Volume 44 | number 4 | Jul . Aug, 2018 -The July-August 2018 issue of the International Braz J Urol presents original contributions with a lot of interesting papers…
Vol. 44 (4): 662-663, July – August, 2018
Luciano A. Favorito 1, 2, 3
1 Professor Titular, Unidade Urogenital da Univ. Est. do Rio de Janeiro – UERJ, RJ, Brasil; 2 Urologista do Hospital da Lagoa Federal, Rio de Janeiro , RJ, Brasil; 3 Editor Associado do International Braz J Urol
The July-August 2018 issue of the International Braz J Urol presents original contributions with a lot of interesting papers in different fields: Infertility, Bariatric Surgery, Bladder Cancer, Erectile Dysfunction, Prostate Cancer, Renal Cell Carcinoma, Prostate Biopsy, Renal stones, epididymo-orchitis, Pelvic Organ Prolapse, Penile Trauma, Nocturnal Enuresis, Prenatal Hydronephrosis, Basic Research, Prostatic Utricle Cyst, Urethral Stricture and Vesico-ureteral Reflux. The papers come from many different countries such as Canada, Egypt, Lebanon, Italy, Brazil, USA, UK, Turkey, China, Taiwan, India and Spain, and as usual the editor´s comment highlights some papers. We decided to comment the paper about a very interesting topic: Bladder Diverticula in BPH.
Vol. 44 (4): 664-666, July – August, 2018
Armand Zini 1
1 Department of Surgery, St. Mary’s Hospital, McGill University, Montreal, Canada
The advent of intracytoplasmic sperm injection (ICSI) has revolutionized the management of male factor infertility (1). Shortly after the technique was introduced, studies demonstrated that ICSI could successfully treat couples with severe male factor infertility. Several investigators reported that neither sperm concentration, morphology, nor progressive motility had any impact on ICSI outcomes (2-4). However, the only sperm characteristic that portended a negative ICSI outcome was the injection of a totally immotile (and presumably dead) spermatozoon (4-6).
Testicular versus ejaculated sperm should be used for intracytoplasmic sperm injection (ICSI) in cases of infertility associated with sperm DNA fragmentation | Opinion: Yes
Vol. 44 (4): 667-675, July – August, 2018
DIFFERENCE OF OPINION
Sandro C. Esteves 1,2,3
1 ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, SP, Brasil; 2 Departamento de Cirurgia (Disciplina de Urologia), Faculdade de Ciências Médicas, Universidade de Campinas (UNICAMP), Campinas, SP, Brasil; 3 Faculty of Health, Aarhus University, 8000 Aarhus C, Denmark
Keywords: Semen; Infertility, Male; Sperm Injections, Intracytoplasmic; Sperm DNA Fragmenttion; Testicular Sperm
The use of testicular in preference over ejaculated sperm for intracytoplasmic sperm injection (ICSI) has gained increased attention due to reports of better pregnancy outcomes using testicular sperm for cases of infertility associated with high sperm DNA fragmentation (SDF) (reviewed by Esteves et al. (1)). Indeed, it has been a common practice to perform testicular sperm retrieval for ICSI (Testi-ICSI) in selected groups of non-azoospermic men. In a recent survey study involving infertility experts from 19 countries, 67% responders admitted that na abnormal SDF test result would affect their decision to utilize testicular instead of ejaculated sperm for ICSI (2). Interestingly, identical numbers were reported by attendees of an interactive debate session held during the 2017 annual meeting of the American Society for Reproductive Medicine (unpublished data).
Testicular versus ejaculated sperm should be used for intracytoplasmic sperm injection (ICSI) in cases of infertility associated with sperm DNA fragmentation | Opinion: No
Vol. 44 (4): 676-679, July – August, 2018
DIFFERENCE OF OPINION
Mark Sigman 1
1 Department of Urology Brown University and The Miriam Hospitals, RI 02906, EUA
Keywords: Semen; Infertility, Male; Sperm Injections, Intracytoplasmic; Sperm DNA Fragmenttion; Testicular Sperm
The argument for the use of testicular sperm instead of ejaculated sperm for infertility due to sperm DNA fragmentation (SDF) relies on several assumptions. When each assumption is examined, it becomes clear that the assumptions are either unproven, due to insufficient data, or just plain wrong. These assumptions are: 1) sperm DNA fragmentation assays are good diagnostic tests; 2) IVF/ICSI failed because of elevated SDF; and 3) testicular sperm will result in pregnancy or live birth when ejaculated sperm will not. It has been demonstrated that when comparing populations, SDF is greater in infertile than in fertile populations. In addition, SDF is negatively associated with pregnancy rates by IVF/ICSI with an odds ratio of 1.68 (1).
Vol. 44 (4): 680-687, July – August, 2018
Aline A. Yacoubian 1, Rami Nasr 1
1 Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
Background: Obesity is a worldwide challenging health problem. Weight loss through medical management of obesity has not always been successful, thus, giving rise to the need for surgical intervention. Bariatric surgery has been shown to be helpful for morbidly obese patients. However, studies have also shown the effect of surgery on stone formation, fertility and erectile function. This review summarizes the main findings of several studies that analyze stone formation and fertility in men as well as erectile function post bariatric surgery. The underlying pathophysiologic alterations post bariatric surgery include increased absorption of oxalate leading to hyperoxaluria, hypocitraturia and increased urinary calcium oxalate supersaturation. Contradicting data exist on the effect of bariatric surgery on fertility and erectile function. Further studies are needed to analyze the mechanisms.
Keywords: Obesity; Bariatric Surgery; Nephrolithiasis; Fertility
Diagnostic accuracy of multiparametric magnetic resonance imaging in detecting extracapsular extension in intermediate and high – risk prostate cancer
Vol. 44 (4): 688-696, July – August, 2018
Cristina Dominguez 1, Mauricio Plata 1, Juan Guillermo Cataño 1, Mauricio Palau 2, Diego Aguirre 3, Jorge Narvaez 3, Stephanie Trujillo 3, Felipe Gómez 1, Carlos Gustavo Trujillo 1, Juan Ignacio Caicedo 1, Camilo Medina 1
1 Department of Urology; 2 Department of Pathology; 3 Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia, CO
Objectives: To evaluate the diagnostic performance of preoperative multiparametric magnetic resonance imaging (mp-MRI) as a predictor of extracapsular extension (ECE) and unfavorable Gleason score (GS) in patients with intermediate and high-risk prostate cancer (PCa).
Materials and Methods: Patients with clinically localized PCa who underwent radical prostatectomy (RP) and had preoperative mp-MRI between May-2011 and December-2013. Mp-MRI was evaluated according to the European Society of Urogenital Radiology MRI prostate guidelines by two different readers. Histopathological RP results were the standard reference.
Results: 79 patients were included; mean age was 61 and median preoperative prostate-specific antigen (PSA) 7.0. On MRI, 28% patients had ECE evidenced in the mp-MRI, 5% seminal vesicle invasion (SVI) and 4% lymph node involvement (LNI). At RP, 39.2% had ECE, 26.6% SVI and 12.8% LNI. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of mp-MRI for ECE were 54.9%, 90.9%, 76%, 81% and 74.1% respectively; for SVI values were 19.1%, 100%, 77.3%, 100% and 76.1% respectively and for LNI 20%, 98.4%, 86.7%, 66.7% and 88.7%.
Conclusions: Major surgical decisions are made with digital rectal exam (DRE) and ultrasound studies before the use of Mp-MRI. This imaging study contributes to rule out gross extraprostatic extension (ECE, SVI, LNI) without competing with pathological studies. The specificity and NPV are reasonable to decide surgical approach. A highly experienced radiology team is needed to provide accurate estimations of tumor extension and aggressiveness.
Keywords: Prostatic Neoplasms; Magnetic Resonance Imaging; Prostatectomy
Changes observed in prostate biopsy practices in an inner city hospital with a high risk patient population following the 2012 uspstf psa screening recommendations
Vol. 44 (4): 697-703, July – August, 2018
Andrew W. Tam 1, Johnathan A. Khusid 1, Igor Inoyatov 1, Adan Z. Becerra 2, 3, Jonathan Davila 1, Jyoti D. Chouhan 1, Jeffrey P. Weiss 1, Llewellyn M. Hyacinthe 1, Brian K. McNeil 1, Andrew G. Winer 1
1 Department of Urology, University Hospital of Brooklyn, State University of New York Downstate College of Medicine, Brooklyn, NY, USA; 2 Department of Public Health Sciences and Division of Epidemiology, University of Rochester Medical Center, Rochester, NY, USA; 3 Department of Surgery, University of Rochester Medical Center, Surgical Health Outcomes and Research Enterprise (SHORE), Rochester, NY, USA
Introduction: We compared characteristics of patients undergoing prostate biopsy in a high-risk inner city population before and after the 2012 USPSTF recommendation against PSA based prostate cancer screening to determine its effect on prostate biopsy practices.
Materials and Methods: This was a retrospective study including patients who received biopsies after an abnormal PSA measurement from October 2008-December 2015. Patients with previously diagnosed prostate cancer were excluded. Chi-square tests of independence, two sample t-tests, Mann-Whitney U tests, and Fisher’s exact tests were performed.
Results: There were 202 and 208 patients in the pre-USPSTF and post-USPSTF recommendation cohorts, respectively. The post-USPSTF cohort had higher median PSA (7.8 versus 7.1ng/mL, p=0.05), greater proportion of patients who were black (96.6% versus 90.5%, p=0.01), and greater percentage of biopsy cores positive for disease (58% versus 29.5%, p<0.001). Multivariable analysis supported that the increase in PSA was independent of the increase in the proportion of patients who were black. The proportion of patients who were classified as D’Amico intermediate and high-risk disease increased in the post-USPSTF cohort and approached statistical significance (70.1% versus 58.8%, p=0.12).
Conclusions: Our study suggests that the USPSTF recommendations may have led to na increase in pre-biopsy PSA as well as greater volume of disease. Also, a greater proportion of patients were being classified with intermediate or high risk disease. While the clinical significance of these findings is unknown, what the data suggests is somewhat troubling. Future research should further examine these changes in a larger cohort as well as resultant long-term outcomes.
Keywords: Mass Screening; Prostatic Neoplasms; Prostate-Specific Antigen
Polygamy, sexual behavior in a population under risk for prostate cancer diagnostic: an observational study from the Black Sea Region in Turkey
Vol. 44 (4): 704-708, July – August, 2018
Abdullah Cirakoglu 1, Erdal Benli 1, Ahmet Yuce 1
1 Department of Urology, Ordu University, Faculty of Medicine, Ordu, Turkey
Aim: Although prostate cancer (PCa) is the most common cancer type in men, a replaceable risk factor has not yet been established. In our study, we assessed the relationship between the number of sexual partners, age of first sexual experience and age of first masturbation and prostate cancer incidence.
Materials and Methods: In Ordu University Department of Urology between January 2013 and September 2016, in PSA elevation and rectal examination, patients with prostate biopsy were evaluated due to nodule palpation in the prostate. At younger ages and at present, their first masturbation ages, first sexual debut ages, and total sexual partner numbers were recorded. The correlation between the obtained data and PCa frequency was evaluated.
Results: The study included 146 patients with PCa identified on biopsy and 171 patients with benign biopsy results who answered the questions. 66.7% of the ones whose biopsy results were benign and 40.6% of cancer suspects had only one sexual partner.
The median number of sexual partners was 1±4 (1-100) in the benign group and 2±6 (1-500) in the malignant group (p=0.039). There was a negative correlation between age of first sexual debut and number of partners (r: -0,479; p <0.001).
Conclusion: In our study, it appears that there may be an association between the number of sexual partners and prostate cancer in the patient group with PSA level above 4ng/mL. Avoidance of sexual promiscuity or participation in protected sex may be beneficial to protect against prostate cancer.
Keywords: Prostatic Neoplasms; Marriage; Sexual Behavior
Impact of PSA density of transition zone as a potential parameter in reducing the number of unnecessary prostate biopsies in patients with psa levels between 2.6 and 10.0 ng/mL
Vol. 44 (4): 709-716, July – August, 2018
Hugo A. Socrates Castro 1, Wagner Iared 2, José Eduardo Mourão Santos 1, Raphael Sandes Solha 2, David Carlos Shigueoka 1, Sergio Aron Ajzen 2
1 Departamento de Diagnóstico por Imagem, 2 Departamento de Radiologia, Universidade Federal de São Paulo, Unifesp, São Paulo, SP, Brasil
Purpose: To assess the accuracy of prostate-specific antigen (PSA) adjusted for the transition zone volume (PSATZ) in predicting prostate cancer by comparing the ability of several PSA parameters in predicting prostate cancer in men with intermediate PSA levels of 2.6 – 10.0 ng/mL and its ability to reduce unnecessary biopsies.
Materials and Methods: This study included 656 patients referred for prostate biopsy who had a serum PSA of 2.6 – 10.0 ng/mL. Total prostate and transition zone volumes were measured by transrectal ultrasound using the prolate ellipsoid method. The clinical values of PSA, free-to-total (F/T) ratio, PSA density (PSAD) and PSATZ for the detection of prostate cancer were calculated and statistical comparisons between biopsy-positive (cancer) and biopsy-negative (benign) were conducted.
Results: Cancer was detected in 172 patients (26.2%). Mean PSA, PSATZ, PSAD and F/T ratio were 7.5 ng/mL, 0.68 ng/mL/cc. 0.25 ng/mL/cc and 0.14 in patients with prostate cancer and 6.29 ng/mL, 0.30 ng/mL/cc, 0.16 ng/mL/cc and 0.22 in patients with benign biopsies, respectively. ROC curves analysis demonstrated that PSATZ had a higher area under curve (0.838) than F/T ratio (0.806) (P<0.001) and PSAD (0.806) (P<0.001).
With a cut-off value of 0.22 ng/mL/cc, PSATZ had 100% of sensitivity and could have prevented 24% of unnecessary biopsies.
Conclusions: PSATZ may be useful in enhancing the specificity of serum PSA. Compared to other PSA related parameters, it was better in differentiating between prostate cancer and benign prostatic enlargement. Also, PSATZ could reduce a significant number of unnecessary biopsies.
Keywords: Prostate; Biopsy; Diagnosis
Comparing the short – term outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors in patients with coronary artery disese: a prospective, randomized, controlled study
Vol. 44 (4): 717-725, July – August, 2018
Deniz Bolat 1, Bulent Gunlusoy 1, Ozgu Aydogdu 1, Mehmet Erhan Aydin 1, Cetin Dincel 1
1 Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
Introduction: To compare the perioperative outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors (TURBT) in patients with coronary artery disease (CAD).
Materials and Methods: A total of 90 CAD patients with newly diagnosed bladder cancer who underwent TURBT were randomized into monopolar TURBT (M-TURBT) and bipolar TURBT (B-TURBT) groups. Primary outcome was safety of the procedures including obturator jerk, bladder perforation, clot retention, febrile urinary tract infection and TUR syndrome. The secondary outcome was the efficacy of TURBT procedures, including complete tumor resection, sampling of the deep muscle tissue and sampling of the qualified tissues without any thermal damage.
Results: Mean ages of the patients in M-TURBT and B-TURBT groups were 71.36±7.49 and 73.71±8.15 years, respectively (p=0.157). No significant differences were found between M-TURBT and B-TURBT groups regarding complete tumor resection (76.2% vs. 87.5%, p=0.162) and muscle tissue sampling rates (71.4% vs. 64.6%,p=0.252). Obturator jerk was detected in 16.7% of the patients in M-TURBT group and 2.1% in B-TURBT group (p=0.007). No statistically significant differences were found between the groups regarding intraoperative and postoperative complications.
Conclusions: Both monopolar and bipolar systems can be used safely and effectively during TURBT procedure in CAD patients. Due to the more frequently seen obturator jerk in M-TURBT than B-TURBT, careful surgical approach is needed during M-TURBT.
Keywords: Urinary Bladder Neoplasms; Prostatectomy; Coronary Artery Disease
Acute kidney injury following radical cystectomy and urinary diversion: predictors and associated morbidity
Vol. 44 (4): 726-733, July – August, 2018
Yasser Osman 1, Ahmed M. Harraz 1, Samer El-Halwagy 1, Mahmoud Laymon 1, Ahmed Mosbah 1, Hassan Abol-Enein 1, Atalla A. Shaaban 1
1 Urology and Nephrology Center, Mansoura University, Egypt
Introduction: Acute kidney injury (AKI) after major surgeries is associated with significant morbidity and mortality. We aim to report incidence, predictors and associated comorbidities of AKI after radical cystectomy in a large cohort of patients.
Materials and Methods: We conducted a retrospective analysis of 1000 patients who underwent open radical cystectomy in a tertiary referral center. Perioperative serum creatinine measurements were used to define AKI according to the RIFLE criteria (as Risk, Injury and Failure). The predictors of AKI after surgery were determined using univariate and multivariate analyses.
Results: Out of 988 evaluable patients, AKI developed in 46 (4.7%). According to RIFLE criteria; AKI-Risk, AKI-Injury and AKI-Failure occurred in 26 (2.6%), 9 (0.9%) and 11 (1.1%) patients, respectively. Multivariate analysis showed that performing nephroureterectomy with cystectomy (Odds ratio [OR]: 4.3; 95% Confidence interval [CI]: 1.3-13.6; p=0.01) and the development of high grade complications (OR: 3.8; 95% CI 1.9-7.2; p<0.0001) were independently associated with AKI.
Conclusions: AKI is a significant morbidity after radical cystectomy and the term should be included during routine cystectomy morbidity assessment.
Keywords: Acute Kidney Injury; Cystectomy; Urinary Diversion
Vol. 44 (4): 734-739, July – August, 2018
Diler Us Altay 1, Esref Edip Keha 2, Ersagun Karagüzel 3, Ahmet Menteşe 2, Serap Ozer Yaman 2, Ahmet Alver 2
1 Department of Chemistry and Chemical Processing Technology, Ulubey Vocational School, Laboratory Technology Program, Ordu University, Ordu, Turkey; 2 Department of Medical Biochemistry, Faculty of Medicine, Karadeniz Technical University Trabzon, Turkey; 3 Department of Urology, Faculty of Medicine, Karadeniz Technical University Trabzon, Turkey
Purposes: The aim of this study was to determine the diagnostic significance of fibronectin type III domain containing protein 5 (FNDC5)/Irisin levels in the sera of patients with renal cell cancer.
Materials and Methods: In the study, 48 individuals were evaluated. The patient group included 23 subjects diagnosed with renal tumor, and the control group of 25 healthy individuals. Patients diagnosed with renal tumor received surgical treatment consisting of radical or partial nephrectomy. Blood specimens were collected and serum FNDC5/ Irisin and carcinoembryonic antigen (CEA) levels were determined using enzyme-linked immunosorbent assay (ELISA).
Results: FNDC5/irisin and CEA levels in renal cancer patients were significantly higher compared with the control group (p=0.0001, p=0.009, respectively). Also, FNDC5 levels was more sensitive and specific than CEA levels. The best cut-off points for FNDC5/ irisin were >105pg/mL and CEA were >2.67ng/mL for renal cancer.
Conclusions: FNDC5/Irisin may be used as a diagnostic biomarker for renal cancer.
Keywords: Carcinoma, Renal Cell; FNDC5 protein, rat [Supplementary Concept]; Urologic Neoplasms
The preoperative stratification of patients based on renal scan data is unable to predict the functional outcome after partial nephrectomy
Vol. 44 (4): 740-749, July – August, 2018
Riccardo Bertolo 1, 2 Cristian Fiori 1, 2 Federico Piramide 1, 2 Daniele Amparore 1, 2 Francesco Porpiglia 1, 2
1 Division of Urology, 2 Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
Introduction: eGFR-categories are used to predict functional outcome after partial nephrectomy (PN); no study categorized patients according to preoperative renal scan (RS) data. Aim of the study was to evaluate if stratification of patients according to RS is a reliable method to predict minor/major loss of renal function after PN.
Materials and Methods: We considered patients who underwent PN and RS pre-/post-PN for T1 tumor in our Institution (2007-2017). Demographics, perioperative and specifically functional data were analysed. On the basis of the baseline Split Renal Function (SRF), patients were stratified into risk-categories: 1) baseline operated-kidney SRF range 45-55%; 2) baseline operated-kidney SRF <45%. Risk categories were analysed with postoperative functional outcome: postoperative operated-kidney SRF decrease below 90% of baseline was considered significant loss of function. Contingency tables and univariate/multivariate regression were analysed looking for independent factors of postoperative functional impairment.
Results: 224 patients were analysed, 125 (55.8%) maintained >90% of their baseline function. Worse probability of maintaining ≥90 baseline renal function was found in patients with Charlson’s Comorbidity Index (CCI≥3) (p=0.004) and patients with PADUA score ≥8 (p=0.023). After stratification by baseline renal function, ischemia was the only independent factor: no effect on patients with poorer baseline renal function. Patients with baseline SRF 45-55% who did not experience ischemia had the highest probability to maintain ≥90% baseline SRF (p=0.028). Ischemia >25 minutes was detrimental (p=0.017).
Conclusions: Stratification of patients by SRF before PN is not a reliable predictor of renal functional outcome. Ischemia seems to scarcely influence patients with poorer renal function.
Keywords: Acute Kidney Injury; Nephrectomy; Carcinoma, Renal Cell
Ureteroscopy and stone treatment in the elderly (≥70 years): prospective outcomes over 5- years with a review of literature
Vol. 44 (4): 750-757, July – August, 2018
Sarah Prattley 1, James Voss 1, Stephanie Cheung 1, Robert Geraghty 1, Patrick Jones 1, Bhaskar K. Somani 1
1 University Hospital Southampton, NHS Trust, United Kingdom, UK
Objective: To assess outcomes of ureteroscopy for treatment of stone disease in the elderly. Ureteroscopy (URS) is an increasingly popular treatment modality for urolithiasis and its applications are ever expanding with the development of newer technologies. Its feasibility and outcomes within the elderly population to our knowledge remain under-reported.
Materials and Methods: We examined the patient demographics and surgical outcomes from our prospective database for patients ≥70 years who underwent URS for urolithiasis, in a 5-year period between March 2012 and December 2016.
Results: A total of 110 consecutive patients underwent 121 procedures (1.1 procedure/ patient) with a mean age of 77.2 years (range: 70-91 years). Stone location was in the kidney/ pelviureteric junction (PUJ) in 29%, ureter in 37% and in multiple locations in 34%. The initial and final stone free rate (SFR) was 88% and 97% respectively. While 73% were done as true day case procedures, 89% patients were discharged within 24 hours. Eleven patients (9%) underwent complications of which 10 were Clavien I/II including acute urinary retention, urinary tract infection, stent symptoms and pneumonia. One patient underwent Clavien IV complication where they needed intensive care unit admission for urosepsis but fully recovered and were discharged home subsequently.
Conclusion: Ureteroscopy is a safe and effective method of managing urolithiasis in elderly patients. Although most patients are discharged within 24-hours, consideration needs to be made for patients where social circumstances can impact their discharge planning.
Keywords: Ureteroscopy; Calculi; Therapeutics
Effect of phyllanthus niruri on metabolic parameters of patients with kidney stone: a perspective for disease prevention
Vol. 44 (4): 758-764, July – August, 2018
Nidia D. Pucci 1, Giovanni S. Marchini 2, Eduardo Mazzucchi 2, Sabrina T. Reis 3, Miguel Srougi 2, Denise Evazian 1, William C. Nahas 2
1 Divisão de Nutrição e Dietética, Instituto Central, Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina. São Paulo, Brasil; 2 Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brasil; 3 Laboratório de Investigação Médica, Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brasil
Phyllanthus niruri (P.niruri) or stone breaker is a plant commonly used to reduce stone risk, however, clinical studies on this issue are lacking.
Objective: to prospectively evaluate the effect of P. niruri on the urinary metabolic parameters of patients with urinary lithiasis.
Materials and Methods: We studied 56 patients with kidney stones <10mm. Clinical, metabolic, and ultrasonography assessment was conducted before (baseline) the use of P. niruri infusion for 12-weeks (P. niruri) and after a 12-week (wash out) Statistical analysis included ANOVA for repeated measures and Tukey’s/McNemar´s test for categorical variables. Significance was set at 5%.
Results: Mean age was 44±9.2 and BMI was 27.2±4.4kg/m2. Thirty-six patients (64%) were women. There were no significant changes in all periods for anthropometric and several serum measurements, including total blood count, creatinine, uric acid, sodium, potassium, calcium, urine volume and pH; a significant increase in urinary potassium from 50.5±20.4 to 56.2±21.8 mg/24-hour (p=0.017); magnesium/creatinine ratio 58±22.5 to 69.1±28.6mg/ gCr24-hour (p=0.013) and potassium/creatinine ratio 39.3±15.1 to 51.3±34.7mg/gCr24- hour (p=0.008) from baseline to wash out. The kidney stones decreased from 3.2±2 to 2.0±2per patient (p<0.001). In hyperoxaluria patients, urinary oxalate reduced from 59.0±11.7 to 28.8±16.0mg/24-hour (p=0.0002), and in hyperuricosuria there was a decrease in urinary uric acid from 0.77±0.22 to 0.54±0.07mg/24-hour (p=0.0057).
Conclusions: P.niruri intake is safe and does not cause significant adverse effects on serum metabolic parameters. It increases urinary excretion of magnesium and potassium caused a significant decrease in urinary oxalate and uric acid in patients with hyperoxaluria and hyperuricosuria. The consumption of P.niruri contributed to the elimination of urinary calculi.
Keywords: Kidney Calculi; Disease; Urolithiasis
The role of bladder diverticula in the prevalence of acute urinary retention in patients with BPH who are candidates to surgery
Vol. 44 (4): 765-770, July – August, 2018
Alexandre Iscaife 1, Gabriel dos Anjos 1, Cristovão Barbosa Neto 1, Willian Carlos Nahas 1, Miguel Srougi 1, Alberto Azoubel Antunes 1
1 Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo – FMUSP, SP, Brasil
Introduction: The urinary bladder diverticula (BD) secondary to benign prostatic hyperplasia (BPH) is a complication that can lead to urinary stasis, stone, urinary tract infection (UTI) and tumors. It’s role in acute urinary retention (AUR) is not totally understood.
Objectives: To determine the effect of BD size on AUR rates in patients with BPH candidates to surgery.
Subjects and Methods: We performed a retrospective cohort study of 47 patients with BPH and BD who underwent BPH surgery associated to complete bladder diverticulectomy from 2006 to 2016. We analyzed risk factors for AUR in patients with BD using univariate, multivariate and correlation analysis.
Results: There was a difference in the size of the diverticula, with 6.8 cm vs. 4.5 cm among patients with and without AUR respectively (p=0.005). The ROC curve showed a correlation between the size of BD and the risk of AUR. The value of 5.15 cm presented a sensitivity of 73% and a specificity of 72%. The area under the curve was 0.75 (p=0.01). Comparing groups with BD >5.0 cm vs. ≤5.0 cm, the AUR incidence was 74% and 27.8% respectively with an OR of 2.65 (1.20-5.85) (p=0.005). In the multivariate analysis, only the size of the diverticula reached statistical significance (p=0.012).
Conclusions: The diameter of BD is an independent risk factor for AUR in patients with BPH and BD who are candidates to surgery. A diameter greater than 5.15 cm increases the risk of AUR.
Keywords: Bladder Diverticulum [Supplementary Concept]; Prostatic Hyperplasia; Urinary Retention
Vol. 44 (4): 771-778, July – August, 2018
Ali Cift 1, Mehmet Ozgur Yucel 1
1 Department of Urology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
Objectives: Brucellosis is a multi-system infectious disease that is associated with inflammation, which causes an increase in acute phase reactants. Hematological inflammatory markers of brucellosis include mean platelet volume (MPV), red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR).
In this study, we aimed to evaluate the diagnostic value of hematological inflammatory markers in Brucella epididymo-orchitis (BEO), and to investigate the utility of these markers for differential diagnosis from non-Brucella epididymo-orchitis (non-BEO).
Materials and Methods: We retrospectively reviewed the records of 22 BEO and 50 non-BEO patients. Hematological parameters were recorded and compared between the two groups. The main diagnostic criteria for BEO were positive clinical findings (i.e., testicular pain, tenderness and scrotal swelling), a positive Rose Bengal test result, standard tube agglutination (STA) titer ≥ 1/160, and/or a positive blood culture.
Results: The most decisive factors in discriminating between BEO and non-BEO were NLR, RDW, and MPV, in decreasing order of their strength. Regardless of other factors, NLR values < 2.3 significantly increased the odds of BEO (OR=8.080, 95% CI: 1.929-33.843, p=0.004). After adjusting for other factors, RDW values >14.45% significantly increased the odds of BEO (OR=7.020, 95% CI: 1.749-28.176, p=0.006). Independent of the other factors, patients with MPV < 7.65 fL had a 6.336 times higher risk for BEO (95% CI: 1.393 – 28.822, p=0.017).
Conclusion: Hematological inflammatory markers such as NLR, RDW, and MPV can aid in the differential diagnosis of BEO and non-BEO.
Keywords: Brucella; Infectious Disease Medicine; Hematologic Neoplasms
Comparison of the Kelly’s plication and TOT simultaneously with vaginal hysterectomy, on the incontinence, and sexual functions
Vol. 44 (4): 779-784, July – August, 2018
Neslihan Bayramoglu Tepe 1, Omer Bayrak 2, Huseyin Caglayan Ozcan 1, Mete Gurol Ugur 1, Ilker Seckiner 2
1 Department of Obstetrics and Gynecology, University of Gaziantep, Gaziantep, Turkey; 2 Department of Urology, University of Gaziantep, Gaziantep, Turkey
Purpose: To compare the effect of vaginal hysterectomy-anterior/posterior colporrhaphy with Kelly’s plication(VH-KP), versus vaginal hysterectomy-anterior/posterior colporrhaphy-transobturator tape(VH-TOT) surgeries on incontinence, quality of life, and sexual functions in patients with pelvic organ prolapse(POP), and concurrent obvious stress urinary incontinence(SUI).
Materials and Methods: Between 2013 and 2017, fifty patients treated with VH-KP(n = 25), and VH-TOT(n = 25) due to POP and SUI, were evaluated prospective consecutively. Age, parity, duration of urinary incontinence,and the daily pad use were recorded.
Patients were filled “rinary Distress Inventory-6(UDI-6)”, “Incontinence Impact Questionnaire 7(IIQ-7)” and “Index of Female Sexual Function(IFSI)” questionnaire forms at preoperatively,and postoperative 6th month. No usage of pads was accepted as subjective cure rate.Intraoperative,and postoperative complications were noted.
Results: There was no statistically significant difference between two groups, for the mean age of the patients, parity, duration of SUI, and the daily pad use, preoperatively (p > 0.05). Decreased UDI-6 scores, IIQ-7 scores and daily pad usage, and increased IFSF scores were found statistical significantly in each group, at the postoperative 6 th month (p < 0.05). However, VH-TOT group had higher improvement rates, on UDI-6 scores (69.5% vs 63.0%, p = 0.04). In addition, it was notable that the the rates of the patients had IFSF scores ≥ 25 was higher in VH-KP group (p = 0.05). Four (16%) patients had recurrent SUI in the VH-KP group (p = 0.039) and vaginal extrusion occurred in 2 (8%) patients in the VH-TOT group (p = 0.153), postoperatively.
Conclusions: Although the effects of VH-TOT surgery are superior to conventional methods for incontinence and quality of life; negative effects on sexual functions are notable. In addition, although recurrence rates of TOT are low, complications such as vaginal extrusion are accompanied by drawbacks of mesh usage.
Keywords: Pelvic Organ Prolapse; Urinary Incontinence; Quality of Life
Clinical features of carriers of reciprocal chromosomal translocations involving chromosome 2: report of nine cases and review of the literature
Vol. 44 (4): 785-793, July – August, 2018
Xinyue Zhang 1, Hongguo Zhang 1, Cong Hu 1, Ruixue Wang 1, Qi Xi 1, Ruizhi Liu 1
1 Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China
Objective: To explore the clinical features of carriers of chromosome 2 translocations, enabling informed genetic counseling of these patients.
Materials and Methods: Eighty-two male carriers of a translocation who were infertile or receiving fertility counseling were recruited. Cytogenetic analyses were performed using G-banding. A search of PubMed was performed to determine whether the identified translocations on chromosome 2 are involved in male infertility. The relationships of translocation breakpoints with male infertility and recurrent pregnancy loss were analyzed.
Results: Of the 82 translocation carriers, 9 (11%) were carriers of a chromosome 2 translocation. Four cases had oligozoospermia or infertility, while five had normal semen. In an analysis of the literature, 55 patients who were carriers of chromosome 2 translocations were also reviewed. Breakpoints at 2p13 and 2q31 were observed in six patients each, and were the most common. Breakpoints at 2p23, 2p13, 2p11.2, 2q31, and 2q37 were associated to both pre-gestational and gestational infertility, while other breakpoints were associated with gestational infertility.
Conclusions: All breakpoints at chromosome 2 were correlated with gestational infertility. Carriers of chromosome 2 translocations should therefore receive counseling to continue with natural conception and use of different technologies available via assisted reproductive technology, such as preimplantation genetic diagnosis.
Keywords: Infertility, Male; Chromosomes, Human, Pair 2; Genetic Counseling
Vol. 44 (4): 794-799, July – August, 2018
Aliseydi Bozkurt 1, Mehmet Karabakan 2, Binhan Kagan Aktas 3, Murat Gunay 4, Ercüment Keskin 1, Erkan Hirik 1
1 Department of Urology, Erzincan University Mengucek Gazi Research and Training Hospital, Erzincan, Turkey; 2 Department of Urology, Mersin Toros State Hospital, Mersin, Turkey; 3 Department of Urology, Ankara Numune Research and Training Hospital, Ankara, Turkey; 4 Department of Clinical Biochemistry, Erzincan University Mengucek Gazi Research and Training Hospital, Erzincan, Turkey
Objective: Melatonin is a hormone secreted from the pineal gland and has anti-oxidative and anti-inflammatory effects. Oxidative stress is considered as an important factor in the etiology of erectile dysfunction (ED), and in many experimental models, positive results have been obtained with melatonin treatment. This study aimed to measure serum melatonin levels in ED patients and to investigate the possible relationship between ED and melatonin levels.
Materials and Methods: Sixty-two patients diagnosed with mild, moderate or severe ED according to the five-item International Erectile Function Index (IIEF-5) and 22 healthy individuals were included in the study. The serum melatonin levels, anthropometric data, and other biochemical and hormonal parameters of all the subjects were recorded. Detailed anamnesis was also obtained in terms of diabetes, hypertension, cardiovascular diseases, smoking status, and alcohol use.
Results: The serum melatonin level was found 34.2±13.3 ng/dL in the mild ED group, 33.3±14.7 ng/dL in the moderate ED group, 34.8±17.2 ng/dL in the severe ED group, and 44.6±16.5 ng/dL in the control group. The serum melatonin levels were significantly lower in all ED groups compared to the control group (p=0.019). There was no significant difference in the serum melatonin levels between the three ED groups. Diabetes, hypertension, cardiovascular diseases, smoking and alcohol use were not significantly different between the ED groups (p>0.05).
Conclusion: We consider that if our findings are supported by further studies with larger populations, the measurement of the serum melatonin level may have a future role in the diagnosis and treatment of ED.
Keywords: Erectile Dysfunction; etiology [Subheading]; Melatonin; Oxidative Stress
Vol. 44 (4): 800-804, July – August, 2018
Rodrigo Barros 1, Matheus Guimarães 1, César Nascimento Jr. 1, Luis Rogério Araújo 1, Leandro Koifman 1, Luciano Alves Favorito 2, 3
1 Hospital Municipal Souza Aguiar, Rio de Janeiro , RJ, Brasil; 2 Universidade do Estado do Rio de Janeiro, UERJ, Rio de Janeiro, RJ, Brasil; 3 Serviço de Urologia do Hospital Federal da Lagoa, Rio de Janeiro , RJ, Brasil
Objective: To report our institutional experience with penile refracture, including demographic data, recurrence time, etiology and operative findings in the first and second episodes.
Materials and methods: Between January 1982 and September 2017, 281 patients underwent surgical treatment for penile fracture (PF) at our institution. Demographic data, clinical presentation, besides operative findings and follow-up of patients with relapsed PF were retrospectively assessed by reviewing medical records.
Results: Of a total of 281 cases of PF operated at our institution, 3 (1.06%) patients experienced two episodes of trauma. Age ranged from 38 – 40 years (mean: 39.3). The recurrence time varied from 45 to 1560 days (mean: 705). Two patients presented the new fracture episode at the same site of the previous lesion, while in the other case the lesion was observed at another site.
Conclusion: Recurrent FP is an extremely rare entity. The risk factors for its occurrence are still unknown. Although the lesion of the corpus cavernosum ipsilateral to the scar tissue of the prior FP is more common, contralateral rupture may be present. Nevertheless, prospective studies with larger samples should be conducted.
Keywords: Penis; etiology [Subheading]; Diagnostic Techniques, Surgical
Are uroflowmetry and post – void residual urine tests necessary in children with primary nocturnal enuresis?
Vol. 44 (4): 805-811, July – August, 2018
Shang-Jen Chang 1, Stephen Shei-Dei Yang 1
1 Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan, and School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
Objectives: To examine the benefits of repetitive uroflowmetry and post void residual urine (PVR) tests in children with primary nocturnal enuresis (PNE).
Material and methods: Children aged ≥6 years with PNE who visited our clinics for management of enuresis were included for study. Patients were requested to complete a questionnaire including baseline characteristics and Dysfunctional Voiding Symptom Score (DVSS), 2-day bladder diary, and Rome III criteria for constipation. Two uroflowmetry and PVR tests were requested. Children with congenital or neurogenic genitourinary tract disorders were excluded. All children underwent urotherapy and desmopressin combined with anticholinergics or laxatives if indicated. The definition of abnormal flow patterns (≥1 abnormal), elevated PVR (≥1 abnormal), small maximal voided volume (MVV), nocturnal polyuria (NP) and response to treatment complied with the ICCS standardization document. Kaplan-Meier survival analysis and Cox proportional-hazards regression tests were used to evaluate the predictors of response.
Results: In total, 100 children aged 8.5}2.3 years were enrolled for study (M: F=66:34) with 7.3}7.4 months of follow-up. Poor correlation was observed between DVSS/small MVV and PVR (p>0.05). Univariate analysis revealed that elevated PVR is associated with significantly less hazard of complete response to medical treatment (HR: 0.52, p=0.03), while not significantly associated with abnormal flow patterns, NP, constipation or small MVV. Multivariate analysis revealed that only elevated PVR (HR 0.30, 95% CI 0.12-0.80) and NP (HR 2.8, 95% CI 1.10-7.28) were significant predictors for complete response.
Conclusions: In managing pediatric enuresis, elevated PVR is a significant predictor for lower chance of complete response to treatment whether they had high DVSS or not.
Keywords: Urinary Bladder, Neurogenic; Enuresis; Child
Vol. 44 (4): 812-818, July – August, 2018
Osama M. Sarhan 1, 2, Ahmed El Helaly 2,3, Abdulhakim Al Otay 2, Mustafa Al Ghanbar 2, Ziad Nakshabandi 2
1 Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 2 Division Urology Pediatric, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 3 Mansoura Health Insurance Hospital, Mansoura, Egypt
Purpose: To assess the need for postnatal evaluation and the medium term outcome in patients with isolated unilateral low grade prenatally detected hydronephrosis.
Materials and Methods: We prospectively selected 424 patients (690 kidney units) with a prenatal diagnosis of urinary tract dilatation between 2010 and 2013. We included only those patients with isolated unilateral low-grade hydronephrosis who underwent at least 2 postnatal ultrasound examinations. The Society for Fetal Urology (SFU) grading system was utilized for assessment of the hydronephrosis. We excluded patients with bilateral dilation or other urological abnormalities. The fate of hydronephrosis including resolution, stability or worsening was documented.
Results: A total of 66 infants (44 boys and 22 girls) with antenatally diagnosed unilateral urinary tract dilation (23 right and 43 left) were identified. Ultrasounds showed SFU grade 1 hydronephrosis in 32 patients (48%) and SFU grade 2 hydronephrosis in 34 (52%). After a mean follow-up period of 32 months (range 12 to 60), 37 patients (56%) had complete resolution of hydronephrosis while the remaining 29 were stable (44%). None of our patients developed UTIs during follow-up and none required surgical intervention.
Conclusions: Prenatally detected, isolated unilateral low-grade hydronephrosis usually have a favorable prognosis. All cases in our cohort showed either stability or resolution of hydronephrosis without any harmful consequences. Based on our findings on medium-term in this category of patients, long-term follow-up is not warranted.
Keywords: Hydronephrosis; Follow-Up Studies; Urinary Tract
Pro – inflammatory cytokines and metalloproteinase activation in polypropylene mesh implant in rat subcutaneous tissue
Vol. 44 (4): 819-825, July – August, 2018
Elaine Bronzatto 1, Cássio Luis Zanettini Riccetto 1
1 Departamento de Urologia, Universidade Estadual de Campinas – Unicamp, Campinas, SP, Brasil
Aims and Objectives: Polypropylene meshes have been increasingly adopted for correction of pelvic organ prolapse due to its lower recurrence rate when compared to surgeries without meshes. The study of the interaction of these materials with the host tissue may contribute to the development of materials with best biocompatibility and, consequently, less complication rates.
Materials and Methods: The present study compares the inflammatory reaction of standard-weight (SW) and lightweight (LW) meshes (72 g/m216g/m2 respectively), implanted in the abdomen of 20 adult rats, which were euthanized in four or 30 days.
Quantification of pro-inflammatory markers, IL-1 and TNF-α, and of metalloproteinases, MMP2 and MMP3, were carried out through immunohistochemistry with AxioVision ® software.
Results: There were no significant differences in the quantification of IL-1 and TNF-α in LW versus SW meshes. However, IL-1 quantification increased along time (30 days >4 days, p=0.0269). Also, MMP-2 quantification was similar to SW and LW and both presented a significant increase along time (30 days >4 days, p <0.0001). MMP-3 quantification also showed no difference between the SW and LW groups, but increased along time (30 days >4 days, p=0.02).
Conclusions: Mesh’s density did not influence the quantification of pro-inflammatory cytokines IL-1 and TNF-α and metalloproteinases 2 and 3. The increased expression of IL-1, MMP-2 and MMP-3 over time could represent a longstanding inflammatory response after PP mesh implantation. Possibly, the occurrence of adverse events following PP prosthetic implants can be influenced by other factors, not solely related to the amount of implanted material.
Keywords: Metalloproteases; Cytokines; Polypropylenes; polyamide mesh [Supplementary Concept]
Vol. 44 (4): 826-830, July – August, 2018
CHALLENGING CLINICAL CASES
Vikash Kumar 1, Chirag Punatar 1, Kunal Jadhav 1, Sharad Sagade 1
1 Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
Prostatic utricle cyst is a rare congenital anomaly. Symptomatic cysts require treatment. Surgical excision is the treatment of choice, but is challenging due to close proximity to vas deferens, ejaculatory ducts, bladder, prostate, rectum and pelvic nerves. Complications include rectal injury, ureteral injury, impotence, infertility and faecal incontinence. We here report a rare complication in which bladder was accidentally removed during laparoscopic excision of prostatic utricle cyst. To best of our knowledge such a complication has never been reported previously. We also describe the possible cause of this accident and suggest ways to prevent this disastrous complication.
Keywords: Cystectomy; Intraoperative Complications; Prostate
Vol. 44 (4): 831-834, July – August, 2018
CHALLENGING CLINICAL CASES
Cristiano Linck Pazeto 1, Fábio José Nascimento 1, Lucila Heloisa Simardi Santiago 2, Sidney Glina 1
1 Departamento de Urologia, Faculdade de Medicina do ABC (FMABC), Santo André, SP, Brasil; 2 Departamento de Patologia, Faculdade de Medicina do ABC (FMABC), Santo André, SP, Brasil
Context: Polyacrylate-polyalcohol copolymer is a synthetic product, non-biodegradable, with low rate of therapeutic failure and lower incidence of reactions at the site of injection, when compared to biodegradable agents. We report an unprecedent, exuberant and persistent inflammatory reaction following injection of that substance.
Patient: a 17 years-old patient with vesico-ureteral reflux and complete pyelocaliceal right duplication was submitted to treatment with polyacrylate-polyalcohol copolymer (STING technique). In the seventh day of post-operatory, she presented intense dysuria and hypogastric pain, without laboratory exams alterations; a symptomatic treatment was started. After two months, the symptoms persisted and an ultrasound detected thickening of bladder wall close to the uretero-vesical junction. After that exam, a cystostopic biopsy showed epithelial hyperplasia with increased edema of lamina propria, suggesting an adverse reaction to the polymer. After four months, there was complete remission, but the reflux persisted with the same grade.
Hypothesis: This is an unprecedent reaction following injection of this copolymer. The presence of characteristics such as absence of infection, temporal relation between treatment and beginning of symptoms, and detection of epithelial hyperplasia at the local of injection reinforce the hypothesis of association of the substance and adverse reaction. In that patient, important complains motivated early investigation of urinary tract, that confirmed those aspects. Maybe if that reaction had occurred in patients with lower capacity of expression (such as in infants) it would be unnoticed.
Keywords: lidocaine-polyacrylate [Supplementary Concept]; Vesico-Ureteral Reflux; Hyperplasia
Vol. 44 (4): 835-837, July – August, 2018
Pablo Garrido-Abad 1, Miguel Ángel Rodríguez-Cabello 1, Cristina González-Gordaliza 2, Roberto Vera-Berón 3, Arturo Platas-Sancho 1
1 Department of Urology, Hospital Universitario Sanitas La Moraleja, Madrid, Spain; 2 Department of Radiology, Hospital Universitario Sanitas La Moraleja, Madrid, Spain; 3 LABCO (SYNLAB) Pathology, Madrid, Spain
No abstract available
Double inlay plus ventral onlay buccal mucosa graft for simultaneous penile and bulbar urethral stricture
Vol. 44 (4): 838-839, July – August, 2018
Luciano A. Favorito 1, Paulo P. Conte 1, Ulisses G. Sobrinho 1, Rodrigo G. Martins 1, Tomas Accioly 1
Seção de Urologia, Hospital Federal da Lagoa – Rio de Janeiro, RJ, Brasil
Objectives: Buccal mucosa grafts and fascio-cutaneous flaps are frequently used in long anterior urethral strictures (1). The inlay and onlay buccal mucosa grafts are easier to perform, do not need urethral mobilization and generally have good long-term results (2-4). In the present video, we present a case where we used a double buccal mucosa graft technique in a simultaneous penile and bulbar urethral stricture.
Materials and Methods: A 54 year-old male patient was submitted to appendectomy where a urethral catheter was used for two days in May 2015. Three months after surgery, the patient complained of acute urinary retention and a supra-pubic tube was indicated. Urethrocystography was performed two weeks later and showed strictures in penile and bulbar urethra with 3.5 cm and 3 cm in length respectively. Urethroplasty was proposed for the surgical treatment in this case. We used a perineal approach with a ventral sagittal urethrotomy in both strictures. Penile urethra stricture measuring 3.5 cm in length was observed and a free graft from the buccal mucosa was harvested and placed into the longitudinal incision in the dorsal urethra and fixed with interrupted suture as dorsal inlay. Bulbar urethra stricture measuring 3 cm was observed and a free graft from the buccal mucosa was harvested and placed into the longitudinal incision in the ventral urethra and fixed with interrupted suture as ventral onlay. The ventral urethrotomy was closed over a 16Fr Foley catheter and the skin incision was then closed in layers.
Results: No intraoperative or postoperative complications occurred. The patient could achieve satisfactory voiding and no complication was seen during the six-month follow-up. Postoperative imaging demonstrated a widely patent urethra, and the mean peak flow was 12 mL/s.
Conclusion: The BMG placement can be ventral, dorsal, lateral or combined dorsal and ventral BMG in the meeting of stricture but the first two are most common (5, 6). Ventral location provides the advantages of ease of exposure and good vascular supply by avoiding circumferential rotation of the urethra (7). Early success rates of dorsal and ventral onlay with BMG were 96 and 85%, respectively. However, long-term follow-up revealed essentially no difference in success rates (8-11). Anterior urethral stricture treatments are various, and comprehensive consideration should be given in selecting individualized treatment programs, which must be combined with the patient’s stricture, length, complexity, and other factors. Traditionally, anastomotic procedures with transection and urethral excision are suggested for short bulbar strictures, while longer strictures are treated by patch graft urethroplasty preferably using the buccal mucosa as gold-standard material due to its histological characteristics. The current management for complex urethral strictures commonly uses open reconstruction with buccal mucosa urethroplasty. However, there are multiple situations whereby buccal mucosa is inadequate (pan-urethral stricture or prior buccal harvest) or inappropriate for utilization (heavy tobacco use or oral radiation). Multiple options exist for use as alternatives or adjuncts to buccal mucosa in complex urethral strictures (injectable antifibrotic agents, augmentation urethroplasty with skin flaps, lingual mucosa, colonic mucosa, and new developments in tissue engineering for urethral graft material). In the present case, our patient had two strictures and we chose to correct the first stricture with a dorsal graft and the bulbar stricture with a ventral graft because of our personal expertise. We can conclude that the double buccal mucosa graft is easier to perform and can be an option to repair multiple urethral strictures.
Available at: http://www.intbrazjurol.com.br/video-section/20170067_Favorito_et_al
Int Braz J Urol. 2018; 44 (Video #9): 838-9
Dusting utilizing suction technique (DUST) for percutaneous nephrolithotomy: use of a dedicated laser handpiece to treat a staghorn stone
Vol. 44 (4): 840-841, July – August, 2018
Khurshid R. Ghani 1,2, Ali H. Aldoukhi 2, William W. Roberts 2
1 Department of Surgery, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; 2 Department of Urology, University of Michigan, Ann Arbor, MI, USA
No abstract available
Retzius-sparing robot-assisted radical prostatectomy is safe for patients with prior transurethral prostate surgery
Vol. 44 (4): 842-843, July – August, 2018
Lawrence H. C. Kim 1, Glen Denmer Santok 1, Ali Abdel Raheem 1, 2, Kidon Chang 1, Trenton Lum 1, Byung Ha Chung 1, Young Deuk Choi 1, Koon Ho Rha 1
1 Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea; 2 Department of Urology, Tanta University Medical School, Egypt
No abstract available
Vol. 44 (4): 844-845, July – August, 2018
Rafael Batista Rebouças 1,2,3, Rodrigo Campos Monteiro 1,3, João Paulo Pereira Lima 1, Filipe de Pádua B. F. Almeida 1,Cesar Araujo Britto 4, Marcos Tobias Machado 5, Carlo Passerotti 6,7
1 Departamento de Urologia, Hospital da Polícia Militar Edson Ramalho, João Pessoa, PB, Brasil; 2 Departamento de Urologia, Universidade de João Pessoa – UNIPE, João Pessoa, PB, Brasil; 3 Departamento de Uro-oncológica, Hospital São Vicente de Paulo, João Pessoa, PB, Brasil; 4 Departamento de Urologia, Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil; 5 Faculdade de Medicina do ABC, Santo André, SP, Brasil; 6 Centro de Cirurgia Robótica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil; 7 Departamento de Urologia, Escola de Medicina de São Paulo – Laboratório de Investigação Médica (LIM55), São Paulo, SP, Brasil
Introduction: Preservation of urinary continence is a great challenge in Radical Prostatectomy. In order to improve functional results, Asimakopoulos et al. (2010) described a robot-assisted surgical technique with preservation of the pubovesical complex (PVC). We present a pure laparoscopic execution.
Presentation: A 61-year-old male patient with a diagnosis of prostate cancer, with PSA 6.54ng/ml, DRE: T1C and Gleason 6 (3+3) 1/12 fragments. All therapeutic possibilities were discussed, including active surveillance. The patient opted for surgical treatment.
A transperitoneal technique was used. We started the dissection on the left side, in the limit between the detrusor and the base of the prostate. The left seminal vesicle was dissected and left neurovascular bundle released by a high anterior dissection. We repeated the same procedure on the right side. The urethra was then divided, prostatic apex was laterally drawn and PVC was released. The bladder neck was divided and an urethrovesical anastomosis was achieved. A pelvic drain was placed.
Results: The total operative time was 150 minutes. The estimated blood loss was 300mL. The drain was removed on the 1st postoperative day and the patient was discharged. The Foley catheter was removed after 7 days and the patient remained completely dry. Hystopathology revealed adenocarcinoma Gleason 6, negative margins. PSA after 30 days was <0.04ng/mL, and the patient reported partial penile erection.
Conclusion: The Pubovesical Complex-Sparing Technique on Laparoscopic Radical Prostatectomy was feasible and safe.
Further adequately designed studies are needed to confirm whether this technique enhances early functional outcomes.
Int Braz J Urol. 2018; 44 (Video #12): 844-5
Re: Endourologic strategies for a minimally invasive management of urinary tract stones in patients with urinary diversion
Vol. 44 (4): 846-847, July – August, 2018
LETTER TO THE EDITOR
Ines Mendes Pina, 1, Michael S. Floyd Jr. 1, Simon R. Stubington 2
1 Department of Reconstructive Urology, St Helens & Knowsley Hospital NHS Trust, United Kingdom, UK; 2 Department of Urology, Michael Heal Unit, Mid Cheshire Hospital NHS Foundation Trust, United Kingdom, UK
REPLY TO THE AUTHORS: Re: Endourologic strategies for a minimally invasive management of urinary tract stones in patients with urinary diversion
Vol. 44 (4): 848-849, July – August, 2018
LETTER TO THE EDITOR
FangLing Zhong 1, Gurioli Alberto 2, GuangMing Chen 1, Wei Zhu 1, FuCai Tang 1, Guohua Zeng 1, Ming Lei 1
1 Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China; 2 Department of Urology, Turin University of Studies, Turin, Italy
Vol. 44 (4): 850-851, July – August, 2018
LETTER TO THE EDITOR
Ines Mendes Pina 1, Ahmed M. Omar 1, Rauf N. Khadr 2, Michael S. Floyd Jr. 1, 2
1 Department of Reconstructive Urology, St Helens & Knowsley Hospital NHS Trust, Whiston Hospital, Liverpool, United Kingdom, UK; 2 Northwest Regional Spinal Cord Injury Unit, Southport & Ormskirk NHS Foundation Trust, Town Lane, Kew, Merseyside, United Kingdom, UK