Vol. 42 n. 1 Jan . Feb, 2016

The best treatment for small renal masses has been subject of debates. Despite of the small size, endophitic lesions may represent a challenge, especially in posterior side of the kidneys. In the section Difference of Opinion (pages 3-10), experts of Interventional radiology of Albert Einstein Hospital in São Paulo, claims for cryoablation, while the colleagues from Sonora University

EDITORIAL – IN THIS ISSUE

Vol. 42 (1): 01-01, January – February, 2016

doi: 10.1590/S1677-5538.IBJU.2016.01.01


EDITOR’S THIS ISSUE


The best treatment for small renal masses has been subject of debates. Despite of the small size, endophitic lesions may represent a challenge, especially in posterior side of the kidneys. In the section Difference of Opinion (pages 3-10), experts of Interventional radiology of Albert Einstein Hospital in São Paulo, claims for cryoablation, while the colleagues from Sonora University, Mexico and Southern California University, are favorable to robotic partial nephrectomy.
At the Review Article, an interesting multidisciplinary study, performed by Tiseo et al., from the Urology and Rheumatology groups from the University of São Paulo, is presented. The authors reviewed extensively the literature since 1970, regarding the influence of the more prevalent rheumatologic diseases and/or treatments on male fertility. These are useful information for the urologist’s daily practice, which might include these investigations during the initial anamnesis of infertile men. Among urologists, it is almost consensual to avoid brachytherapy in patients previously submitted to transurethral resection of the prostate (TURP); two Spanish groups from Cantabria reported good oncological and functional outcomes (only 1.7% of urinary incontinence) in 57 patients submitted to dose brachytherapy implantation after TURP, in a medium follow up of
104 months (page 37). Middle East Groups have identified prognostic factors for urinary sepsis after transrectal prostatic biopsy in Lebanon (page 50), and a differential expression of leucocytes and of neutrophil to lymphocyte ratio in Turkish patients with localized testis cancer (page 43).
Moving to minimally invasive surgery, an electronic survey revealed that almost half of Portuguese surgeons are favorable to transvaginal extraction of kidney, after laparoscopic nephrectomies; interestingly, female surgeon gynecologists preferred the vaginal approach (page 68).
A Brazilian group (Marchinni et al., page 80), reported the feasibility, the pitfalls and initial results of the laparoscopic single port bilateral nephrectomy in porcine models, performed by post-graduated students.
On page 154, Parente et al. proposed the use of a high pressure balloon to investigate the etiology of ureteropelvic junction obstruction (UPJO) in children: when at fluoroscopy a “waist” in the balloon is verified, an intrinsic UPJO is considered, and is managed by a dismembered pyeloplasty; on the other hand, when there is “no waist” at fluoroscopy, only a vascular hitch is performed regarding the lower pole crossing vessels. In relation to ischemic priapism (IP), according to Ufuk et al., men with IP present higher mean platelet volumes than healthy controls; probably these elevated platelets volumes contribute in the venno-occlusive mechanisms. In an induced IP rat model, the peritoneal infusion of dipyridamole was tested as protective drug against the endothelial reperfusion injury processes (page 108).
A new method of semen microcentrifugation, developed by Hallak’s group is proposed as an easy, low cost, and reproducible option for the investigation of non-obstructive azospermia. Sperm positivity was identified in 21 of 148 samples (page 122).

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

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EDITOR’S COMMENT

Vol. 42 (1): 02-02, January – February, 2016

doi: 10.1590/S1677-5538.IBJU.2016.01.02


EDITOR’S COMMENT


In the current year, the Brazilian Society of Urology celebrates its 90th year of continuous activity and the official scientific journal of the society “International Brazilian Journal of Urology” will present several important modifications throughout this festive year.

The electronic Int Braz J Urol page (www.brazjurol.com.br) was updated and became more interactive and friendly, facilitating the access to all information. From now on, it is possible to directly access all articles published from the first publication of the Brazilian Journal of Urology (the former name of our magazine), providing instant consultation. Visit the new webpage in www.intbrazjurol.com.br
Finally, Int Braz J Urol will become part of Pubmed Central, the free access to the digital collection of the National Center for Biotechnology Information (NCBI). With this achievement, our Journal will be more widespread in the international scientific community. Read Int Braz J Urol, publish at the Int Braz J Urol, quote the good papers of Int Braz J Urol!

Sidney Glina, MD, PhD
Editor-In-Chief
Internacional Braz J Urol

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DIFFERENCE OF OPINION – Which is the best treatment on a 2 cm complete endophitic tumor on the posterior side of the left kidney?

Vol. 42 (1): 03-07, January – February, 2016

doi: 10.1590/S1677-5538.IBJU.2016.01.03


DIFFERENCE OF OPINION


Which is the best treatment on a 2 cm complete endophitic tumor on the posterior side of the left kidney?
Opinion: Cryoablation

Rodrigo Gobbo Garcia
Radiologista intervencionista, Centro de Imagem, Hospital Israelita Albert Einstein, São Paulo, Brasil


Keywords: Therapeutics: Neoplasms; Cryosurgery; Nephrectomy


The Clinical Problem

With the increased use of advanced imaging techniques, incidental renal mass have become a very frequent finding (1).
Approximately 13 to 27% of abdominal imaging studies incidentally identify a renal lesion , a fact that makes suspected renal cell carcinoma be diagnosed at an early stage (2).
Most excised small renal cancers are classified as low grade at the time of diagnosis and synchronous metastases are very infrequent finding associated to such small lesions (3).
Although partial nephrectomy remains the reference standard for treatment of small renal masses, the guidelines of the American Urological Association support consideration of thermal ablative techniques for the treatment of patients with T1a disease (< 4 cm) (4).
Furthermore, the development of ablative techniques has widened the range of treatment options available to these patients and international consensus panels support other indications for ablative therapy for renal tumors (patients with a increased risk of multiple RCC tumors – e.g. von Hippel–Lindau syndrome, clinical conditions not suitable for surgery and solitary or transplanted kidney) (5).

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DIFFERENCE OF OPINION – Which is the best treatment on a 2 cm complete endophitic tumor on the posterior side of the left kidney?

DIFFERENCE OF OPINION – Which is the best treatment on a 2 cm complete endophitic tumor on the posterior side of the left kidney?

Vol. 42 (1): 08-10, January – February, 2016

doi: 10.1590/S1677-5538.IBJU.2016.01.04


DIFFERENCE OF OPINION


Which is the best treatment on a 2 cm complete endophitic tumor on the posterior side of the left kidney?
Opinion: Robotic partial nephrectomy

Juan Arriaga 1, Rene Sotelo 2
1 University of Sonora, Hospital CIMA, Hermosillo Sonora, México; 2 USC Institute od Urology, University Southern California, USA


Keywords: Therapeutics: Neoplasms; Cryosurgery; Nephrectomy


The routine use of abdominal imaging has led to increased detection of small renal masses incidentally, even before they cause symptoms (1). Partial nephrectomy is now the standard therapy for the treatment of small renal masses in stage T1a and even for certain patients with T1b tumors, offering equivalent cancer control to radical nephrectomy with better preservation of renal function and improving survival (2). The recurrence-free survival at 5 years for small renal masses less than 4 cm and 4-7 cm is about 96% and 83% respectively (3). It has been found that radical nephrectomy can lead to an increased risk of chronic kidney disease (4), and is associated with a higher risk of adverse cardiac events, hospitalization and death (5).
The location of the tumor and the endophytic component can be the determining factors on the feasibility and the degree of difficulty in performing a partial nephrectomy, even more important to consider than just the size of the tumor.
A completely intraparenchymal tumor is defined as an injury that is completely surrounded by normal renal parenchyma on all sides (6) or one located at a distance less than 5 mm of the collecting system or hilar vessels without exophytic component (7).
Partial nephrectomy is the treatment of choice for a tumor 2 cm diameter (3, 8) completely intrarenal on the posterior side of the left kidney, considering the context of clinical presentation such as age and comorbidities, even when the contralateral kidney is healthy.

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Male fertility potential alteration in rheumatic diseases: a systematic review

Vol. 42 (1): 11-21, January – February, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0595


REVIEW ARTICLE


Male fertility potential alteration in rheumatic diseases: a systematic review

Bruno Camargo Tiseo 1, Marcello Cocuzza 1, Eloisa Bonfá 2, Miguel Srougi 1, Clovis A. Silva 2,3
1 Departamento de Urologia da Faculdade de Medicina da Universidade de São Paulo, Brasil; 2 Divisão de Reumatologia da Faculdade de Medicina da Universidade de São Paulo, Brasil; 3 Unidade de Reumatologia Pediátrica do Departamento de Pediatria da Faculdade de Medicina da Universidade de São Paulo, Brasil


ABSTRACT

Background: Improved targeted therapies for rheumatic diseases were developed recently resulting in a better prognosis for affected patients. Nowadays, patients are living longer and with improved quality of life, including fertility potential. These patients are affected by impaired reproductive function and the causes are often multifactorial related to particularities of each disease. This review highlights how rheumatic diseases and their management affect testicular function and male fertility.
Materials and Methods: A systematic review of literature of all published data after 1970 was conducted. Data was collected about fertility abnormalities in male patients with systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, ankylosing spondylitis, Behçet disease and gout. Two independent researchers carried out the search in online databases.
Results: A total of 19 articles were included addressing the following diseases: 7 systemic lupus erythematosus, 6 Behçet disease, 4 ankylosing spondylitis, 2 rheumatoid arthritis, 2 dermatomyositis and one gout. Systemic lupus erythematosus clearly affects gonadal function impairing spermatogenesis mainly due to antisperm antibodies and cyclophosphamide therapy. Behçet disease, gout and ankylosing spondylitis patients, including those under anti-TNF therapy in the latter disease, do not seem to have reduced fertility whereas in dermatomyositis, the fertility potential is hampered by disease activity and by alkylating agents. Data regarding rheumatoid arthritis is scarce, gonadal dysfunction observed as consequence of disease activity and antisperm antibodies.
Conclusions: Reduced fertility potential is not uncommon. Its frequency and severity vary among the different rheumatic diseases. Permanent infertility is rare and often associated with alkylating agent therapy.

Keywords: Rheumatic Diseases; Fertility; Infertility, Male

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Are we following the guidelines on non-muscle invasive bladder cancer?

Vol. 42 (1): 22-28, January – February, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0122


ORIGINAL ARTICLE

Are we following the guidelines on non-muscle invasive bladder cancer?

Leonardo Oliveira Reis 1, Juliano Cesar Moro 2, Luis Fernando Bastos Ribeiro 2, Brunno Raphael Iamashita Voris 2, Marcos Vinicius Sadi 3
1 Divisão de Urologia Oncológica, Faculdade de Medicina, Centro de Ciências da Vida, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, São Paulo, Brazil; 2 Disciplina de Urologia, Departamento de Cirurgia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas, (UNICAMP), Campinas, São Paulo, Brazil; 3 Disciplina de Urologia, Escola Paulista de Medicina (EPM, Unifesp), São Paulo, São Paulo, Brazil


ABSTRACT

Objectives: To evaluate the clinical practice of non-muscle invasive bladder cancer (NMIBC) treatment in Brazil in relation to international guidelines: Sociedade Brasileira de Urologia (SBU), European Association of Urology (EAU) and American Urological Association (AUA).
Materials and Methods: Cross-sectional study using questionnaires about urological practice on treatment of NMIBC during the 32nd Brazilian Congress of Urology. A total of 650 question forms were answered.
Results: There were 73% of complete answers (total of 476 question forms). In total, 246 urologists (51.68%) lived in the southeast region and 310 (65.13%) treat 1 to 3 cases of NMIBC per month.
Low risk cancer: Only 35 urologists (7.5%) apply the single intravesical dose of immediate chemotherapy with Mitomicin C recommended by the above guidelines. Adjuvant therapy with BCG 2 to 4 weeks after TUR is used by 167 participants (35.1%) and 271 urologists (56.9%) use only TUR.
High risk tumors: 397 urologists (83.4%) use adjuvant therapy, 375 (78.8%) use BCG 2 to 4 weeks after TUR, of which 306 (64.3%) referred the use for at least one year. Intravesical chemotherapy with Mitomicin C (a controversial recommendation) was used by 22 urologists (4.6%). BCG dose raised a lot of discrepancies. Induction doses of 40, 80 and 120mg were referred by 105 (22%), 193 (40.4%) and 54 (11.3%) respectively. Maintenance doses of 40, 80 and 120mg were referred by 190 (48.7%), 144 (37.0%) and 32 (8.2%) urologists, respectively. Schemes of administration were also varied and the one cited by SWOG protocol was the most used: 142 (29.8%).
Conclusion: SBU, EAU and AUA guidelines are partially respected by Brazilian urologists, particularly in low risk tumors. In high risk tumors, concordance rates are comparable to international data. Further studies are necessary to fully understand the reasons of such disagreement.

Keywords: Urinary Bladder Neoplasms; BCG Vaccine; Practice Guidelines as Topic

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Brazilian data of renal cell carcinoma in a public university hospital

Vol. 42 (1): 29-36, January – February, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0452


ORIGINAL ARTICLE

Brazilian data of renal cell carcinoma in a public university hospital

Pedro Aguiar Junior 1, Tiago Costa Pádua 1, Daiane Pereira Guimarães 1
1 Departamento de Oncologia, Unifesp, São Paulo, Brasil


ABSTRACT

Purpose: Among renal malignancies, renal cell carcinoma (RCC) accounts for 85% of cases. Stage is a relevant prognostic factor; 5-year survival ranges from 81% to 8% according to the stage of disease. The treatment is based on surgery and molecularly targeted therapy has emerged as a choice for metastatic disease.
Materials and Methods: Retrospective study by reviewing the medical records of patients with RCC treated in the last 10 years at UNIFESP. The primary end point of this trial was to evaluate the overall survival (OS) of the patients. The secondary end point was to evaluate the progression-free survival (PFS) after nephrectomy.
Results: 118 patients with RCC were included. The mean age was 58.3 years, 61.9% men; nephrectomy was performed in 90.7%, clear cell was the histology in 85.6%, 44 patients were classified as stage IV at diagnosis. Among these, 34 had already distant metastasis. 29 patients were treated with sunitinib. The median OS among all patients was 55.8 months. The median PFS after nephrectomy was 79.1 months. Sarcomatoid differentiation HR29.74 (95% CI, 4.31-205.26), clinical stage IV HR1.94 (95% CI, 1.37-2.75) and nephrectomy HR0.32 (95% CI, 0.15-0.67) were OS prognostic factors. Sunitinib had clinical activity.
Conclusions: Patients treated in our hospital achieved median OS compatible with literature.
Nevertheless, this study has shown a high number of patients with advanced disease. For patients with advanced disease, treatment with sunitinib achieved median OS of 28.7 months, consistent with the literature.

Keywords: Renal carcinoma; nephrectomy; sunitinib; survival

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Three-dimensional reconstructive kidney volume analyses according to the endophytic degree of tumors during open partial or radical nephrectomy

Vol. 42 (1): 37-46, January – February, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0417


ORIGINAL ARTICLE

Three-dimensional reconstructive kidney volume analyses according to the endophytic degree of tumors during open partial or radical nephrectomy

Dong Soo Park 1, Young Kwon Hong 1, Seung Ryeol Lee 1, Jin Ho Hwang 1, Moon Hyung Kang 1, Jong Jin Oh 2
1 Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Korea; 2 Department
of Urology, Seoul National University Bundang Hospital, Seongnam, Korea


ABSTRACT

Objectives: To investigate the renal function outcomes and contralateral kidney volume change measured by using a 3-dimensional reconstructive method after open partial nephrectomy (PN) or open radical nephrectomy (RN) according to the endophytic degree of tumors.
Materials and Methods: We included 214 PN and 220 RN patients. According to the endophytic degree of the tumors, we divided patients into 3 groups. Patients were assessed for renal function and kidney volume change both preoperatively and postoperatively at 6 months. Kidney volume was calculated by using personal computer-based software. Subgroup analyses was performed for tumor >4cm.
Results: Larger and complex tumors were more frequent in the RN group than PN group. Among patients with exophytic and mild endophytic tumors, the mean postoperative renal function was well preserved in PN group and the mean contralateral kidney volume significantly increased in the RN compared to the PN group (PN, 145.55 to 149.98mL; 3.0% versus RN, 143.93 to 169.64mL;17.9% p=0.006). However, in fully
endophytic tumors, compensatory hypertrophy of the contralateral kidney was similar between PN and RN (PN, 138.16 to 159.64mL; 15.5 % versus RN, 138.65 to 168.04mL; 21.2% p=0.416) and renal functional outcomes were similar between both groups. These results were also confirmed in tumors >4cm in size.
Conclusions: In fully endophytic tumors, especially large tumors, the postoperative renal function and contralateral kidney volume were similar; therefore, we should consider RN preferentially as surgical option for these tumors.

Keywords: Kidney; Nephrectomy; Surgical Procedures, Operative; Neoplasms

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Low-dose-rate brachytherapy for patients with transurethral resection before implantation in prostate cancer. Longterm results

Vol. 42 (1): 47-52, January – February, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0531


ORIGINAL ARTICLE

Low-dose-rate brachytherapy for patients with transurethral resection before implantation in prostate cancer. Longterm results

Pedro J. Prada 1, Javier Anchuelo 1, Ana Garcia Blanco 1, Gema Paya 1, Juan Cardenal 1, Enrique Acuna 1, Maria Ferri 1, Andres Vazquez 2, Maite Pacheco, Jesica Sanchez 2
1 Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain; 2 Department of Radiation Physics, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain


ABSTRACT
Objectives: We analyzed the long-term oncologic outcome for patients with prostate cancer and transurethral resection who were treated using low-dose-rate (LDR) prostate brachytherapy.
Methods and Materials: From January 2001 to December 2005, 57 consecutive patients were treated with clinically localized prostate cancer. No patients received external beam radiation. All of them underwent LDR prostate brachytherapy. Biochemical failure was defined according to the “Phoenix consensus”. Patients were stratified as low and intermediate risk based on The Memorial Sloan Kettering group definition.
Results: The median follow-up time for these 57 patients was 104 months. The overall survival according to Kaplan-Meier estimates was 88% (±6%) at 5 years and 77% (±6%) at 12 years. The 5 and 10 years for failure in tumour-free survival (TFS) was 96% and respectively (±2%), whereas for biochemical control was 94% and respectively (±3%) at 5 and 10 years, 98% (±1%) of patients being free of local recurrence. A patient reported incontinence after treatment (1.7%). The chronic genitourinary complains grade I were 7% and grade II, 10%. At six months 94% of patients reported no change in bowel function.
Conclusions: The excellent long-term results and low morbidity presented, as well as the many advantages of prostate brachytherapy over other treatments, demonstrates that brachytherapy is an effective treatment for patients with transurethral resection and clinical organ-confined prostate cancer.

Keywords: Brachytherapy; Transurethral Resection of Prostate; Prostatic Neoplasms

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White blood cell counts and neutrophil to lymphocyte ratio in the diagnosis of testicular cancer: a simple secondary serum tumor marker

Vol. 42 (1): 53-59, January – February, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0593


ORIGINAL ARTICLE

White blood cell counts and neutrophil to lymphocyte ratio in the diagnosis of testicular cancer: a simple secondary serum tumor marker

Ozgur Haki Yuksel 1, Ayhan Verit 1, Aytac Sahin 1, Ahmet Urkmez 1, Fatih Uruc 1
1 Department of Urology, Fatih Sultan Mehmet Research & Training Hospital, Istanbul, Turkey


ABSTRACT

Purpose: The aim of the study was to investigate white blood cell counts and neutrophil to lymphocyte ratio (NLR) as markers of systemic inflammation in the diagnosis of localized testicular cancer as a malignancy with initially low volume.
Materials and Methods: Thirty-six patients with localized testicular cancer with a mean age of 34.22±14.89 years and 36 healthy controls with a mean age of 26.67±2.89 years were enrolled in the study. White blood cell counts and NLR were calculated from complete blood cell counts.
Results: White blood cell counts and NLR were statistically significantly higher in patients with testicular cancer compared with the control group (p<0.0001 for all).
Conclusions: Both white blood cell counts and NLR can be used as a simple test in the diagnosis of testicular cancer besides the well-known accurate serum tumor markers as AFP (alpha fetoprotein), hCG (human chorionic gonadotropin) and LDH (lactate dehydrogenase).

Keywords: NLR protein, mouse [Supplementary Concept]; Testicular Neoplasms; Biomarkers, Tumor

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