to gynecologic surgery for benign disease (15 / 23; 65.2%), mesh / sling erosion (2 / 23; 8.7%), and malignancy (6 / 23; 26.1%). The follow-up period was one year.

Results: DUF was closed in 22 patients (95.6%). Satisfaction and complete dryness was achieved in 16 patients (69.6%) after the first procedure. Postoperative complications were: postoperative hematoma in 1 (4.4%), primary failure in 1 (4.4%), overactive bladder (OAB) syndrome in 3 (13.2%) and postoperative incontinence in 6 (26.4%) patients. A fascial sling was placed in patients with incontinence. All patients were dry after the secondary surgery. Anticholinergics were used for the treatment of OAB syndrome. Discomfort at the flap harvesting site was of minor importance. Finally, 22 out of 23 patients (95.6%) were satisfied.

Conclusion: A Martius flap and additional fascial sling could be successfully used to optimize DUF treatment.

 ARTICLE INFO

Available at: http://www.intbrazjurol.com.br/video-section/20170444_Ignjatovic_et_al

Int Braz J Urol. 2018; 44 (Video #21): 1265-5

[Full Text]


 

Related Post

The present and future enhanced recovery after surgery for bladder cancer

Vol. 44 (6): 1266-1271, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0282


LETTER TO THE EDITOR

Michael A. Poch 1, Sephalie Patel 2, Rosemarie Garcia-Getting 2
1 Department of Genito-Urinary Oncology, Moffitt Cancer Center, Tampa, Florida, United States; 2 Department of Anesthesia, Moffitt Cancer Center, Tampa, Florida, United States

ABSTRACT

Not available

[Full Text]


 

Related Post

The role and importance of SBRT in prostate cancer

Vol. 44 (6): 1272-1274, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.0484


LETTER TO THE EDITOR

Yasemin Cihan 1
1 Department of Radiation Oncology, Kayseri Egitim ve Arastirma Hastanesi, Hastane cad Kayseri, Kayseri, Turkey

ABSTRACT

Not available

[Full Text]


 

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Comment on ‘polygamy, sexual behavior in a population under risk for prostate cancer diagnostic: an observational study from the black sea region in turkey’

Vol. 44 (6): 1275-1276, November – December, 2018

doi: 10.1590/S1677-5538.IBJU.2018.0459


LETTER TO THE EDITOR

Mete Özkidik 1, Anar İbrahimov 2
1 Department of Urology, Sanliurfa Egitim ve Arastirma Hastanesi, Karşıyaka, Şanlıurfa, Turkey; 2 Ankara university, Ankara, Turkey

ABSTRACT

Not available

[Full Text]


 

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