Volume 43 | number 5 | September . October, 2017 – The fate of some urologic innovations from the last century
Vol. 43 (5): 796-797, September – October, 2017
EDITORIAL in this Issue
Stênio de Cássio Zequi
Editor Associado, International Braz J Urol
Divisão de Urologia do A.C. Camargo Cancer Center
Fundação A. Prudente, São Paulo, Brasil
Around the 1980’s the external shockwave lithotripsy (ESWL) promoted a revolution in the millenary open surgical approach of urinary stones. After the ESWL, the Endourology procedures and its devices progressed a lot, but several controversies persist in this area, as: What is the best approach during the flexible ureteroscopic lithotripsy, to promote stone fragmentation or dusting? These two visions were put underdebate in the Difference of Opinion Section (page 798), respectively by the doctors Meller and Lopes Neto, from Brazil. During this time, ESWL had expanded its applications in in Orthopedics and in Pain Medicine. More recently, new ESWL devices, were developed for new a urologic use: The treatment of erectile dysfunction, but this approach is subject of doubts and some skepticism. To help our readers in understanding this kind of treatment, a Chinese Group performed a review of 15 studies and a metanalisys of 4 controlled randomized trials, focusing in the early treatment results (30 days after intervention) They concluded that low intensity ESWL results in better improvement of erectile function in comparison with the sham treatment groups (page 805)…
Vol. 43 (5): 798-801, September – October, 2017
DIFFERENCE OF OPINION
Alex Meller 1
1 Divisão de Endourologia e Litíase Renal e Disciplina de Urologia – Universidade Federal de São Paulo, UNIFESP/EPM, SP, Brasil
Keywords: Calculi; Lasers, Solid-State; Kidney
Since the introduction of Holmiun YAG (Ho-YAG) laser to treat kidney or ureteral stones, a dramatic change in techniques of stone treatment has occurred, especially how to adjust the ideal laser setting to achieve ideal fragmentation.
First reports of Ho-YAG laser clinical application had been focused on tissue cutting or destruction (1), but few years later, the ability to fragment stones through a thermal mechanism was demonstrated (2). The laser emission superheats water surrounding the laser fiber tip, thus creating a microscopic vaporization bubble that is able to destabilize or vaporize tissue or a stone. Based on this mechanism, the ideal energy setting to treat a stone had been discussed and evaluated….
Vol. 43 (5): 802-804, September – October, 2017
DIFFERENCE OF OPINION
Antonio Correa Lopes Neto 1
1 Grupo de Litíase e Endourologia da Disciplina de Urologia da Faculdade de Medicina ABC, Santo André, SP, Brasil
Keywords: Calculi; Lasers, Solid-State; Kidney
Flexible ureterorenolithotripsy is rapidly developing and becoming the treatment of choice around the World for the invasive treatment of lithiasis (1). According to calculi dimensions, they can be removed integrated or by using an intracorporeal lithotripter. According to laser parameters adjustments, it is possible to vaporize calculi (“dusting”). In this case, it is necessary to use high frequency of impulses (>15HZ), low energy (<0.5J) and long pulses (800 ᶭsec), whenever the equipment allows for these options. Recently, it has been debated which is the best way to program the equipment at the moment of calculi lithotripsy. There are few evidences in literature to conclude, but it seems that dusting has some advantages in relation to fragmentation + basketing…
Short-term efficacy and safety of low-intensity extracorporeal shock wave therapy in erectile dysfunction: a systematic review and meta-analysis
Vol. 43 (5): 805-821, September – October, 2017
Zi-jun Zou 1, Liang-you Tang 1, Zhi-hong Liu 1, Jia-yu Liang 1, Ruo-chen Zhang 1, Yu-jie Wang 1, Yong-quan Tang 1, Rui Gao 2 , Yi-ping Lu 1
1 Department of Urology, Institute of Urology , West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China; 2 Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China
Aim: The role of low-intensity extracorporeal shock wave therapy (LI-ESWT) in erectile dysfunction (ED) is not clearly determined. The purpose of this study is to investigate the short-term efficacy and safety of LI-ESWT for ED patients.
Materials and Methods: Relevant studies were searched in Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), WANFANG and VIP databases. Effective rate in terms of International Index of Erectile Function-Erectile Function Domain (IIEF-EF) and Erectile Hardness Score (EHS) at about 1month after LI-ESWT was extracted from eligible studies for meta-analysis to calculate risk ratio (RR) of effective treatment in ED patients treated by LI-ESWT compared to those receiving sham-treatment.
Results: Overall fifteen studies were included in the review, of which four randomized controlled trials (RCTs) were for meta-analysis. Effective treatment was 8.31 [95% confidence interval (CI): 3.88-17.78] times more effective in the LI-ESWT group (n=176) than in the sham-treatment group (n=101) at about 1 month after the intervention in terms of EHS, while it was 2.50 (95% CI: 0.74-8.45) times more in the treatment group (n=121) than in the control group (n=89) in terms of IIEF-EF. Nine-week protocol with energy density of 0.09mJ/mm2 and 1500 pluses seemed to have better therapeutic effect than five-week protocol. No significant adverse event was reported.
Conclusion: LI-ESWT, as a noninvasive treatment, has potential short-term therapeutic effect on patients with organic ED irrespective of sensitivity to PDE5is. Owing to the limited number and quality of the studies, more large-scale, well-designed and long-term follow-up time studies are needed to confirm our analysis.
Keywords: Erectile Dysfunction; Therapeutics; Meta-Analysis as Topic
Vol. 43 (5): 822-834, September – October, 2017
Cristiano Mendes Gomes 1, Fabrício Leite Carvalho 1, Carlos Henrique Suzuki Bellucci 1, Thiago Souto Hemerly 1, Fábio Baracat 1, Jose de Bessa Jr. 1, Miguel Srougi 1, Homero Bruschini 1
1 Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
Synthetic suburethral slings have become the most widely used technique for the surgical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on patients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings.
Keywords: Urinary Incontinence; Polypropylenes; Postoperative Complications
Vol. 43 (5): 835-840, September – October, 2017
Haitham Abdelmoteleb 1, Fatima Rashed 1, Amr Hawary 1
1 Great Western Hospital, Swindon, United Kingdom
In contemporary practice, the number of patients presenting with prostatic abscess have significantly declined due to the widespread use of antibiotics. However, when faced with the pathology, prostatic abscess tends to pose a challenge to clinicians due to the difficulty of diagnosis and lack of guidelines for treatment. Treatment consists of an array of measures including parenteral broad-spectrum antibiotic administration and abscess drainage.
Keywords: Prostate; Disease Management; Guidelines as Topic
Adjuvant radiotherapy for the primary treatment of adrenocortical carcinoma: Are we offering the best?
Vol. 43 (5): 841-848, September – October, 2017
Victor Srougi 1, Jose Bessa Junior 2, Fabio Y. Tanno 1, Amanda M. Ferreira 3, Ana O. Hoff 4, João E. Bezerra 4, Cristiane M. Almeida 5, Madson Q. Almeida 3, 4, Berenice B. Mendonça 3, William C. Nahas 1, Jose L. Chambô 1, Miguel Srougi 1, Maria C. B. V. Fragoso 3, 4
1 Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil; 2 Divisão de Urologia, Universidade de Feira de Santana, BA, Brasil; 3 Unidade de Suprerrenal da Divisão de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, Brasil; 4 Divisão de Endocrinologia do Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil; 5 Divisão de Radioterapia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
Purpose: To evaluate the role of ARDT after surgical resection of ACC.
Materials and Methods: Records of patients from our institutional ACC database were retrospectively assessed. A paired comparison analysis was used to evaluate the oncological outcomes between patients treated with surgery followed by ARDT or surgery only (control). The endpoints were LRFS, RFS, and OS. A systematic review of the literature and meta-analysis was also performed to evaluate local recurrence of ACC when ARDT was used.
Results: Ten patients were included in each Group. The median follow-up times were 32 months and 35 months for the ARDT and control Groups, respectively. The results for LRFS (p=0.11), RFS (p=0.92), and OS (p=0.47) were similar among subsets. The mean time to present with local recurrence was significantly longer in the ARDT group compared with the control Group (419±206 days vs. 181±86 days, respectively; p=0.03). ARDT was well tolerated by the patients; there were no reports of late toxicity. The meta-analysis, which included four retrospective series, revealed that ARDT had a protective effect on LRFS (HR=0.4; CI=0.17-0.94).
Conclusions: ARDT may reduce the chance and prolong the time to ACC local recurrence. However, there were no benefits for disease recurrence control or overall survival for patients who underwent this complementary therapy.
Keywords: Adrenocortical Carcinoma; Radiotherapy, Adjuvant; Therapeutics
Vol. 43 (5): 849-856, September – October, 2017
Ding Peng 1, Zhi-song He 1, Xue-song Li 1, Qi Tang 1, Lei Zhang 1, Kai-wei Yang 1, Xiao-teng Yu 1, Cui-jian Zhang 1, Li-qun Zhou 1
1 Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China
Objectives: To evaluate the prognosis of non-metastatic T3a renal cell carcinoma (RCC) with partial nephrectomy (PN).
Patients and Methods: We retrospectively evaluated 125 patients with non-metastatic T3a RCC. Patients undergoing PN and radical nephrectomy (RN) were strictly matched by clinic-pathologic characteristics. Log-rank test and Cox regression model were used for univariate and multivariate analysis.
Results: 18 pair patients were matched and the median follow-up was 35.5 (10-86) months. PN patients had a higher postoperative eGFR than RN patients (P=0.034). Cancer-specific survival (CSS) and recurrence-free survival (RFS) did not differ between two groups (P=0.305 and P=0.524). On multivariate analysis, CSS decreased with positive surgical margin and anemia (both P <0.01) and RFS decreased with Furhman grade, positive surgical margin, and anemia (all P<0.01).
Conclusions: For patients with non-metastatic pT3a RCC, PN may be a possible option for similar oncology outcomes and better renal function.
Keywords: Carcinoma, Renal Cell; Nephrectomy; Patients
Vol. 43 (5): 857-862, September – October, 2017
Matvey Tsivian 1, Efrat Tsivian 1, Yury Stanevsky 2, Roman Bass 2, A. Ami Sidi 2, Alexander Tsivian 2
1 Division of Urology and Department of Surgery, Duke University Medical Center Durham, NC; 2 Department of Urologic Surgery, The E. Wolfson Medical Center, Holon and Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
Purpose: To assess and report the outcomes of laparoscopic partial nephrectomy )LPN) for T2 renal masses.
Materials and Methods: Retrospective review of patients undergoing LPN for clinically localized renal masses ≥7cm between the years 2005-2016. Descriptive analyses were generated for demographics, lesion characteristics, perioperative variables (operative time, warm ischemia time (WIT), estimated blood loss (EBL), intra-operative and post-operative complications (IOC and POC) and pathologic variables (pathology, subtype and Fuhrman grade).
Results: A total of 27 patients underwent LPN for a T2 renal mass at our institution between 2005 and early 2016 of which 19 were males. The mean age was 66 (52-72). All procedures were transperitoneal with 16 on the right and 11 on the left. Median operative time was 200 minutes (IQR 181-236) and median WIT 19 minutes (IQR 16-23). EBL was 125mL (IQR 75-175). One case was converted to laparoscopic radical nephrectomy due to suspected tumor thrombus in the renal vein. Surgical margins were positive in one renal tumor in a patient with multiple tumors. There was a total of 2 IOC (7.4%) and 3 POC (11%) classified as Clavien grade 3.
Conclusions: To our knowledge, this series is the first to describe the outcomes of LPN for cT2 renal masses. In our series, LPN for larger renal masses appears feasible with favorable perioperative outcomes. Additional data are needed to further explore the benefits of minimally invasive surgical approaches to larger renal masses.
Keywords: Nephrectomy; Laparoscopy; Neoplasms
Vol. 43 (5): 863-870, September – October, 2017
Onur Kaygisiz 1, Sinan Çelen 2, Berna Aytac Vuruşkan 3, Hakan Vuruşkan 1
1 Department of Urology, Uludag University, Faculty of Medicine, Bursa, Turkey; 2 Afyon Sandikli Government Hospital, Afyon, Turkey; 3 Department of Surgical Pathology, Faculty of Medicine, Uludag University, Bursa, Turkey
Objective: To comparatively evaluate the traditional interrupted knot-tying and running suture renorrhaphy with Monocryl® in laparoscopic partial nephrectomy (LPN).
Materials and Methods: A retrospective analysis of 62 consecutive patients undergoing LPN using traditional interrupted knot-tying suture renorrhaphy (Group 1; n=31) or running suture technique renorrhaphy with 2-0 monofilament polyglecaprone (Monocryl®, Ethicon) (Group 2; n=31) from December 2011 to October 2015 at the University. All patients underwent LPN performed by an experienced laparoscopic surgeon. The demographic, perioperative and postoperative parameters were compared between the groups, and the effect of both suture techniques on the warm ischemic time (WIT) and trifecta were evaluated.
Results: The running suture renorrhaphy with Monocryl® reduced WIT, estimated blood lost and length of hospitalization stay significantly without increasing postoperative complication rate during LPN in comparison with interrupted knot-tying suture.
Conclusion: The renorrhaphy using the running suture with Monocryl® is an effective and safe technique with the advantage of shortening WIT even in more challenging and larger tumors during LPN.
Keywords: Nephrectomy; Laparoscopy; Suture Techniques
The influence of previous robotic experience in the initial learning curve of laparoscopic radical prostatectomy
Vol. 43 (5): 871-879, September – October, 2017
José Anastácio Dias Neto 1, Marcos F. Dall’oglio 1, João Roberto Colombo Jr. 1, Rafael F. Coelho 1, William Carlos Nahas 1
1 Divisão de Urologia, Universidade de São Paulo Escola Médica, São Paulo, SP, Brasil
Introduction: This study analyzed the impact of the experience with Robotic-Assisted Laparoscopic Prostatectomy (RALP) on the initial experience with Laparoscopic Radical Prostatectomy (LRP) by examining perioperative results and early outcomes of 110 patients. LRPs were performed by two ro-botic fellowship trained surgeons with daily practice in RALP.
Patients and Methods: 110 LRP were performed to treat aleatory selected patients. The patients were divided into 4 groups for prospective analyses. A transperitoneal approach that simulates the RALP technique was used.
Results: The median operative time was 163 minutes (110-240), and this time significantly decreased through case 40, when the time plateaued (p=0.0007). The median blood loss was 250mL. No patients required blood transfusion. There were no life-threatening complications or deaths. Minor complications were uniformly distributed along the series (P=0.6401). The overall positive surgical margins (PSM) rate was 28.2% (20% in pT2 and 43.6% in pT3). PSM was in the prostate apex in 61.3% of cases. At the 12-month follow-up, 88% of men were continent (0-1 pad).
Conclusions: The present study shows that there are multiple learning curves for LRP. The shallowest learning curve was seen for the operative time. Surgeons transitioning between the RALP and LRP techniques were considered competent based on the low perioperative complication rate, absence of major complications, and lack of blood transfusions. This study shows that a learning curve still exists and that there are factors that must be considered by surgeons transitioning between the two techniques.
Keywords: Laparoscopy; Prostatectomy; Robotic Surgical Procedures
Quality of life and urolithiasis: the patient – reported outcomes measurement information system (PROMIS)
Vol. 43 (5): 880-886, September – October, 2017
Nishant Patel 1, Robert D. Brown 1, Carl Sarkissian 1, Shubha De 1, Manoj Monga 1
1 Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
Background: With a high rate of recurrence, urolithiasis is a chronic disease that impacts quality of life. The Patient Reported Outcomes Measurement Information System is an NIH validated questionnaire to assess patient quality of life. We evaluated the impact of urolithiasis on quality of life using the NIH-sponsored PROMIS-43 questionnaire.
Materials and Methods: Patients reporting to the kidney stone clinic were interviewed to collect information on stone history and demographic information and were asked to complete the PROMIS-43 questionnaire. Quality of life scores were analyzed using gender and age matched groups for the general US population. Statistical comparisons were made based on demographic information and patient stone history. Statistical significance was P<0.05.
Results: 103 patients completed the survey. 36% of respondents were male, the average age of the group was 52 years old, with 58% primary income earners, and 35% primary caregivers. 7% had never passed a stone or had a procedure while 17% passed 10 or more stones in their lifetime. Overall, pain and physical function were worse in patients with urolithiasis. Primary income earners had better quality of life while primary caregivers and those with other chronic medical conditions were worse. Patients on dietary and medical therapy had better quality of life scores.
Conclusions: Urolithiasis patients subjectively have worse pain and physical function than the general population. The impact of pain on quality of life was greatest in those patients who had more stone episodes, underscoring the importance of preventive measures. Stone prevention measures improve quality of life.
Keywords: Kidney Calculi; Quality of Life; Pain
Early term effect of ureterorenoscopy (URS) on the Kidney: research measuring NGAL, KIM-1, FABP and CYS C levels in urine
Vol. 43 (5): 887-895, September – October, 2017
Erdal Benli 1, Sema Nur Ayyildiz 2, Selma Cirrik 3, Tevfik Noyan 2, Ali Ayyildiz 4, Abdullah Cirakoglu 1
1 Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey; 2 Department of Biochemistry, Faculty of Medicine, Ordu University, Ordu, Turkey; 3 Department of Physiology, Faculty of Medicine, Ordu University, Ordu, Turkey; 4 Department of Urology, Research and Training Hospital, Ankara, Turkey
Aim: URS is a very commonly used procedure for treatment of ureter stones. Increased hydrostatic pressure in the collecting system linked to fluids used during the procedure may cause harmful effects on the kidney. The aim of this study is to determine whether the URS procedure has a negative effect on the kidney by investigating NGAL, KIM-1, FABP and Cys C levels in urine.
Material and Methods: This study included 30 patients undergoing ureterorenoscopy (URS) for ureter stones. Urine samples were collected 5 times; before the URS procedure (control) and at 1, 3, 5 and 12 hours following the procedure. NGAL, KIM-1, FBAP and Cys C levels were measured in urine and compared with the control values.
Results: The NGAL levels in urine before the procedure and at 1, 3, 5 and 12 hours after the procedure were 34.59±35.34; 62.72±142.32; 47.15±104.48; 45.23±163.16 and 44.99±60.79ng/mL, respectively (p=0.001). Similarly, the urinary KIM-1, FABP and Cys C levels were found to increase compared to control values; however this increase did not reach statistical significance (p >0.05).
Conclusions: After the URS procedure, there were important changes in NGAL, FABP, KIM-1 and Cys C levels. These changes reached statistical significance for NGAL, but did not reach significance for the other parameters. In conclusion, the URS procedure significantly affects the kidney; however, this effect disappears over time.
Keywords: Acute Kidney Injury; Kidney; Lithotripsy
Vol. 43 (5): 896-902, September – October, 2017
Patrícia Lordelo 1, Andrea Vilas Boas 2, Danielle Sodré 1, Amanda Lemos 1, Sibele Tozetto 3, Cristina Brasil 1
1 Centro de Atenção ao Piso Pélvico (CAAP), Divisão de Fisioterapeutas e Pós-Graduação, Escola Bahiana de Medicina e Saúde Pública (EBMSP), BA, Brasil; 2 Centro de Atenção ao Piso Pélvico (CAAP), Divisão de Programas de Ginecologia e Pós-Graduação, Escola Bahiana de Medicina e Saúde Pública (EBMSP), BA, Brasil; 3 Divisão de Ciências Morfofuncionais, Universidade Federal do Recôncavo Baiano, BA, Brasil
Purpose: To evaluate the clinical response and adverse effects of radiofrequency on the urethral meatus in the treatment of stress urinary incontinence in women.
Materials and Methods: This phase one study included ten women with Stress Urinary Incontinence (SUI). The evaluation consisted of 1 hour Pad tests to quantify urine loss and to assess the degree of procedure satisfaction by using the Likert scale. To evaluate safety, we observed the number of referred side effects.
Results: Average age was 53.10 years±7.08 years. In assessing the final Pad Test, 70% showed a reduction and 30% a worsening of urinary loss. Using the Pad Test one month later, there was a reduction in all patients (p=0.028). The degree of satisfaction was 90% and no side effects have been observed. One patient reported burning sensation.
Conclusion: The treatment of SUI with radiofrequency on the urethral meatus has no adverse effects, being a low risk method that reduces urinary loss in women. However, to increase the validity of the study, larger clinical trials are warranted.
Keywords: Pulsed Radiofrequency Treatment; Urinary Incontinence, Stress; Women
Laparoscopic pectopexy: initial experience of single center with a new technique for apical prolapse surgery
Vol. 43 (5): 903-909, September – October, 2017
Ahmet Kale 1, Alper Biler 2, Hasan Terzi 1, Taner Usta 3, Ebru Kale 4
1 Department of Obstetrics and Gynecology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey; 2 Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey; 3 Department of Obstetrics and Gynecology, Bagcılar Training and Research Hospital, Istanbul, Turkey; 4 Department of Biochemistry, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
Objective: To share our first experience with laparoscopic pectopexy, a new technique for apical prolapse surgery, and to evaluate the feasibility of this technique.
Materials and Methods: Seven patients with apical prolapse underwent surgery with laparoscopic pectopexy. The lateral parts of the iliopectineal ligament were used for a bilateral mesh fixation of the descended structures. The medical records of the patients were reviewed, and the short-term clinical outcomes were analyzed.
Results: The laparoscopic pectopexy procedures were successfully performed, without intraoperative and postoperative complications. De novo apical prolapse, de novo urgency, de novo constipation, stress urinary incontinence, anterior and lateral defect cystoceles, and rectoceles did not occur in any of the patients during a 6-month follow-up period.
Conclusion: Although laparoscopic sacrocolpopexy has shown excellent anatomical and functional long-term results, laparoscopic pectopexy offers a feasible, safe, and comfortable alternative for apical prolapse surgery. Pectopexy may increase a surgeon’s technical perspective for apical prolapse surgery.
Keywords: Laparoscopy; Pelvic Organ Prolapse; Vagina
Editorial Comment: Laparoscopic pectopexy: initial experience of single center with a new technique for apical prolapse surgery
Vol. 43 (5): 910-910, September – October, 2017
Bruno Nicolino Cezarino 1
1 Serviço de Urologia do Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brasil
No Abstract available
Vol. 43 (5): 911-916, September – October, 2017
Paul H. Chung 1, Jordan A. Siegel 1, Timothy J. Tausch 1, Alexandra K. Klein 1, Jeremy M. Scott 1, Allen F. Morey 1
1 Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
Objective: Many patients who undergo inflatable penile prosthesis (IPP) replacement are often upsized to larger cylinders, suggesting the IPP may serve as a tissue expander and increase internal penile length. The objective of this study is to evaluate whether cylinder length increases with subsequent IPP insertion.
Materials and Methods: We queried American Medical Systems and Coloplast Patient Information Form databases to identify patients who underwent IPP placement and replacement between 2004-2013. Patients were grouped by device type and time to replacement (<2 or ≥2 years). We selected the 2-year mark for subgroup analysis to allow time for tissue expansion to occur and to exclude patients who underwent early explantation (e.g. erosion or infection).
Results: Two thousand, seven hundred and forty nine patients (1,532 AMS 700 LGX, 717 AMS 700 CX, and 500 Coloplast Titan) met the inclusion criteria. Mean time between implants was earlier for LGX (29 months) than CX (39 months) and Titan (48 months) patients (p<0.001). Patients who underwent device replacement at <2 years did not experience an increase in mean cylinder length. On the contrary, patients who underwent device replacement at ≥2 years did experience significant increases in mean cylinder length (LGX 1.2 cm, CX 1.1 cm, and Titan 0.9 cm, p<0.001). The mean increases in length at ≥2 years were similar between the 3 devices (p=0.20). Sixty percent of patients demonstrated increases of >0.5 cm and 40% demonstrated increases of ≥1 cm.
Conclusions: As demonstrated, the IPP may provide tissue expansion over time. Further evaluation is needed to determine if increased cylinder length correlates to increased functional length and patient satisfaction.
Keywords: Penile Prosthesis; Erectile Dysfunction; Surgical Procedures, Operative
Unilateral extravesical ureteral reimplantation via inguinal incision for the correction of vesicoureteral reflux: a 10-year experience
Vol. 43 (5): 917-924, September – October, 2017
Michael Yap 1, Unwanabong Nseyo 1, Hena Din 1, Madhu Alagiri 1
1 Rady Children’s Hospital, San Diego, CA, USA
Introduction and Objective: Multiple options exist for the surgical management of vesicoureteral reflux (VUR). We report on our 10-year experience using the inguinal approach to extravesical ureteral reimplantation (EVR).
Materials and Methods: Patient characteristics of age, gender, and reflux grade were obtained and outcomes of operative time, hospital stay, and radiographic resolution were assessed.
Results: 71 girls and 20 boys with a mean age of 74 months (range 14-164) underwent inguinal EVR via a 3.5-cm inguinal mini-incision. Mean follow up was 10.9 months (range 0.4-69.7). Average grade of reflux was 2.80. Average operative time was 91 minutes (range 51-268). The procedure was successful in 87 of 91 patients (95.6%). The 3 cases of reflux that persisted were all grade 1 and managed expectantly. Contralateral reflux developed in 9 cases, all of which resolved after treatment with either Deflux or ureteral reimplant. There were 4 case of urinary retention that resolved after a brief period of CIC or indwelling catheterization. There were no cases of ureteral obstruction.
Most patients were discharged on post-operative day 1 (85/91) and no hospitalization extended beyond 3 days.
Conclusions: The inguinal approach to extravesical ureteral reimplantation should be considered as a potentially minimally invasive alternative to endoscopic and robotic treatment of VUR with a success rate more comparable to traditional open approaches. We feel it is the method of choice in cases of unilateral VUR requiring surgical correction.
Keywords: Urinary Incontinence; Minimally Invasive Surgical Procedures; Vesico-Ureteral Reflux
An unanswered question in pediatric urology: the post pubertal persistence of prepubertal congenital penile curvature correction by tunical plication
Vol. 43 (5): 925-931, September – October, 2017
Ünsal Ozkuvanci 1, Orhan Ziylan 1, M. Irfan Dönmez 1, Omer Baris Yucel 1, Tayfun Oktar 1, Haluk Ander 1, Ismet Nane 1
1 Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
Objective: The aim of this study is to analyze post pubertal results of pre pubertal tunica albuginea plication with non-absorbable sutures in the correction of CPC.
Materials and Methods: The files of patients who underwent tunica albuginea plication without incision (dorsal/lateral) were retrospectively reviewed. Patients younger than 13 years of age at the time of operation and older than 14 years of age in November 2015 were included. Patients with a penile curvature of less than 30 degrees & more than 45 degrees and penile/urethral anomalies were excluded. All of the patients underwent surgery followed by circumcision.
Results: The mean age of patients at the time of the operation was 9.7 years (range, 6-13 years). The mean degree of ventral penile curvature measured during the operation was 39 degrees while it was 41 degrees in the lateral curvatures. All of the patients were curvature-free at the end of the operation. At the time of the follow-up examination, the mean age was 16.7 years (range, 14-25 years). Six patients had a straight (0-10 degrees) penis during erection and seven patients had recurrent penile curvatures ranging from 30 to 50 degrees.
Conclusion: Pre pubertal tunica albuginea plication of congenital penile curvature (30-45 degrees) with non-absorbable sutures performed without incision is a minimal invasive method especially when performed during circumcision. However, recurrence might be observed in half of the patients after puberty.
Keywords: Penile Diseases; Penile Induration; Circumcision, Male
Vol. 43 (5): 932-938, September – October, 2017
Eyyup Sabri Pelit 1, Bülent Kati 1, Cengiz Çanakci 2, Süleyman Sağir 1, Halil Çiftçi 1
1 Department of Urology, Harran University Faculty of Medicine, Sanliurfa, Turkey; 2 Bolvadin State Hospital, Istanbul, Turkey
Objectives: The present study was aim to evaluate the safety and efficacy of Mini-PNL to treat kidney stones in patients aged <3 years. This is the one of the largest series in the literature in this age group of patients.
Material and methods: From May 2012 to April 2016, the medical records of 74 infant patients who underwent mini-PNL for renal stones were reviewed retrospectively. All infants were evaluated with the plain abdominal radiograph, urinary ultrasound, noncontrast computerized tomography and/or intravenous urogram. Pre-operative, intraoperative and post-operative data were analyzed.
Results: A total of 74 infant (42 male, 32 female) with a mean age 21.5±8.2 (10-36) months were included in this study. The mean size of the stones was 22.0±5.9 (14-45) mm. A 17 Fr rigid pediatric nephroscope with a pneumatic intracorporeal lithotripsy were used through 20-22 Fr access sheath. The stone-free rate was 84.7% at 1 month after the operation. Mean operative time was 74.0 (40-140) min. Mean fluoroscopy screening time was as 4.3(3.1-8.6) min. Average hospitalization time was 3.8 (2-9) day.
Auxiliary procedures were performed to 11(15.3%) patients (7 extracorporeal shock wave lithotripsy, 3 re- percutaneous nephrolitotomy, 1 retrograde intrarenal surgery).
No major complication classified as Clavien IV-V observed in study group.
Conclusions: Mini-PNL with pneumatic intracorporeal lithotripsy can be performed safely and effectively to manage kidney stones in infants with high stone free rate and low complications.
Keywords: Nephrostomy, Percutaneous; Kidney Calculi; Infant
Vol. 43 (5): 939-945, September – October, 2017
Omer Kurt 1, Fethullah Gevher 2, Cenk Murat Yazici 1, Mustafa Erboga 3, Mucahit Dogru 4, Cevat Aktas 3
1 Department of Urology, Namık Kemal University, School of Medicine, Tekirdag, Turkey; 2 Department of Urology, Anadolu Hospital, Istanbul, Turkey; 3 Department of Histology, Namık Kemal University, School of Medicine, Tekirdag, Turkey; 4 Department of Radiology, Namık Kemal University, School of Medicine, Tekirdag, Turkey
Urethral stricture is a common disease with high recurrence rate. Several manipulations were defined to prevent the recurrence but the results were disappointing. This study aimed to evaluate the efficacy of triamcinolone and mitomycin-C on urethral stricture formation and their effect on inhibition of urethral fibrosis. A total of 24 New Zealand rabbits were divided into 3 groups. Urethras of rabbits were traumatized with pediatric resectoscope. Resection area was irrigated with 10mL saline, swapped with a cotton wool soaked with 0.5mg/mL MMC and injected by 40mg triamcinolone in groups 1, 2 and 3 respectively. Retrograde urethrogram was performed at 28th day of procedure and the urethra was removed for histopathologic evaluation. There were significant differences in urethral diameters and in lumen reduction rate between the control and study groups (p<0.001). Compared to control group, all treatment groups showed mild fibrosis, less collagen bundle irregularity, and lower numbers of fibroblasts (p=0.003). The Tunnel assay showed that the number of apoptotic cells in the submucosal connective tissue was quantitatively higher in control groups (p=0.034). In the view of efficacy and safety, MMC and triamcinolone have the potential to replace the use of stents, clean intermittent catheterization, or long term catheters following internal urethrotomy. There were no statistically significant differences between two agents in terms of preventing urethral stricture formation in the present study. Mitomycin C and triamcinolone decreased the recurrence rates of urethral stricture.
Keywords: Endoscopy; Mitomycin; Triamcinolone; Urethral Stricture
Attenuation of partial unilateral ureteral obstruction -induced renal damage with hyperbaric oxygen therapy in a rat model
Vol. 43 (5): 946-956, September – October, 2017
Eyup Burak Sancak 1, Yusuf Ziya Tan 2, Hakan Turkon 3, Coskun Silan 4
1 Department of Urology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey; 2 Department of Nuclear Medicine, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey; 3 Department of Biochemistry, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey; 4 Department of Pharmacology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale, Turkey
Objective: The objective of the present study was to evaluate the effectiveness of HBO therapy on biochemical parameters, renal morphology and renal scintigraphy in rats undergoing chronic unilateral partial ureteral obstruction (UPUO).
Material and methods: Thirty-five rats were divided into five equal groups: Control group; Sham group; HBO group; UPUO group and UPUO/HBO group. The effects of HBO therapy were examined using biochemical parameters and histopathological changes. After calculating the score for each histopathological change, the total histopathological score was obtained by adding all the scores. In addition, dynamic renal scintigraphy findings were evaluated.
Results: Serum parameters indicating inflammation, serum tumor necrosis factoralpha, ischemia modified-albumin, IMA/albumin ratio and Pentraxin-3 levels, were observed to be high in the UPUO group and low in the UPUO/HBO treatment group. Similarly, in the treatment group, the reduction in malondialdehyde, total oxidant status and oxidative stress index levels and increase in total antioxidant capacity values were observed to be statistically significant compared to the UPUO group (p<0.001, p=0.007, p<0.001, p=0.001, respectively). The total score and apoptosis index significantly decreased after administration of HBO treatment. Dynamic 99mTc-MAG3 renal scintigraphy also showed convincing evidence regarding the protective nature of HBO against kidney injury. In the UPUO/HBO therapy group, the percentage contribution of each operated kidney increased significantly compared to the UPUO group (41.73% versus 32.72%).
Conclusion: The findings of this study indicate that HBO therapy had a reno-protective effect by reducing inflammation and oxidative stress, and preserving renal function after renal tissue damage due to induction of UPUO.
Keywords: Hyperbaric Oxygenation; Ureteral Obstruction; Apoptosis
The prostate after castration and hormone replacement in a rat model: structural and ultrastructural analysis
Vol. 43 (5): 957-965, September – October, 2017
Bruno Felix-Patrício 1, Alexandre F. Miranda 2, Jorge L. Medeiros Jr. 3, Carla B. M. Gallo 2, Bianca M. Gregório 2, Diogo B. de Souza 2, Waldemar S. Costa 2, Francisco J. B. Sampaio 2
1 Instituto de Ciências Humanas e da Saúde, Universidade Federal Fluminense, Rio das Ostras, RJ, Brasil; 2 Urogenital Research Unit, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; 3 Fundação Educacional Dom André Arcoverde, Valença, RJ, Brasil
Purpose: To evaluate if late hormonal replacement is able to recover the prostatic tissue modified by androgenic deprivation.
Materials and Methods: 24 rats were assigned into a Sham group; an androgen deficient group, submitted to bilateral orchiectomy (Orch); and a group submitted to bilateral orchiectomy followed by testosterone replacement therapy (Orch+T). After 60 days from surgery blood was collected for determination of testosterone levels and the ventral prostate was collected for quantitative and qualitative microscopic analysis.
The acinar epithelium height, the number of mast cells per field, and the densities of collagen fibers and acinar lumen were analyzed by stereological methods under light microscopy. The muscle fibers and types of collagen fibers were qualitatively assessed by scanning electron microscopy and polarization microscopy.
Results: Hormone depletion (in group Orch) and return to normal levels (in group Orch+T) were effective as verified by serum testosterone analysis. The androgen deprivation promoted several alterations in the prostate: the acinar epithelium height diminished from 16.58±0.47 to 11.48±0.29μm; the number of mast cells per field presented increased from 0.45±0.07 to 2.83±0.25; collagen fibers density increased from 5.83±0.92 to 24.70±1.56%; and acinar lumen density decreased from 36.78±2.14 to 16.47±1.31%. Smooth muscle was also increased in Orch animals, and type I collagen fibers became more predominant in these animals. With the exception of the densities of collagen fibers and acinar lumen, in animals receiving testosterone replacement therapy all parameters became statistically similar to Sham. Collagen fibers density became lower and acinar lumen density became higher in Orch+T animals, when compared to Sham. This is the first study to demonstrate a relation between mast cells and testosterone levels in the prostate. This cells have been implicated in prostatic cancer and benign hyperplasia, although its specific role is not understood.
Conclusion: Testosterone deprivation promotes major changes in the prostate of rats. The hormonal replacement therapy was effective in reversing these alterations.
Keywords: Hormone Replacement Therapy; Prostate; Orchiectomy; Hypogonadism
Vol. 43 (5): 966-973, September – October, 2017
Omer Kutlu 1, 2, Ersagun Karaguzel 2, Ali Ertan Okatan 2, Ahmet Mentese 3, Esin Yulug 4, Ilke Onur Kazaz 2, Selcuk Kutlu 5, Eyup Dil 2, Huseyin Eren 2, Ahmet Alver 6
1 Department of Urology, School of Medicine, Akdeniz University, Antalya, Turkey; 2 Department of Urology School of Medicine, Karadeniz Technical University, Trabzon, Turkey; 3 Program of Medical Laboratory Techniques, Vocational School of Health Sciences. Karadeniz Technical University, Trabzon, Turkey; 4 Department of Histology and Embryology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey; 5 Department of Urology, Aydin State Hospital, Aydin, Turkey; 6 Department of Biochemistry, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
Purpose: Despite the nerve-sparing technique, many patients suffer from erectile dysfunction after radical prostatectomy (RP) due to cavernous nerve injury. The aim of this study was to evaluate dipyridamole as a potential treatment agent of post-radical prostatectomy erectile dysfunction.
Material and methods: A total of 18 male Sprague-Dawley rats were randomized into three experimental Groups (SHAM+DMSO, BCNI+DMSO and BCNI+DIP). An animal model of bilateral cavernous nerve crush injury (BCNI) was established to mimic the partial nerve damage during nerve-sparing RP. After creating of BCNI, dimethyl sulphoxide (DMSO) was administered transperitoneally as a vehicle to SHAM+DMSO and BCNI+DMSO Groups. BCNI+DIP Group received dipyiridamole (10mg/kg/day) as a solution in DMSO for 15 days. Afterwards, rats were evaluated for in vivo erectile response to cavernous nerve stimulation. Penile tissues were also analyzed biochemically for transforming growth factor-β1 (TGF-β1) level. Penile corporal apoptosis was determined by TUNEL method.
Results: Erectile response was decreased in rats with BCNI and there was no significant improvement with dipyridamole treatment. TGF-β1 levels were increased in rats with BCNI and decreased with dipyridamole treatment. Dipyridamole led to reduced penile apoptosis in rats with BCNI and there was no significant difference when compared to sham operated rats.
Conclusions: Although fifteen-day dipyridamole treatment has failed to improve erectile function in rats with BCNI, the decline in both TGF-β1 levels and apoptotic indices with treatment may be helpful in protecting penile morphology after cavernous nerve injury.
Keywords: Erectile Dysfunction; Dipyridamole; Penis
Use of indocyanine green angiography in microsurgical subinguinal varicocelectomy – lessons learned from our initial experience
Vol. 43 (5): 974-979, September – October, 2017
Chak-Lam Cho 1, Kwan-Lun Ho 1, Wayne Kwun-Wai Chan 1, Ringo Wing-Hong Chu 1, In-Chak Law 1
1 Division of Urology, Department of Surgery, Kwong Wah Hospital, Hong Kong
Microsurgical subinguinal varicocelectomy (MSV) is generally considered the gold standard nowadays in view of the lower risk of complications and recurrence. To achieve complete ligation of veins while preserving testicular artery (TA) during the procedure remains challenging despite the application of high power optical magnification and micro-Doppler ultrasonography. The use of intraoperative indocyanine green angiography (ICGA) with infrared fluorescence operative micro-scope in MSV potentially lowers the incidence of TA injury and shortens the learning curve of nov-ice surgeons. We present our initial experience in the application of the technique in nine patients and explore the potential of the new adjunct.
Keywords: Varicocele; Microsurgery; Indocyanine Green
Editorial Comment: Use of indocyanine green angiography in microsurgical subinguinal varicocelectomy – lessons learned from our initial experience
Vol. 43 (5): 980-981, September – October, 2017
Marcello Cocuzza 1
1 Departamento de Urologia, Universidade de São Paulo, SP, Brasil
No abstract available
Vol. 43 (5): 982-986, September – October, 2017
CHALLENGING CLINICAL CASES
Horacio J. Alvarez Garzón 1,2, Thomas Maubon 3, Camille Jauffret 3, Pierre Vieille 2, Brigitte Fatton 2, Renaud de Tayrac 2
1 Department of Urology, Hospital Privado Centro Medico de Córdoba, Argentina; 2 Department of Obstetrics and Gynaecology, Nîmes University Hospital, Nîmes, France; 3 Department of Urology and Surgical Oncology, Institut Paoli Calmettes, Marseille, France
Introduction: Perineal hernia is a protrusion of intra-abdominal viscera through a defect in the pelvic floor and is a rare but challenging complication after extensive abdominoperineal surgery. There have been small series published after colorectal exenteration, but no cases have been reported after radical cystectomy and urethrectomy.
Case Presentation: A 68 years old woman developed an anterior perineal hernia, with no vaginal prolapse, after an anterior exenteration for bladder cancer. A perineal approach with the use of a synthetic polypropylene mesh was chosen to resolve the condition. After 6 months of follow-up, the patient has no symptoms or recurrence of the anterior perineal hernia.
Conclusion: To our knowledge, this case is the first report of perineal hernia after radical urethrocystectomy. Although being a case report, this article describes a potential and challenging complication after extensive anterior pelvic surgery, that could increase its incidence in the future. Literature review shows that whether perineal, abdominal or combined approach is chosen, surgery must respect hernia repair principles.
Keywords: Perineum; Pelvis; Cystectomy
Vol. 43 (5): 987-989, September – October, 2017
Mariana Athaniel Silva Rodrigues 1, Eduardo Kaiser Ururahy Nunes Fonseca 1, Fernando Ide Yamauchi 1, Ronaldo Hueb Baroni 1
1 Departamento de Imagem, Hospital Israelita Albert Einstein, São Paulo – Brasil
The anastomosing hemangioma is a recent described rare variant, which histologically simulates an angiosarcoma and occurs primarily in the genitourinary tract. We present a case of renal anastomosing hemangioma from a radiologic perspective, describing its imaging features and reviewing its presentation and management.
Keywords: Radiology; Kidney; Magnetic Resonance Imaging
Vol. 43 (5): 990-993, September – October, 2017
Yu Xi Terence Law 1, Irfan Khan Sagir 2, Lincoln Tan Guan Lim 1
1 Department of Urology, National University Hospital, National University Health System, Singapore; 2 Department of Pathology, National University Hospital, National University Health System, Singapore
No abstract available
Vol. 43 (5): 994-994, September – October, 2017
Peter A. Caputo 1, Daniel Ramirez 1, Matthew Maurice 1, Onder Kara 1, Ryan Nelson 1, Ercan Malkoc 1, Jihad Kaouk 1
1 Department of Urology, Cleveland Clinic, Cleveland, Ohio, USA
Introduction: Augmentation ileocystoplasty is a common treatment in adults with low capacity bladders due to neurogenic bladder dysfunction. We describe here our technique for robotic assisted laparoscopic augmentation ileocystoplasty in an adult with a low capacity bladder due to neurogenic bladder dysfunction.
Materials and Methods: The patient is a 35 years-old man with neurogenic bladder due to a C6 spinal cord injury in 2004. Cystometrogram shows a maximum capacity of 96cc and Pdet at maximum capacity of 97cmH2O. He manages his bladder with intermittent catheterization and experiences multiple episodes of incontinence between catheterizations.
He experiences severe autonomic dysreflexia symptoms with indwelling urethral catheter. He has previously failed non operative management options of his bladder dysfunction. Our surgical technique utilizes 6 trocars, of note a 12mm assistant trocar is placed 1cm superior to the pubic symphysis, and this trocar is solely used to pass a laparoscopic stapler to facilitate the excision of the ileal segment and the enteric anastomosis. Surgical steps include: development of the space of Retzius/dropping the bladder; opening the bladder from the anterior to posterior bladder neck; excision of a segment of ileum; enteric anastomosis; detubularizing the ileal segment; suturing the ileal segment to the incised bladder edge.
Results: The surgery had no intraoperative complications. Operative time was 286 minutes (4.8 hours). Estimated blood loss was 50cc. Length of hospital stay was 8 days. He did experience a postoperative complication on hospital day 3 of hematemesis, which did not require blood transfusion. Cystometrogram at 22 days post operatively showed a maximum bladder capacity of 165cc with a Pdet at maximum capacity of 10cmH2O.
Conclusions: As surgeon comfort and experience with robotic assisted surgery grows, robotic surgery can successfully be applied to less frequently performed procedures. In this case we successfully performed a robotic assisted laparoscopic augmentation ileocystoplasty displaying improvement in measurable functional outcomes.
Vol. 43 (5): 995-996, September – October, 2017
Cristina Redondo 1, Victor Srougi 2, José Batista da Costa 3, Mohammed Baghdad 4, Guillermo Velilla 3, Igor Nunes-Silva 3, Sebastien Bergerat 3, Silvia Garcia-Barreras 3, François Rozet 3, Alexandre Ingels 4, Marc Galiano 4, Rafael Sanchez-Salas 4, Eric Barret 4, Xavier Cathelineau 4
1 Hospital Universitario de Getafe – Servicio de Urología, Getafe, Spain; 2 Hospital das Clínicas da Faculdade de Medicina da USP – Urologia, São Paulo, Brasil; 3 Institut Mutualiste Montsouris Ringgold standard institution, Paris, Île-de-France, France; 4 L´Institut Mutualiste Montsouris – Urology, Paris, France
Introduction and objective: Focal cryotherapy emerged as an efficient option to treat favorable and localized prostate cancer (PCa). The purpose of this video is to describe the procedure step by step.
Materials and methods: We present the case of a 68 year-old man with localized PCa in the anterior aspect of the prostate.
Results: The procedure is performed under general anesthesia, with the patient in lithotomy position. Briefly, the equipment utilized includes the cryotherapy console coupled with an ultrasound system, argon and helium gas bottles, cryoprobes, temperature probes and an urethral warming catheter. The procedure starts with a real-time trans-rectal prostate ultrasound, which is used to outline the prostate, the urethra and the rectal wall. The cryoprobes are pretested and placed in to the prostate through the perineum, following a grid template, along with the temperature sensors under ultrasound guidance. A cystoscopy confirms the right positioning of the needles and the urethral warming catheter is installed. Thereafter, the freeze sequence with argon gas is started, achieving extremely low temperatures (-40ºC) to induce tumor cell lysis. Sequentially, the thawing cycle is performed using helium gas. This process is repeated one time. Results among several series showed a biochemical disease-free survival between 71-93% at 9-70 month- follow-up, incontinence rates between 0-3.6% and erectile dysfunction between 0-42% (1-5).
Conclusions: Focal cryotherapy is a feasible procedure to treat anterior PCa that may offer minimal morbidity, allowing good cancer control and better functional outcomes when compared to whole-gland treatment.
Vol. 43 (5): 997-997, September – October, 2017
Lucas Medeiros Burttet 1, Fernando Jahn da Silva Abreu 1, Gabrielle Aguiar Varaschin 1, Brasil Silva Neto 1, Milton Berger 1
1 Serviço de Urologia – Hospital de Clínicas de Porto Alegre, RS, Brasil
Introduction: Ganglioneuromas are rare benign neoplasms of the sympathetic nervous system. We describe the case of an incidentally found ganglioneuroma in a woman. To our knowledge this is the first described case of robotic excision of a retroperitoneal ganglioneuroma.
Case: A 41-year-old female had an incidental retroperitoneal mass found during a routine US. CT scan and MRI showed an 8.3cm homogeneous mass, adjacent to left kidney upper pole, with peripheral contrast enhancement. Metabolic tests were normal. Patient was positioned in a left flank position and five ports were introduced transperitoneally. A 4-arm Da Vinci SI was docked at a 45º angle to the table. Lesion was dissected along with left adrenal gland, beginning at the left renal hilum and proceeding cephalad. Results: Operating time was 325min and blood loss was 50ml. Patient was discharged after 72hours. There were no post-operative complications. Pathology showed ganglionic cells with neural tissue, and normal adrenal.
Discussion: Ganglioneuromas rare benign tumors originating from neural crest and typically affect young adults. Most frequent locations are posterior mediastinum, retroperitoneum and adrenal gland. As in this case, ganglioneuromas are usually silent, slow growing tumors discovered incidentally or by mass effect. US and CT imaging may suggest the diagnosis while MRI findings can be specific for ganglioneuroma. Percutaneous biopsy is an option. Although benign, usually requires surgical excision for treatment.
Conclusions: Our case shows that a robotic approach is feasible and allows for meticulous and safe dissection of vascular structures, facilitating adequate hemostasis while maintaining oncological principles.
Re: Insufficient conclusions regarding the association between overactive bladder symptoms and degree of dementia
Vol. 43 (5): 998-999, September – October, 2017
LETTER TO THE EDITOR
Jae Heon Kim 1
1 Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University Medical College, Seoul, Korea
No abstract available
Re: Preliminary assessment of neck circumference in benign prostatic hyperplasia in patients with metabolic syndrome
Vol. 43 (5): 1000-1001, September – October, 2017
LETTER TO THE EDITOR
Huseyin Besiroglu 1, Emin Ozbek 2
1 Department of Urology, Çatalca Ilyas Çokay State Hospital, Istanbul, Turkey; 2 Department of Urology, Istanbul Training and Research Hospital, Istanbul, Turkey
No abstract available
Vol. 43 (5): 1002-1003, September – October, 2017
LETTER TO THE EDITOR
Mustafa Kadihasanoglu 1, Emin Özbek 1
1 Department of Urology, Istanbul Training and Research Hospital, Istanbul, Turkey
No abstract available
Re: Persistent Mullerian Duct Syndrome: a rare entity with a rare presentation in need of multidisciplinary management
Vol. 43 (5): 1004-1004, September – October, 2017
LETTER TO THE EDITOR
Lisieux Eyer de Jesus 1
1 Departmento Cirurgia Pediátrica, Hospital Universitario Antonio Pedro, Niterói, RJ
No abstract available
REPLY BY THE AUTHORS: Re: Persistent Mullerian Duct Syndrome: a rare entity with a rare presentation in need of multidisciplinary management
Vol. 43 (5): 1005-1006, September – October, 2017
LETTER TO THE EDITOR
Lin Da Aw 1,2, Murizah M. Zain 1, Sandro C. Esteves 3,4, Peter Humaidan 2,4
1 Department of Obstetrics & Gynaecology, Hospital Sultanah Bahiyah, Kedah Darul Aman, Malaysia; 2 Fertility Clinic, Skive Regional Hospital, Denmark; 3 Androfert, Andrology & Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, Brazil; 4 Faculty of Health, Aarhus University, Denmark
No abstract available