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Volume 43 | number 6 | November . December, 2017 – In November, 5th, 2017, on the day Dr. Anthony J. Thomas Jr. would turn 74, he passed away. He was an internationally recognized reputed urologist

Editorial: Anthony J. Thomas Jr.

Vol. 43 (6): 1012-1012, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2017.06.01

EDITORIAL in This Issue

In November, 5th, 2017, on the day Dr. Anthony J. Thomas Jr. would turn 74, he passed away. He was an internationally recognized reputed urologist, that popularized microsurgery in the urological community.

Tony was a great friend of Brazilian Urology. He opened the doors of the Cleveland Clinic Foundation to Brazilian urologists. When he introduced me to his colleagues during meetings, he always stressed that I was his first fellow at Cleveland Clinic; he joined the Clinic in 1982, and worked there for more than 30 years. During that period, many other Brazilians attended fellowship under his guidance.

He always supported SBU and many times helped us bring several American experts to our Congresses without costs. He himself attended several Brazilian Congresses of Urology, and many national courses on Infertility.

But Tony’s main quality was that he was a Family man. He involved his heart in all his actions. His patients firstly were persons that deserved his greater respect. He was a very thoughtful person, always with a nice and pleasant word for all. His concern with his fellows was touching. My car was very old, and he always would catch me when we had meetings together, since he was afraid that I would not make it due to mechanical problems. And I lived in the other side of the city! Probably he was the most honest, ethical and professional man that I have ever met.

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Focal therapy will be the next step on prostate cancer management? | Opinion: Yes

Vol. 43 (6): 1013-1016, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2017.06.02


Stênio de Cássio Zequi 1,2
1 Editor Associado, International Braz J Urol; 2 Divisão de Urologia do A.C. Camargo Cancer Center Fundação A. Prudente, São Paulo, Brasil

Keywords: Therapeutics; Prostatic Neoplasms; Disease Management; Kidney Neoplasms

In the last decades, the main goal of the treatment of several solid malignancies was the maintenance of high cure rates, along with morbidity reduction. As occurred with the drastic reduction of radical mastectomies for breast cancer and popularization of nephron sparing surgeries for kidney cancer, winds for reducing the radicality of prostate cancer (PC) treatment are blowing the candles.

Despite of recent recommendations against PC screening, the high rates of overdiagnosis and overtreatment of PC patients are still observed and relevant. Nowadays, many of PC cases are diagnosed in early stages, comprising no more than 5 or 10% of the gland, and much of them are low or intermediate risk PC (1-3). However, for decades, the accepted treatments for all localized PC cases have not changed and were based in whole gland therapies (WGT), for example: radical prostatectomy, or radical external beam radiotherapy, brachytherapy, cryotherapy, HIFU or androgen deprivation (1-3).

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Focal therapy will be the next step on prostate cancer management? | Opinion: No

Vol. 43 (6): 1017-1020, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2017.06.03


Wagner Eduardo Matheus 1, Ubirajara Ferreira 2
1 Departamento de Cirurgia, Departamento de Uro-oncologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brasil; 2 Departamento Urologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil

Keywords: Therapeutics; Prostatic Neoplasms; Disease Management; Kidney Neoplasms

Several procedures are being described to treat prostate cancer (PCa) using minimally invasive methods (MIM), in order to achieve total cure of the disease, lower side effects and preservation of quality of life. However, we must pay maximum attention to existing scientific studies, verifying follow-up time, number of patients treated and well-designed comparative studies.

In spite of all technological advances, curative surgery is still the most important treatment for localized PCa. Alternatives to radical prostatectomy include active surveillance (for minimum volume or indolent tumors), radiotherapy and focal treatment.

Evidences obtained by randomized controlled studies show that there are very few differences among active surveillance, surgery and radiotherapy, regarding global and specific survival of low risk localized PCa in a medium follow up of 10 years. Choice of treatment by patients many times is related to urinary and rectal side effect rates presented (1-5), and cultural, economic, psychological and emotional aspects.

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Prostate cancer in renal transplant recipients

Vol. 43 (6): 1021-1032, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0510


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



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


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

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

Vol. 43 (6): 1033-1042, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0494


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



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

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

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

Results: We provide ‘tips and tricks’ for optimizing the procedure and proper positioning of the RBI. Please watch the animation, see video in

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

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

Keywords: Prostatic Neoplasms; Radiotherapy; Biodegradable Plastics

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

Vol. 43 (6): 1043-1051, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0627


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


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

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

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

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

Keywords: Prostatectomy; Anastomosis, Surgical

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

Vol. 43 (6): 1052-1059, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2017.0218


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


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

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

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

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

Keywords: Urinary Bladder Neoplasms; Hydronephrosis; Therapeutics

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

Vol. 43 (6): 1060-1067, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0595


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


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

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

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

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

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

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

Vol. 43 (6): 1068-1074, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0619


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


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

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

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

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

Keywords: Fosfomycin; Prostate; Biopsy

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Nephrometry scores and perioperative outcomes following robotic partial nephrectomy

Vol. 43 (6): 1075-1083, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0571


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



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

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

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

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

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

Keywords: Kidney Neoplasms; Nephrectomy; Robotics

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

Vol. 43 (6): 1084-1091, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0258


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



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

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

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

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

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

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

Vol. 43 (6): 1092-1101, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0350


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


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

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

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

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

Keywords:  Prostatic Hyperplasia; Prostate; Urinary Bladder

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

Vol. 43 (6): 1102-1109, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0586


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


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

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

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

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

Keywords: Nomograms; Diagnosis; Calculi

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

Vol. 43 (6): 1110-1114, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0630


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


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

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

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

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

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

Keywords: Calculi; Lithotripsy; therapy [Subheading]

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

Vol. 43 (6): 1115-1121, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0233


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


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

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

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

Vol. 43 (6): 1122-1128, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0622


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



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

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

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

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

Keywords:  Urinary Bladder, Overactive; Botulinum Toxins

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Schooling impacts on the overactive bladder diagnosis in women

Vol. 43 (6): 1129-1135, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0575


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


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

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

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

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

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

Keywords: Women; Urinary Bladder; Diagnosis

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

Vol. 43 (6): 1136-1143, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0005


Lucio Dell’Atti 1

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


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

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

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

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

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

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

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

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

Vol. 43 (6): 1144-1151, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0269


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


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

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

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

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

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

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

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Transition to adulthood with a bladder augmentation: histopathologic concerns

Vol. 43 (6): 1152-1159, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0548


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


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

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

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

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

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

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

Keywords: Urinary Bladder; Neoplasms; Pediatrics

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

Vol. 43 (6): 1160-1166, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0546


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



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

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

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

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

Keywords:  Ischemia; Oxidative Stress; Spermatic Cord Torsion

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

Vol. 43 (6): 1167-1175, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0677


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


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

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

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

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

Keywords: Prostatic Hyperplasia; Botulinum Toxins; Testosterone

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

Vol. 43 (6): 1176-1184, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0466


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


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

Keywords: Minimally Invasive Surgical Procedures; Prostatectomy; Urinary Incontinence

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A case of retroperitoneal fibrosis responding to steroid therapy

Vol. 43 (6): 1185-1189, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0520


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


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

Keywords: Retroperitoneal Fibrosis; Therapeutics; Steroids

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Gas surrounding the urinary bladder in emphysematous cystitis

Vol. 43 (6): 1190-1191, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0555


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


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

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

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

Vol. 43 (6): 1192-1192, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0227


Peter A. Caputo 1, Daniel Ramirez 1, Matthew Maurice 1, Ryan Nelson 1, Onder Kara 1, Ercan Malkoc 1, David Goldfarb 1, Jihad Kaouk
1 Departament of Urology Cleveland Clinic, Cleveland, Ohio, United States


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

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

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

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

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

Vol. 43 (6): 1193-1193, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0259


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


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

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

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

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

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Surgical management of female paraurethral cyst with concomitant stress urinary incontinence

Vol. 43 (6): 1194-1194, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2014.0582


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



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

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

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

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


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Alternative approach of a Fibroepithelial polyp

Vol. 43 (6): 1195-1195, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0471


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


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


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

Vol. 43 (6): 1196-1197, November – December, 2017

doi: 10.1590/S1677-5538.IBJU.2017.0306


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

No abstract available

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