Vol. 42 n. 2 Mar . Apr, 2016

On the Editor’s Comment section, Prof. Leite, based on more recent knowledge in low grade (Gleason 6: [3+3] )prostate cancer, active surveillance protocols, and in  recent  International Society of Uropathology (ISUP) recommendations,…

EDITORIAL IN THIS ISSUE

Vol. 42 (2): 179-179, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2016.02.01


EDITOR’S THIS ISSUE

On the Editor’s Comment section, Prof. Leite, based on more recent knowledge in low grade (Gleason 6: [3+3] )prostate cancer, active surveillance protocols, and in  recent  International Society of Uropathology (ISUP) recommendations, bring to us her more recent impression favoring the omission of the presence of high grade prostatic intraepithelial neoplasia, in the anatomopathological reports of prostatic biopsies. For the patients, the absence of the term “high grade…. neoplasia” for sure, results in less anxiety. The approach of asymptomatic <1.0 cm lower pole kidney stones  is a crucial dilemma in daily practice, always resulting in debate. In the Difference of Opinion, Prof. Mazzuchhi, from University of Sao Paulo, is favorable to treat it, (mainly in selected groups of patients). On the other hand, Drs. Ludwig and Matlaga, from the John Hopkins University, advocates to not treat these patients, because three quarters of the asymptomatic ones will not present symptoms and will not require therapeutic interventions, being better conducted under surveillance and delayed intervention, if necessary. The first Latin American Consensus of Overactive Bladder (OAB) is a supranational collaborative group, that produced two literature reviews about this complexity neuro-urological entity, described in the last decades: Part I: focusing on the definition of OAB, epidemiological aspects, and research aspects of OAB (page 188), and the Part II (page 199), focusing  on the therapeutics modalities (for primary treatment and for refractory cases. In page 312, some Brazilian collaborators of the above mentioned reviews reported 83% of success in the first 16 cases of sacral neuromodulator implantation in their country; the majority of the cases were indicated for patients with refractory OAB. An Indian Group from Chandigarh has shown no advantage with the use of isolated whole body 18FDG PET (or combination of PET and CT) versus exclusive computorized tomography for  lymph node evaluation in patients with muscle invasive bladder cancer , regarding costs (page 234). The serum dosage of procalcitonin (PCT) has been popularized for septic patients worldwide. In a South Korean study (page 270), PCT was the strongest predictor of septic chock in patients with urinary sepsis due to acute pyelonephritis, secondary of ureteral calculi (area under curve ROC was 0.929). Studies reporting minimally invasive procedures in pediatric population are scarce. In page 277, Patel et al., from San Diego, California, reported the use of single site laparoscopic surgery in 44 children (mean age 6.9 years). They used commercial ports, and auxiliary instruments were inserted through fascial punctions. There was only one conversion to open surgery. Ather and Memmon from Karachi, Pakistan (page 321), reported a so innovative visual pictorial questionnaire to evaluate lower urinary tract symptoms to be applied in illiterate people or among men with low educational level, named VPSS Visual prostate Symptoms Score. VPSS score presented low correlation with maximum urinary flux (Qmax), suggesting it to be a valid tool for poor and low education populations. An ancient, but actual discussion is: what is the best approach in open surgery for large glands with benign prostatic hyperplasia, suprapubic or retropubic ? Sakuramoto et al., from ABC School reported better results for the retropubic surgeries, during the residents learning curve. Returning to children and urinary dysfunction, investigators from Ankara demonstrated that medical therapy is ineffective in more than 50% of kids presenting  giggle incontinence (urinary leaks during giggling or laughing while awake). These findings suggest is preferable to avoid drugs in these children.

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

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EDITOR’S COMMENT – Why do we keep reporting high-grade prostatic intraepithelial neoplasia (HGPIN)?

Vol. 42 (2): 180-182, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2016.02.02


EDITOR’S COMMENT

Why do we keep reporting high-grade prostatic intraepithelial neoplasia (HGPIN)?

Over the years, concepts regarding prostate cancer (PC) have been changing tremendously. Invasive prostate adenocarcinoma has a precursor, in situ lesion, as all other epithelial neoplasia, that McNeal and Bostwick described as “intraductal dysplasia” in 1984 (1) what we now call prostatic intraepithelial neoplasia (PIN).

At first, PIN was classified as I, II or III (2), being later simplified as low or high grade PIN (HGPIN). The latter was the only lesion that should be mentioned in the pathological report, since there was a close relation between HGPIN and invasive cancer (3).
At that point, prostate biopsy was routinely made in sextant with only six fragments taken randomly from the base, medium portion and apex of both sides of the prostate gland as suggested by Hogde in substitution to biopsy directed to nodules identified by rectal examination (4). Following HGPIN the chance of finding cancer was up to 35%, and a new biopsy was recommended after this diagnosis (5).
Different studies suggested that sextant biopsies were not adequate to search for prostate cancer and 12, 14, 16, 18 fragments and even saturation biopsies with over 30 cores taken in one biopsy section were proposed to correctly diagnose the disease. With the increased number of fragments, the diagnosis of HGPIN lost its power to predict PC in subsequent biopsies, with results similar to those found after a benign diagnosis (6). In addition, in the occasion of prostate cancer detection after a HGPIN diagnosis, radical prostatectomy shows favorable characteristics of the tumor (7).
An important change regarding PC was the review of the histological classification proposed by Gleason resulting in the termination of patterns 1 and 2 in biopsies in 2005 (8). Subsequently, the lowest histological grade in routine practice has been Gleason 6(3+3) that is now referred to as grade group 1 or ISUP grade 1 by a new classification proposed by a consensus meeting of the International Society of Urological Pathology (ISUP) on November 1st 2014 (9).
The Hopkins group published earlier a provocative paper proposing a discussion about the probable indolence of a prostate cancer Gleason 6(3+3). They suggested that PC Gleason 6(3+3) after the 2005 ISUP consensus, should not be called cancer considering that it is not related to unfavorable prognostic factors, does not metastasize to lymph nodes nor to distant organs after radical prostatectomy (10).
All the new data supported the management of PC that now prioritizes surveillance over treatment for well differentiated tumors. There are numbers of trials of active surveillance, now with a follow-up of 15 years, that show cancer specific survival of 100%, strengthening even more the Hopkins concept (11). Although there was a significant change in the comprehension and management of PC considering the well differentiated tumors we remain reporting HGPIN. For patients, the term “high grade neoplasia” is very alarming and a motive of great apprehension. Not infrequently, patients reach out to their doctors anxiously when facing this diagnosis in a pathology report, causing stress also to urologists and clinicians.
In addition, some of the lesions that in the past we used to call florid HGPIN are now being called intraductal cancer (IDC), a diagnosis frequently associated with high grade invasive cancer. It is now recommended that a diagnosis of IDC be associated with a note in the pathology report recommending a better attention to this particular patient (12).
Since HGPIN now only correlates with a marginal increase in the incidence of prostate cancer, I would like to propose that we pathologists begin to omit this diagnosis in our reports as we did with low grade PIN in the past. This will certainly reduce stress in patients and doctors.

REFERENCES

1) McNeal JE, Bostwick DG. Intraductal dysplasia: a premalignant lesion of the prostate. Hum Pathol. 1986;17:64-71.
2) Bostwick DG, Brawer MK. Prostatic intra-epithelial neoplasia and early invasion in prostate cancer. Cancer. 1987;59:788-94.
3) Bostwick DG. Prospective origins of prostate carcinoma. Prostatic intraepithelial neoplasia and atypical adenomatous hyperplasia. Cancer. 1996;78:330-6.
4) Hodge KK, McNeal JE, Terris MK, Stamey TA. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate. J Urol. 1989;142:71-4; discussion 4-5.
5) Davidson D, Bostwick DG, Qian J, Wollan PC, Oesterling JE, Rudders RA, et al. Prostatic intraepithelial neoplasia is a risk factor for adenocarcinoma: predictive accuracy in needle biopsies. J Urol. 1995;154:1295-9.
6) Epstein JI, Herawi M. Prostate needle biopsies containing prostatic intraepithelial neoplasia or atypical foci suspicious for carcinoma: implications for patient care. J Urol. 2006;175(3 Pt 1):820-34.
7) Al-Hussain TO, Epstein JI. Initial high-grade prostatic intraepithelial neoplasia with carcinoma on subsequent prostate needle biopsy: findings at radical prostatectomy. Am J Surg Pathol. 2011;35:1165-7.
8) Epstein JI, Allsbrook WC, Jr., Amin MB, Egevad LL, Committee IG. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am J Surg Pathol. 2005;29:1228-42.
9) Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA, et al. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: Definition of Grading Patterns and Proposal for a New Grading System. Am J Surg Pathol. 2016;40:244-52
10) Carter HB, Partin AW, Walsh PC, Trock BJ, Veltri RW, Nelson WG, et al. Gleason score 6 adenocarcinoma: should it be labeled as cancer? J Clin Oncol. 2012;30:4294-6.
11) Tosoian JJ, Mamawala M, Epstein JI, Landis P, Wolf S, Trock BJ, et al. Intermediate and Longer-Term Outcomes From a Prospective Active-Surveillance Program for Favorable-Risk Prostate Cancer. J Clin Oncol. 2015;33:3379-85.
12) Guo CC, Epstein JI. Intraductal carcinoma of the prostate on needle biopsy: Histologic features and clinical significance. Mod Pathol. 2006;19:1528-35.

Katia R. M. Leite, MD, PhD
Conselheiro Internacional para América do Sul da Sociedade Internacional de Patologia Urológica (ISUP) Professor da Universidade de São Paulo (FMUSP) Director do Laboratório de Investigação Médica da FMUSP – LIM 55 Av. Dr. Arnaldo 455, São Paulo, Brazil
E-mail: katiaramos@uol.com.br

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Asymptomatic lower pole stone < 1 cm: to treat or not to treat?

Vol. 42 (2): 183-184, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2016.02.03


DIFFERENCE OF OPINION


Asymptomatic lower pole stone < 1 cm: to treat or not to treat?
Opinion: Treat

Eduardo Mazzuchi
Divisão de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina de
São Paulo, Brasil


Keywords: Urinary Calculi; Kidney Calculi; Hydronephrosis


The prevalence of urinary stones is increasing and reached 8.8% in the United States in 2010 (1). We do not have statistics on this issue in developing countries but the impression is that this is a worldwide tendency thanks to an increase in obesity and to our modern lifestyle. The proportion of asymptomatic renal stones is also increasing probably due to the more frequent use of image methods. According to the literature 20 to 44% of renal stones are located in the lower pole and to treat them or not and how to do that has been motive of debate (2, 3). The importance of this issue is capital once almost every day we are asked to see a completely asymptomatic and surprised patient with an ultrasound done for any other reason showing a small solitary caliceal lower pole stone.

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Asymptomatic lower pole stone < 1 cm: to treat or not to treat?

Vol. 42 (2): 185-187, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2016.02.04


DIFFERENCE OF OPINION


Asymptomatic lower pole stone < 1 cm: to treat or not to treat?
Opinion: Do not treat

Wesley W. Ludwig 1, Justin B. Ziemba 2, Brian R. Matlaga 1
1 James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA;
2 Division of Urology, Department of Surgery, Perelman School of Medicine at the University of
Pennsylvania, Philadelphia, PA, USA


Keywords: Urinary Calculi; Kidney Calculi; Hydronephrosis


The increasing use of cross-sectional imaging has made the incidental detection of asymptomatic stones a common occurrence with an estimated 8% of the population affected (1). Despite its frequency the average asymptomatic stone size is only 3 mm and is frequently located in the lower pole (1, 2). Nevertheless, urologists are often faced with the decision to treat or not to treat these asymptomatic stones. Favoring treatment is the theoretical benefit of preventing a future symptomatic stone event. Against treatment is the potential for morbidity related to our treatment modalities in the setting of a stone which may never become symptomatic. Therefore, we argue that avoidance of treatment in an asymptomatic lower pole renal stone < 1 cm, especially initially, in favor of surveillance is the best management choice.

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Overactive bladder – 18 years – Part I

Vol. 42 (2): 188-198, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0365


REVIEW ARTICLE


Overactive bladder – 18 years – Part I

Jose Carlos Truzzi 1, Cristiano Mendes Gomes 2, Carlos A. Bezerra 3, Ivan Mauricio Plata 4, Jose Campos 5, Gustavo Luis Garrido 6, Fernando G. Almeida 1, Marcio Augusto Averbeck 7, Alexandre Fornari 8, Anibal Salazar 9, Arturo Dell’Oro 10, Caio Cintra 3, Carlos Alberto Ricetto Sacomani 9, Juan Pablo Tapia 11, Eduardo Brambila 12, Emilio Miguel Longo 13, Flavio Trigo Rocha 2, Francisco Coutinho 12, Gabriel Favre 14, José Antonio Garcia 14, Juan Castaño 15, Miguel Reyes 12, Rodrigo Eugenio Leyton 16, Ruiter Silva Ferreira 17, Sergio Duran 12, Vanda López 18, Ricardo Reges 19

1 Escola Paulista de Medicina – EPM – Universidade Federal de São Paulo, SP, Brasil; 2 Departamento de Urologia, Universidade de São Paulo, SP, Brasil; 3 Departamento de Urologia, Faculdade de Medicina do ABC, SP, Brasi; 4 Departamento de Urología, Universidad de los Andes, Bogota, Colombia; 5 Departamento de Urología, Escuela Médico Militar, Cidade do México, Mexico; 6 Cátedra de Urologia, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina; 7 Departamento de Urologia, Mãe de Deus Center Hospital, Porto Alegre, RS, Brasil; 8 Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil; 9 Departamento de Urologia, AC Camargo Hospital, SP, Brasil; 10 Hospital Clinico de la Fuerza Area de Chile, Santiago, Chile; 11 Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico; 12 Departamento de Urologia, Hospital Souza Aguiar, RJ, Brasil; 13 Servicio de Urología, del Complejo Médico Policial Churruca Visca, Buenos Aires, Argentina; 14 Centro Policlínico Valencia “La Viña”, Valencia, Venezuela; 15 Hospital Pablo Tobón Uribe, Medellin, Colômbia; 16 Servicio de Urología, Clinica Indisa, Providencia, Chile; 17 Centro de Reabilitação e Readaptação Dr. Henrique Santillo, Goiânia, Brasil; 18 Servicio de Urología, del Hospital Universitario de Caracas, Caracas, Venezuela; 19 Divisão de Urologia, Universidade Federal do Ceará, CE, Brasil

ABSTRACT

Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals – including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients’ access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic
drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.

Keywords: Overactive Bladder; Muscarinic Antagonists; Beta-adrenergic agonists; Botulinum Toxin; Sacral neuromodulation; Urodynamics

[Full Text]


Overactive bladder – 18 years – Part II

Vol. 42 (2): 199-214, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0367


REVIEW ARTICLE


Overactive bladder – 18 years – Part II

Jose Carlos Truzzi 1, Cristiano Mendes Gomes 2, Carlos A. Bezerra 3, Ivan Mauricio Plata 4, Jose Campos 5, Gustavo Luis Garrido 6, Fernando G. Almeida 1, Marcio Augusto Averbeck 7, Alexandre Fornari 8, Anibal Salazar 9, Arturo Dell’Oro 10, Caio Cintra 3, Carlos Alberto Ricetto Sacomani 9, Juan Pablo Tapia 11, Eduardo Brambila 12, Emilio Miguel Longo 13, Flavio Trigo Rocha 2, Francisco Coutinho 12, Gabriel Favre 14, José Antonio Garcia 14, Juan Castaño 15, Miguel Reyes 12, Rodrigo Eugenio Leyton 16, Ruiter Silva Ferreira 17, Sergio Duran 12, Vanda López 18, Ricardo Reges 19

1 Escola Paulista de Medicina – EPM – Universidade Federal de São Paulo, SP, Brasil; 2 Departamento de Urologia, Universidade de São Paulo, SP, Brasil; 3 Departamento de Urologia, Faculdade de Medicina do ABC, SP, Brasi; 4 Departamento de Urología, Universidad de los Andes, Bogota, Colombia; 5 Departamento de Urología, Escuela Médico Militar, Cidade do México, Mexico; 6 Cátedra de Urologia, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina; 7 Departamento de Urologia, Mãe de Deus Center Hospital, Porto Alegre, RS, Brasil; 8 Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil; 9 Departamento de Urologia, AC Camargo Hospital, SP, Brasil; 10 Hospital Clinico de la Fuerza Area de Chile, Santiago, Chile; 11 Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico; 12 Departamento de Urologia, Hospital Souza Aguiar, RJ, Brasil; 13 Servicio de Urología, del Complejo Médico Policial Churruca Visca, Buenos Aires, Argentina; 14 Centro Policlínico Valencia “La Viña”, Valencia, Venezuela; 15 Hospital Pablo Tobón Uribe, Medellin, Colômbia; 16 Servicio de Urología, Clinica Indisa, Providencia, Chile; 17 Centro de Reabilitação e Readaptação Dr. Henrique Santillo, Goiânia, Brasil; 18 Servicio de Urología, del Hospital Universitario de Caracas, Caracas, Venezuela; 19 Divisão de Urologia, Universidade Federal do Ceará, CE, Brasil

ABSTRACT

Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics – pillars of the overactive bladder pharmacotherapy – started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning – as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder – 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

Keywords: Overactive Bladder; Muscarinic Antagonists; Beta-adrenergic agonists; Botulinum Toxin; Sacral neuromodulation; Urodynamics

[Full Text]


“Total reconstruction” of the urethrovesical anastomosis contributes to early urinary continence in laparoscopic radical prostatectomy

Vol. 42 (2): 215-222, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0666


ORIGINAL ARTICLE


“Total reconstruction” of the urethrovesical anastomosis contributes to early urinary continence in laparoscopic radical prostatectomy

Xiaoxing Liao 1, 2, Peng Qiao 1, Zhaohui Tan 3, Hongbin Shi 4, Nianzeng Xing 1

1 Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; 2 Department of Urology, Beijing Aerospace General Hospital, Beijing, China; 3 Department of Urology, Inner Mongolia People’s Hospital, Inner Mongolia, China; 4 Department of Urology, General Hospital of Ningxia Medical University, Yinchuan, China

 ABSTRACT

Purpose: To demonstrate the effect of total reconstruction technique on postoperative urinary continence after laparoscopic radical prostatectomy (LRP).
Material and Methods: LRP was performed using a standard urethrovesical anastomosisin 79 consecutive patients (Group-A) from June 2011 to October 2012, and a total reconstruction procedure in 82 consecutive patients (Group-B) from June 2012 to June 2013. The primary outcome measurement was urinary continence assessed at 1, 2, 4, 12, 24 and 52 weeks after catheter removal. Other data recorded were patient age, body mass index, International Prostate Symptoms Score, prostate volume, preoperative PSA, Gleason score, neurovascular bundle preservation, operation time, estimated blood loss, complications and pathology results.
Results: In Group-A, the continence rates at 1, 2, 4, 12, 24 and 52 weeks were 7.59%, 20.25%, 37.97%, 58.22%, 81.01% and 89.87% respectively. In Group-B, the continence rates were 13.41%, 32.92%, 65.85%, 81.71%, 90.24% and 95.12% respectively. Group-B had significantly higher continence rates at 4 and 12 weeks after surgery (P<0.001 and P=0.001). There were no significant differences between the groups with respect to patient’s age, body mass index, prostate-specific antigen level, prostate volume, IPSS, estimated blood loss, number of nerve-sparing procedures and postoperative complications.
Conclusions: Total reconstruction technique in the procedure of urethrovesical anastomosis during LRP improved early recovery of continence.

Keywords: Laparoscopy; Prostatectomy; Urinary Incontinence; Prostatic Neoplasms; Reconstructive Surgical Procedures

[Full Text]


 

Laparoscopic versus open radical prostatectomy in high prostate volume cases: impact on oncological and functional results

Vol. 42 (2): 223-233, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0385


ORIGINAL ARTICLE


Laparoscopic versus open radical prostatectomy in high prostate volume cases: impact on oncological and functional results

Sciarra Alessandro 1, Gentilucci Alessandro 1, Cattarino Susanna 1, Innocenzi Michele 1, Di Quilio Francesca 1, Fasulo Andrea 2, Magnus Von heland 1, Gentile Vincenzo 1, Salciccia Stefano 1

1 Dipartimento di Urologia – Unità della prostata, Università La Sapienza, Roma, Italia; 2 Istituto Nazionale Italiano di Statistica – Ricercatore di Statistica, Roma, Italia

ABSTRACT

Background and objective: To prospectively compare the laparoscopic versus open approach to RP in cases with high prostate volume and to evaluate a possible diferente impact of prostate volume.
Materials and Methods: From March 2007 to March 2013 a total of 120 cases with clinically localized prostate cancer (PC) and a prostate volume>70cc identified for radical prostatectomy (RP), were prospectively analyzed in our institute. Patients were offered as surgical technique either an open retropubic or an intraperitoneal laparoscopic (LP) approach. In our population, 54 cases were submitted to LP and 66 to open RP. We analyzed the association of the surgical technique with perioperative, oncological and postoperative functional parameters.
Results: In those high prostate volume cases, the surgical technique (laparoscopic versus open) does not represent a significant independent factor able to influence positive surgical margins rates and characteristics (p=0.4974). No significant differences (p>0.05) in the overall rates of positive margins was found, and also no differences following stratification according to the pathological stage and nerve sparing (NS) procedure. The surgical technique was able to significantly and independently influence the hospital stay, time of operation and blood loss (p<0.001). On the contrary, in our population, the surgical technique was not a significant factor influencing all pathological and 1-year oncological or functional outcomes (p>0.05).
Conclusions: In our prospective non randomized analysis on high prostate volumes, the laparoscopic approach to RP is able to guarantee the same oncological and functional results of an open approach, maintaining the advantages in terms of perioperative outcomes.

Keywords: Laparoscopy; Prostatic Neoplasms; Prostate; Prostatectomy; Surgical Procedures, Operative

[Full Text]


 

Is [f-18]-fluorodeoxyglucose fdg-pet/ct better than ct alone for the preoperative lymph node staging of muscle invasive bladder cancer?

Vol. 42 (2): 234-241, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0579


ORIGINAL ARTICLE


Is [f-18]-fluorodeoxyglucose fdg-pet/ct better than ct alone for the preoperative lymph node staging of muscle invasive bladder cancer?

Mete Uttam 1, Nayak Pravin 1, Bhattacharya Anish 2, Kakkar Nandita 3, Mandal Arup 1
1 Department of Urology, PGIMER, Chandigarh; 2 Department of Nuclear Medicine PGIMER, Chandigarh; 3 Department of Histopathology, PGIMER, Chandigarh

ABSTRACT

Objective: To evaluate whether the use of [F-18]-FDG-PET/CT can accurately predict pelvic lymph node metastasis in patients with muscle invasive TCC of the bladder undergoing radical cystectomy.
Materials and Methods: Fifteen patients with muscle invasive bladder cancer had undergone FDG-PET/CT scan from the skull base to the mid-thighs after IV injection of 6.5MBq (Mega-Becquerel)/Kg of FDG. After intravenous hydration IV furosemide was given to overcome the difficulties posed by urinary excretion of 18F-FDG. PET/CT data were analyzed as PET and CT images studied separately as well as fused PET/CT images. The imaging findings were correlated with the histopathology of the nodes (gold standard).
Results: CT and FDG-PET had demonstrated positive lymph nodes in 9 & 8 patients respectively. Among the 15 patients 3 had documented metastasis on histopathology. Both CT and PET could detect the nodes in all these 3 patients (100% sensitivity). Nodes were histologically negative amongst 6&5 patients who had node involvement by CT and PET respectively. Therefore, specificity, positive predictive value (PPV) & negative predictive value (NPV) for CT and PET/CT were 50%, 33.3%, and 100% and 58.3%, 37.5%, and 100% respectively.
Conclusion: The theoretical advantage of this cutting edge technology for whole body imaging has not been translated into clinical practice as we found minimal advantage of combined FDG-PET/CT over CT alone for nodal staging of muscle invasive bladder cancer. This may be due to substantial overlap between standardized uptake values (SUVs) from active inflammatory processes with those of malignant lesion.

Keywords: Urinary Bladder Neoplasms; Positron-Emission Tomography; Tomography, X-Ray Computed; Carcinoma, Transitional Cell

[Full Text]


Urothelial neoplasm of the bladder in childhood and adolescence: a rare disease

Vol. 42 (2): 242-246, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0200


ORIGINAL ARTICLE


Urothelial neoplasm of the bladder in childhood and adolescence: a rare disease

Haci Polat 1, Mehmet M. Utangac 2, Murat T. Gulpinar 3, Ali Cift 1, İbrahim Halil Erdogdu 4, Gul Turkcu 5

1 Adiyaman University, Faculty of Medicine, Department of Urology, Adiyaman, Turkey; 2 Dicle University, Faculty of Medicine, Department of Urology, Diyarbakir, Turkey; 3 Canakkale Onsekiz Mart University, Faculty of Medicine, Department of Urology, Canakkale, Turkey; 4 Adiyaman University, Faculty of Medicine, Department of Medical Pathology, Adiyaman, Turkey; 5 Dicle University, Faculty of Medicine, Department of Medical Pathology, Diyarbakir, Turkey

ABSTRACT

Purpose: Bladder tumors are rare in children and adolescents. For this reason, the diagnosis is sometimes delayed in pediatric patients. We aimed to describe the diagnosis, treatment, and follow-up methods of bladder urothelial neoplasms in children and adolescents.
Materials and Methods: We carried out a retrospective multicenter study involving patients who were treated between 2008 and 2014. Eleven patients aged younger than 18 years were enrolled in the study. In all the patients, a bladder tumor was diagnosed using ultrasonography and was treated through transurethral resection of the bladder (TURBT).
Results: Nine of the 11 patients (82%) were admitted with gross hematuria. The average delay in diagnosis was 3 months (range, 0–16 months) until the ultrasonographic diagnosis was performed from the first episodes of macroscopic hematuria. A single exophytic tumor (1–4cm) was present in each patient. The pathology of all patients was reported as superficial urothelial neoplasm: two with papilloma, one with papillary urothelial neoplasm of low malignant potential (PUNLMP), four with low grade pTa, and four with low grade pT1. No recurrence was observed during regular cystoscopic and ultrasonographic follow-up.
Conclusions: Regardless of the presence of hematuria, bladder tumors in children are usually not considered because urothelial carcinoma in this population is extremely rare, which causes a delay in diagnosis. Fortunately, the disease has a good prognosis and recurrences are infrequent. Cystoscopy may be unnecessary in the follow-up of children with bladder tumors. We believe that ultrasonography is sufficient in follow-up.

Keywords: Urinary Bladder Neoplasms; Adolescent; Ultrasonography

[Full Text]


Low grade urothelial carcinoma mimicking basal cell hyperplasia and transitional metaplasia in needle prostate biopsy

Vol. 42 (2): 247-252, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0512


ORIGINAL ARTICLE


Low grade urothelial carcinoma mimicking basal cell hyperplasia and transitional metaplasia in needle prostate biopsy

Julian Arista-Nasr 1, Braulio Martinez-Benitez 1, Leticia Martinez Bornstein-Quevedo 1, Elizmara Aguilar-Ayala 1, Claudia Natalia Aleman-Sanchez 1, Raul Ortiz-Bautista 1

1 Instituto Nacional de Nutricion–Pathology, Mexico DF, Distrito Federal, Mexico

ABSTRACT

Purpose: The vast majority of urothelial carcinomas infiltrating the bladder are consistent with high-grade tumors that can be easily recognized as malignant in needle prostatic biopsies. In contrast, the histological changes of low-grade urothelial carcinomas in this kind of biopsy have not been studied.
Materials and Methods: We describe the clinicopathologic features of two patients with low-grade bladder carcinomas infiltrating the prostate. They reported dysuria and hematuria. Both had a slight elevation of the prostate specific antigen and induration of the prostatic lobes. Needle biopsies were performed. At endoscopy bladder tumors were found in both cases.
Results: Both biopsies showed nests of basophilic cells and cells with perinuclear clearing and slight atypia infiltrating acini and small prostatic ducts. The stroma exhibited extensive desmoplasia and chronic inflammation. The original diagnosis was basal cell hyperplasia and transitional metaplasia. The bladder tumors also showed low-grade urothelial carcinoma. In one case, the neoplasm infiltrated the lamina propria, and in another, the muscle layer. In both, a transurethral resection was performed for obstructive urinary symptoms. The neoplasms were positive for high molecular weight keratin (34BetaE12) and thrombomodulin. No metastases were found in either of the patients, and one of them has survived for five years.
Conclusions: The diagnosis of low-grade urothelial carcinoma in prostate needle biopsies is difficult and may simulate benign prostate lesions including basal cell hyperplasia and urothelial metaplasia. It is crucial to recognize low-grade urothelial carcinoma in needle biopsies because only an early diagnosis and aggressive treatment can improve the prognosis for these patients.

Keywords: Carcinoma, Transitional Cell; Biopsy, Needle; Hyperplasia

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Functional and oncologic outcomes after nephron-sparing surgery in a solitary kidney: 10 years of experience

Vol. 42 (2): 253-261, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0463


ORIGINAL ARTICLE


Functional and oncologic outcomes after nephron-sparing surgery in a solitary kidney: 10 years of experience

Costabel José Ignacio 1, García Marchiñena Patricio 1, Tirapegui Federico 1, Dantur Augusto 1, Jurado Alberto 1, Gueglio Guillermo 1

1 – Departamento de Urología del Hospital Italiano de Buenos Aires, Argentina

ABSTRACT

Objectives: To evaluate functional and oncologic outcomes of partial nephrectomy (PN) in patients with a solitary kidney.
Materials and Methods: A retrospective analysis of patients with a solitary kidney undergoing nephron-sparing surgery between March 2003 and March 2013 was performed. GFR was recorded before the procedure and 3 months after surgery, thus establishing a change (cGFR). Several variables that may influence cGFR were analyzed. Complications are herein described, namely bleeding, fistula, acute renal failure and end-stage renal disease (ESRD). Local recurrence and margin status are also described. Survival rates were calculated using the Kaplan Meier method (2 patients with metastasis at the time of surgery were excluded from the analysis).
Results: Forty-five patients were available for analysis. Median follow-up was 27.56 months (r 3-96). Mean cGFR was-7.12mL/min (SD 2.1). Variables significantly related with lower GFR after surgery were loss of renal mass (p=0.01)) and male gender (p=0.03). Four patients (8.8%) experienced hemorrhage. Nine patients (20%) developed a urinary fistula. Only one patient with bleeding required open surgery. Two patients (4.4%) needed transient dialysis. Three patients (6.6%) developed ESRD. Four patients (8.8%) had positive surgical margins (PSMs) and four patients (88%) had local recurrence (2 of these had PSMs). Five patients (11.1%) died during follow-up. Four patients (8.8%) died because of renal cancer. Estimated 2-year overall survival, disease-free survival and cancer specific survival rates were 88.4% (CI 95% 70.5-96); 87.7% (CI 95% 68.1-96) and 92.4% (CI 95% 75-98), respectively.
Conclusion: Loss of renal mass and male gender were associated with lower postoperative GFR. Our outcomes were comparable with those in the World literature.

Keywords: Renal carcinoma; solitary kidney; nephron-sparing surgery; partial nephrectomy

[Full Text]


Outcome and complications of percutaneous nephrolithotomy as primary versus secondary procedure for renal calculi

Vol. 42 (2): 262-269, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0619


ORIGINAL ARTICLE


Outcome and complications of percutaneous nephrolithotomy as primary versus secondary procedure for renal calculi

S V Krishna Reddy 1, Ahammad Basha Shaik 2

1 Department of Urology, Narayana Medical College, Nellore, Andhra Pradesh, India; 2 Department of Statistics, Sri Venkateswara University, Tirupati, Andhra Pradesh, India

ABSTRACT

Purpose: To compare the efficacy of percutaneous nephrolithotomy (PCNL) as a primary procedure of patients following previous open surgery or post percutaneous nephrolithotomy (PCNL) for renal calculi.
Materials and Methods: The medical records of 367 patients who underwent PCNL by a single surgeon from January 2008 to December 2013 were reviewed retrospectively. All patients were divided into 3 Groups. Group-1 (n=232) included patients with no history of ipsilateral open stone surgery. Group 2 (n=86) patients had undergone one or more open stone surgeries before PCNL, patients with failed or recurrence following PCNL were placed in Group-3 (n=49). The demographic data, operation duration, stone free rate (SFR), number of attempts to access the collecting system and intra operative and postoperative complications between the three Groups were compared.
Results: There was no difference in sex, Body Mass Index (BMI), stone burden and laterality among the three Groups. Operation time was significantly less in first Group, while there was a statistically significant difference in operation duration between second and third Groups (p<0.05). The number of attempts to enter the collecting system was lower in the first Group in comparison to other two Groups (p<0.5). There was no significant differences among three groups in stone free rate. Intra operative and postoperative complications were slightly more frequent in Groups 2 and 3. Mortality occurred in 1 patient with colon perforation in Group-2.
Conclusion: Our study demonstrated that PCNL can be performed in patients even as secondary procedure without further complications.

Keywords: Kidney Calculi; Nephrostomy, Percutaneous; complications [Subheading]

[Full Text]


Procalcitonin determined at emergency department as an early indicator of progression to septic shock in patient with sepsis associated with ureteral calculi

Vol. 42 (2): 270-276, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0465


ORIGINAL ARTICLE


Procalcitonin determined at emergency department as an early indicator of progression to septic shock in patient with sepsis associated with ureteral calculi

Young Hwii Ko 1, Yoon Seob Ji 1, Sin-Youl Park 2, Su Jin Kim 3, Phil Hyun Song 1

1 Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea; 2 Department of Emergency medicine, College of Medicine, Yeungnam University, Daegu, Korea; 3 Department of Emergency medicine, Korea University Anam Hospital, Seoul, Korea

ABSTRACT

Introduction: To investigate the role of initial procalcitonin (PCT) level as an early predictor of septic shock for the patient with sepsis induced by acute pyelonephritis (APN) secondary to ureteral calculi.
Materials and Methods: The data from 49 consecutive patients who met criteria of sepsis due to APN following ureteral stone were collected and divided into two groups: with (n=15) or without (n=34) septic shock. The clinical variables including PCT level for this outcome were retrospectively compared by univariate analysis, followed by multivariable logistic regression model.
Results: All subjects had hydronephrosis, and were hospitalized with the mean of 11.8 days (3-42 days). The mean size of the ureteral stones was 7.5mm (3-30mm), and 57% were located in upper ureter. At univariate analysis, patients with septic shock were significantly older, a higher proportion had hypertension, lower platelet count and serum albumin level, higher CRP and PCT level, and higher positive blood culture rate. Multivariate models indicated that lower platelet count and higher PCT level are independent risk factors (p=0.043 and 0.046, respectively). In ROC curve, the AUC was significantly wider in PCT (0.929), compared with the platelet count (0.822, p=0.004). At the cut-off of 0.52ng/mL, the sensitivity and specificity were 86.7% and 85.3%.
Conclusion: Our study demonstrated elevated initial PCT levels as an early independent predictor to progress into septic shock in patients with sepsis associated with ureteral calculi.

Keywords: Ureteral Calculi; Pyelonephritis; Shock, Septic

[Full Text]


Laparoendoscopic single site surgery in pediatric urology: does it require specialized tools?

Vol. 42 (2): 277-283, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0444


ORIGINAL ARTICLE


Laparoendoscopic single site surgery in pediatric urology: does it require specialized tools?

Nishant Patel 1, Michael Santomauro 2, Sarah Marietti 3, George Chiang 3

1 Department of Urology, University of California San Diego Health System, San Diego, California; 2 Institute of Urology, University of Southern California, Los Angeles, California; 3 UCSD Department of Urology, Rady Children’s Specialists Pediatric Urology, San Diego, California

ABSTRACT

Purpose: To describe our experience utilizing Laparoendoscopic single site (LESS) surgery in pediatric urology.
Materials and Methods: Retrospective chart review was performed on LESS urologic procedures from November 2009 through March 2013. A total of 44 patients underwent 54 procedures including: nephrectomy (23), orchiopexy (14), varicocelectomy (9), orchiectomy (2), urachal cyst excision (3), and antegrade continence enema (3) (ACE).
Results: Median patient age was 6.9 years old. Estimated blood loss (EBL), ranged from less than 5cc to 47cc for a bilateral nephrectomy. Operative time varied from 56 mins for varicocelectomy to a median of 360 minutes for a bilateral nephroureterectomy. Incision length ranged between 2 and 2.5cm. In our initial experience we used a commercial port. However, as we progressed, we were able to perform the majority of our procedures via adjacent fascial punctures for instrumentation at the single incision site. One patient did require conversion to an open procedure as a result of bleeding. Three complications were noted (6.8%), with two Clavien Grade 3b complications. Two patients required additional procedures at 1-year follow-up.
Conclusions: The use of LESS applies to many pediatric urologic procedures, ideally for ablative procedures or simple reconstructive efforts. The use of adjacent fascial puncture sites for instrumentation can obviate the need for a commercial port or multiple trocars.

Keywords: Laparoscopy; Pediatrics; Surgical Procedures, Operative; Urology

[Full Text]


Open suprapubic versus retropubic prostatectomy in the treatment of benign prostatic hyperplasia during resident’s learning curve: a randomized controlled trial

Vol. 42 (2): 284-292, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0517


ORIGINAL ARTICLE

Open suprapubic versus retropubic prostatectomy in the treatment of benign prostatic hyperplasia during resident’s learning curve: a randomized controlled trial

Arie Carneiro 1, 2, Paulo Sakuramoto 2, Marcelo Langer Wroclawski 1, 2, Pedro Herminio Forseto 2, Alexandre Den Julio 2, Carlos Ricardo Doi Bautzer 2, Leonardo Monte Marques Lins 2, Andre Kataguiri 2, Fernanda Batistini Yamada 2, Gabriel Kushiyama Teixeira 2, Marcos Tobias-Machado 2, Antonio Carlos Lima Pompeo 2

1 Hospital Israelita Albert Einstein, SP, Brasil; 2 Departamento de Urologia, Faculdade de Medicina do ABC, São Paulo, Brasil

ABSTRACT

Purpose: This study compared the suprapubic (SP) versus retropubic (RP) prostatectomy for the treatment of large prostates and evaluated perioperative surgical morbidity and improvement of urinary symptoms.
Materials and Methods: In this single centre, prospective, randomised study, 65 consecutive patients with LUTS and surgical indication with prostate volume greater than 75g underwent open prostatectomy to compare the RP (32 patients) versus SP (33 patients) technique. Results: The SP group exhibited a higher incidence of complications (p=0.002). Regarding voiding pattern analysis (IPSS and flowmetry), both were significantly effective compared to pre-treatment baseline. The RP group parameters were significantly better, with higher peak urinary flow (SP: 16.77 versus RP: 23.03mL/s, p=0.008) and a trend of lower IPSS score (SP: 6.67 versus RP 4.14, p=0.06). In a subgroup evaluation of patients with prostate volumes larger than 100g, blood loss was lower in those undergoing SP prostatectomy (p=0.003). Patients with prostates smaller than 100g in the SP group exhibited a higher incidence of low grade late complications (p=0.004).
Conclusions: The SP technique was related to a higher incidence of minor complications in the late postoperative period. High volume prostates were associated with increased bleeding when the RP technique was utilized. The RP prostatectomy was associated with higher peak urinary flow and a trend of a lower IPSS Score.

Keywords: Prostatic Hyperplasia; Prostatectomy; Postoperative Complications; Prostate

[Full Text]


Holmium laser enucleation of the prostate: surgical, functional, and quality-of-life outcomes upon extended follow-up

Vol. 42 (2): 293-301, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0561


ORIGINAL ARTICLE


Holmium laser enucleation of the prostate: surgical, functional, and quality-of-life outcomes upon extended follow-up

İlter Alkan 1, Hakan Ozveri 2, Yigit Akin 3, Tumay Ipekci 4, Yusuf Alican 5

1 Department of Urology, Okmeydani Teaching and Research Hospital, Istanbul, Turkey; 2 Department of Urology, Acibadem University School of Medicine, Kozyatagi, Istanbul, Turkey; 3 Deparment of Urology, Harran University School of Medicine, Sanliurfa, Turkey; 4 Department of Urology, Baskent University School of Medicine, Alanya Teaching and Research Hospital, Alanya, Antalya, Turkey; 5 Department of Urology, Prosmed Clinic, Nisantasi, Istanbul, Turkey

ABSTRACT

Objectives: To evaluate the long-term surgical, functional, and quality-of-life (QoL) outcomes after Holmium laser enucleation of the prostate (HoLEP) in patients with symptomatic benign prostatic hyperplasia (BPH).
Materials and Methods: We retrospectively reviewed recorded data on patients who underwent HoLEP between June 2002 and February 2005. Ninety-six patients were enrolled. Demographic, perioperative, and postoperative data were recorded. On follow-up, International Prostate Symptom Scores (IPSSs), prostate-specific antigen (PSA) levels, QoL scores, peak uroflowmetric data (Qmax values), and post-voiding residual urine volumes (PVR volumes), were recorded. Complications were scored using the Clavien system. Statistical significance was set at p<0.05.
Results: The mean follow-up time was 41.8±34.6 months and the mean patient age 73.2±8.7 years. The mean prostate volume was 74.6±34.3mL. Significant improvements in Qmax values, QoL, and IPSSs and decreases in PSA levels and PVR volumes were noted during follow-up (all p values=0.001). The most common complication was a requirement for re-catheterisation because of urinary retention. Two patients had concomitant bladder tumours that did not invade the muscles. Eight patients (8.3%) required re-operations; three had residual adenoma, three urethral strictures, and two residual prostate tissue in the bladder. Stress incontinence occurred in one patient (1%). All complications were of Clavien Grade 3a. We noted no Clavien 3b, 4, or 5 complications during follow-up.
Conclusions: HoLEP improved IPSSs, Qmax values, PVR volumes, and QoL and was associated with a low complication rate, during extended follow-up. Thus, HoLEP can be a viable option to transurethral resection of the prostate.

Keywords: Prostatic Hyperplasia; Holmium; Laser Therapy; Prostate; Quality of Life

[Full Text]


Analysis of risk factors leading to postoperative urethral stricture and bladder neck contracture following transurethral resection of prostate

Vol. 42 (2): 302-311, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0500


ORIGINAL ARTICLE


Analysis of risk factors leading to postoperative urethral stricture and bladder neck contracture following transurethral resection of prostate

Huang Tao 1, Yu Yong Jiang 2, Qi Jun 2, Xu Ding 2, Duan Liu Jian 2, Ding Jie 2, Zhu Yu Ping 1

1 Department of Urology, Anhui Provincial Hospital,Hefei, Anhui, China; 2 Department of Urology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

ABSTRACT

Purpose: To determine risk factors of postoperative urethral stricture (US) and vesical neck contracture (BNC) after transurethral resection of prostate (TURP) from perioperative parameters.
Materials and Methods: 373 patients underwent TURP in a Chinese center for lower urinary tract symptoms suggestive of benign prostatic obstruction (LUTS/BPO), with their perioperative and follow-up clinical data being collected. Univariate analyses were used to determine variables which had correlation with the incidence of US and BNC before logistic regression being applied to find out independent risk factors.
Results: The median follow-up was 29.3 months with the incidence of US and BNC being 7.8% and 5.4% respectively. Resection speed, reduction in hemoglobin (ΔHb) and hematocrit (ΔHCT) levels, incidence of urethral mucosa rupture, re-catheterization and continuous infection had significant correlation with US, while PSA level, storage score, total prostate volume (TPV), transitional zone volume (TZV), transitional zone index (TZI), resection time and resected gland weight had significant correlation with BNC. Lower resection speed (OR=0.48), urethral mucosa rupture (OR=2.44) and continuous infection (OR=1.49) as well as higher storage score (OR=2.51) and lower TPV (OR=0.15) were found to be the independent risk factors of US and BNC respectively.
Conclusions: Lower resection speed, intraoperative urethral mucosa rupture and postoperative continuous infection were associated with a higher risk of US while severer storage phase symptom and smaller prostate size were associated with a higher risk of BNC after TURP.

Keywords: Prostatic Hyperplasia; Transurethral Resection of Prostate; Postoperative Complications; Dysuria; Risk Factors

[Full Text]


Initial experience with sacral neuromodulation for the treatment of lower urinary tract dysfunction in Brazil

Vol. 42 (2): 312-320, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0603


ORIGINAL ARTICLE


Initial experience with sacral neuromodulation for the treatment of lower urinary tract dysfunction in Brazil

Luis Augusto Seabra Rios 1, Marcio Augusto Averbeck 2, Wagner França 3, Carlos Alberto Ricetto Sacomani 4, Fernando G. Almeida 3, Cristiano Mendes Gomes 5

1 Deparamento de Urologia, Hospital Albert Einstein, SP, Brasil; 2 Departamento de Urologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil; 3 Universidade Federal de São Paulo, Escola Paulista de Medicina, SP, Brasil; 4 Departamento de Urologia, AC Camargo Hospital, SP, Brasil; 5 Departamento de Urologia, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil

ABSTRACT

Objectives: We report on the short-term outcomes of sacral neuromodulation (SNM) for treatment of idiopathic lower urinary tract dysfunction in Brazil (procedures performed before 2014).
Materials and Methods: Clinical data and surgical outcomes of patients who underwent SNM staged procedures were retrospective evaluated. Urological assessment included a focused medical history and physical examination, measurement of postvoid residual volumes, urodynamics, and bladder diaries. A successful test phase has been defined by improvement of at least 50% of the symptoms, based on bladder diaries.
Results: From January 2011 to December 2013, eighteen consecutive patients underwent test phase for SNM due to refractory overactive bladder (15 patients), non-obstructive chronic urinary retention (2 patients), and bladder pain syndrome/interstitial cystitis (1 patient). All patients underwent staged procedures at four outpatient surgical centers.
Mean age was 48.3±21.2 (range 10-84 years). There were 16 women and 2 men. Median follow-up was 3 months. Fifteen patients (83.3%) had a successful test phase and underwent implantation of the pulse generator (IPG). Median duration of the test phase was 7 days (range 5–24 days). Mean age was 45.6±18.19 years in responders versus 61.66±34.44 years in non-responders (p=0.242). Mean operative time (test phase) was 99±33.12 min in responders versus 95±35 min for non-responders (p=0.852). No severe complications were reported.
Conclusion: SNM is a minimally invasive treatment option for patients with refractory idiopathic lower urinary tract dysfunction. Our initial experience with staged technique showed that tined-lead electrodes yielded a high rate of responders and favorable clinical results in the short-term follow-up.

Keywords: Sacrum; Urinary Tract; Therapeutics

[Full Text]


Relationship between visual prostate score (VPSS) and maximum flow rate (Qmax) in men with urinary tract symptoms

Vol. 42 (2): 321-326, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0032


ORIGINAL ARTICLE


Relationship between visual prostate score (VPSS) and maximum flow rate (Qmax) in men with urinary tract symptoms

M. Hammad Ather 1, Mazhar Memon 1

1 Aga Khan University – Surgery karachi, Sind, Pakistan

ABSTRACT

Objective: To evaluate correlation between visual prostate score (VPSS) and maximum flow rate (Qmax) in men with lower urinary tract symptoms.
Material and Methods: This is a cross sectional study conducted at a university Hospital. Sixty-seven adult male patients>50 years of age were enrolled in the study after signing an informed consent. Qmax and voided volume recorded at uroflowmetry graph and at the same time VPSS were assessed. The education level was assessed in various defined groups. Pearson correlation coefficient was computed for VPSS and Qmax.
Results: Mean age was 66.1±10.1 years (median 68). The mean voided volume on uroflowmetry was 268±160mL (median 208) and the mean Qmax was 9.6±4.96mLs/sec (median 9.0). The mean VPSS score was 11.4±2.72 (11.0). In the univariate linear regression analysis there was strong negative (Pearson’s) correlation between VPSS and Qmax (r=-848, p<0.001). In the multiple linear regression analyses there was a significant correlation between VPSS and Qmax (β-466 with (p <0.001) after adjusting the effect of age, voided volume (V.V) and level of education. Multiple linear regression analysis done for independent variables and results showed that there was no significant correlation between the VPSS and independent factors including age (p=0.27), LOE (p=0.941) and V.V (p=0.082).
Conclusion: There is a significant negative correlation between VPSS and Qmax. The VPSS can be used in lieu of IPSS score. Men even with limited educational background can complete VPSS without assistance.

Keywords: IPSS; Prostate; Urinary Tract; Lower Urinary Tract Symptoms

[Full Text]


Assessing variability of the 24-hour pad weight test in men with post-prostatectomy incontinence

Vol. 42 (2): 327-333, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0506


ORIGINAL ARTICLE


Assessing variability of the 24-hour pad weight test in men with post-prostatectomy incontinence

Rena D. Malik 1, Joshua A. Cohn 1, Pauline A Fedunok M.M.S. 1, PA-C 1, Doreen E. Chung 1, 2, Gregory T. Bales 1

1 University of Chicago Medical Center, Chicago, IL, USA; 2 Mount Sinai Hospital, Chicago, IL, USA

ABSTRACT

Purpose: Decision-making regarding surgery for post-prostatectomy incontinence (PPI) is challenging. The 24-hour pad weight test is commonly used to objectively quantify PPI. However, pad weight may vary based upon activity level. We aimed to quantify variability in pad weights based upon patient-reported activity.
Materials and Methods: 25 patients who underwent radical prostatectomy were prospectively enrolled. All patients demonstrated clinical stress urinary incontinence without clinical urgency urinary incontinence. On three consecutive alternating days, patients submitted 24-hour pad weights along with a short survey documenting activity level and number of pads used.
Results: Pad weights collected across the three days were well correlated to the individual (ICC 0.85 (95% CI 0.74-0.93), p<0.001). The mean difference between the minimum pad weight leakage and maximum leakage per patient was 133.4g (95% CI 80.4-186.5). The mean increase in 24-hour leakage for a one-point increase in self-reported activity level was 118.0g (95% CI 74.3-161.7, p<0.001). Pad weights also varied significantly when self-reported activity levels did not differ (mean difference 51.2g (95% CI 30.3-72.1), p<0.001).
Conclusions: 24-hour pad weight leakage may vary significantly on different days of collection. This variation is more pronounced with changes in activity level. Taking into account patient activity level may enhance the predictive value of pad weight testing.

Keywords: Urinary Incontinence; Suburethral Slings; Urinary Sphincter, Artificial; Stress

[Full Text]


 

Can the success of structured therapy for giggle incontinence be predicted?

Vol. 42 (2): 334-338, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0560


ORIGINAL ARTICLE


Can the success of structured therapy for giggle incontinence be predicted?

Onur Telli 1, Nurullah Hamidi 2, Aytac Kayis 2, Evren Suer 2, Tarkan Soygur 1, Berk Burgu 1

1 Department of Paediatric Urology, School of Medicine, Ankara University, Ankara, Turkey; 2 Department of Urology, School of Medicine, Ankara University, Ankara, Turkey

ABSTRACT

Introduction: To evaluate possible factors that can guide the clinician to predict potential cases refractoriness to medical treatment for giggle incontinence (GI) and to examine the effectiveness of different treatment modalities.
Material and methods: The data of 48 children referred to pediatric urology outpatient clinic between 2000 and 2013 diagnosed as GI were reviewed. Mean age, follow-up, GI frequency, associated symptoms, medical and family history were noted. Incontinence frequency differed between several per day to less than once weekly. Children were evaluated with uroflowmetry-electromyography and post-void residual urine. Clinical success was characterized as a full or partial response, or nonresponse as defined by the International Children’s Continence Society. Univariate analysis was used to find potential factors including age, sex, familial history, GI frequency, treatment modality and dysfunctional voiding to predict children who would possibly not respond to treatment.
Results: Mean age of the patients was 8.4 years (range 5 to 16). Mean follow-up time and mean duration of asymptomatic period were noted as 6.7±1.4 years and 14.2±2.3 months respectively. While 12 patients were treated with only behavioral urotherapy (Group-1), 11 patients were treated with alpha-adrenergic blockers and behavioral urotherapy (Group-2) and 18 patients with methylphenidate and behavioral urotherapy (Group-3). Giggle incontinence was refractory to eight children in-group 1; six children in-group 2 and eight children in-group 3. Daily GI frequency and dysfunctional voiding diagnosed on uroflowmetry-EMG were found as outstanding predictive factors for resistance to treatment modalities.
Conclusions: A variety of therapies for GI have more than 50% failure rate and a standard treatment for GI has not been established. The use of medications to treat these patients would not be recommended, as they appear to add no benefit to symptoms and may introduce severe adverse effects.

Keywords: Urinary Incontinence; Methylphenidate; Laughter

[Full Text]


Adult urethral stricture: practice of Turkish urologists

Vol. 42 (2): 339-345, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0672


ORIGINAL ARTICLE

Adult urethral stricture: practice of Turkish urologists

Mehmet Akyuz 1, Zulfu Sertkaya 1, Orhan Koca 1, Selahattin Calıskan 1, Musab Ali Kutluhan 1, Muhammet Ihsan Karaman 1

1 Department of Urology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey


 

ABSTRACT

Objectives: To evaluate national practice patterns in the treatment of male anterior urethral strictures among Turkish urologists.
Materials and Methods: A survey form including 12 questions prepared to determine active Turkish urologists’ approach to diagnosis and treatment of the adult urethral stricture (US) were filled out. Based on the survey results, the institutions which 218 urologists work and their years of expertise, methods they used for diagnosis and treatment, whether or not they perform open urethroplasty and timing of open urethroplasty were investigated.
Results: Optic internal urethrotomy and dilatation are the most commonly used minimal invasive procedures in treatment of US with the ratios of 93.5% and 63.3% respectively. On the other hand it was seen that urethroplasty was a less commonly used procedure, compared to minimal invasive techniques, with the ratio of 36.7%. Survey results showed us that the number of US cases observed and open urethroplasty procedures performed increases with increasing years of professional experience.
Conclusions: As a method demanding special surgical experience and known as a time-consuming and challenging procedure, open urethroplasty will be able to take a greater part in current urological practice with the help of theoretical education and practical courses given by specific centers and experienced authors.

Keywords: Urethra; Therapeutics; Pathology

[Full Text]


Is there any association between national institutes of health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer?

Vol. 42 (2): 346-350, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0082


ORIGINAL ARTICLE

Is there any association between national institutes of health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer?
 
Omer Gokhan Doluoglu 1, Cavit Ceylan 2, Fatih Kilinc 1, Eymen Gazel 2, Berkan Resorlu 1, Oner Odabas 2

1 Department of Urology Clinic, Ankara Training and Research Hospital, , Ankara Turkey; 2 Department of Urology Clinic of Yüksek Ihtisas Training and Research Hospital, , Ankara Turkey


 

ABSTRACT

Purpose: We investigated the association between National Institutes of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer.
Materials and Methods: The data of 440 patients who had undergone prostate biopsies due to high PSA levels and suspicious digital rectal examination findings were reviewed retrospectively. The patients were divided into two groups based on the presence of accompanying NIH IV prostatitis. The exclusion criteria were as follows: Gleason score>6, PSA level>20ng/mL, >2 positive cores, >50% cancerous tissue per biopsy, urinary tract infection, urological interventions at least 1 week previously (cystoscopy, urethral catheterization, or similar procedure), history of prostate biopsy, and history of androgen or 5-alpha reductase use. All patient’s age, total PSA and free PSA levels, ratio of free to total PSA, PSA density and prostate volume were recorded.
Results: In total, 101 patients were included in the study. Histopathological examination revealed only PCa in 78 (77.2%) patients and PCa+NIH IV prostatitis in 23 (22.7%) patients. The median total PSA level was 7.4 (3.5–20.0) ng/mL in the PCa+NIH IV prostatitis group and 6.5 (0.6–20.0) ng/mL in the PCa group (p=0.67). The PSA level was≤10ng/mL in 60 (76.9%) patients in the PCa group and in 16 (69.6%) patients in the PCa+NIH IV prostatitis group (p=0.32).
Conclusions: Our study showed no statistically significant difference in PSA levels between patients with and without NIH IV prostatitis accompanying PCa.

Keywords: Prostatitis; Prostatic Neoplasms; prostate-specific antigen (146-154) [Supplementary Concept]

[Full Text]


The long-term results of temporary urethral stent placement for the treatment of recurrent bulber urethral stricture disease

Vol. 42 (2): 351-355, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0115


ORIGINAL ARTICLE

The long-term results of temporary urethral stent placement for the treatment of recurrent bulber urethral stricture disease

Gokhan Temeltas 1, Oktay Ucer 1, Mehmet Bilgehan Yuksel 1, Bilal Gumus 1, Volkan Tatli 1, Talha Muezzinoglu 1

1 Department of Urology, Faculty of Medicine – Celal Bayar University, Manisa, Turkey


 

ABSTRACT

Aim: To evaluate the long term outcomes of temporary urethral stent placement for the treatment of recurrent bulbar urethral stricture.
Materials and Methods: Twenty-eight patients who underwent temporary polymer coated urethral stent placement due to recurrent bulbar urethral stricture between 2010 and 2014 were enrolled in the study. The long term outcomes of the patients were analyzed.
Results: The mean age of the patients was 62.3±6.4 (44-81). The overall clinical success was achieved in 18 (64.2%) of the 28 patients at a median (range) follow-up of 29 (7–46) months. No patient reported discomfort at the stent site. Stone formation was observed at the urethral stent implantation area only in one patient. Stenosis occurred in the distal end of the stents in two patients and took place in bulbar urethra in seven patients after removed the stents. The mean maximum urine flow rates were 6.24±2.81mL/sec and 19.12±4.31mL/sec before and at 3 months after the procedure, respectively.
Conclusion: In this study, the success rate of temporary urethral stent placement has remained at 64.2% at a median follow-up of 29 months. Therefore, our outcomes have not achieved desired success rate for the standard treatment of recurrent bulbar urethral stricture.

Keywords: Urethral Stricture; Stents; Disease; Therapeutics

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Use and outcomes of amplatz renal dilator for treatment of urethral strictures

Vol. 42 (2): 356-364, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0578


ORIGINAL ARTICLE

Use and outcomes of amplatz renal dilator for treatment of urethral strictures

Ali Akkoc 1, Cemil Aydin 1, Mahir Kartalmıs 2, Ramazan Topaktas 1, Selcuk Altin 1, Yakup Yilmaz 1

1 Department of Urology, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey; 2 Department of Urology, Selahaddin Eyyubi State Hospital, Diyarbakir, Turkey


ABSTRACT

Introduction: Urethral stricture disease is still a major problem in men. Many procedures are available for the treatment of urethral strictures; urethral dilatation is one of the oldest. The blind dilatation of urethral strictures may be a difficult and potentially dangerous procedure. The purpose of this study was to describe safe urethral dilatation using amplatz renal dilator and to report outcomes.
Materials and Methods: From 2010 to 2014, a total of 26 men with primary urethral strictures were managed by urethral dilatation using amplatz renal dilators. The parameters analyzed included presentation of patients, retrograde urethrography (RGU) findings, pre-and postoperative maximum flow rate (Qmax) on uroflowmetry (UF) and post-void residual urine (PVR). Patients were followed-up at 1.6 and 12 months. The technique described in this paper enables such strictures to be safely dilated after endoscopic placement of a suitable guidewire and stylet over which amplatz renal dilators are introduced.
Results: The mean age of the patients was 57.6 (35-72) years. The median stricture length was 0.82 (0.6-1.5)cm. Pre-operative uroflowmetry showed Qmax of 7.00 (4-12)mL/sec and ultrasonography showed PVR of 75.00 (45-195)mL. Postoperatively, Qmax improved to 18.00 (15-22)mL/sec (p<0.001) at 1 month, 17.00 (13-21)mL/sec (p<0.001) at 6 months and 15.00 (12-17)mL/sec (p<0.001) at 12 months. The post-operative PVR values were 22.50 (10-60)mL (p<0.001), 30.00 (10-70)mL (p<0.001) and 30.00 (10-70)mL (p<0.001) at 1.6 12 months, respectively. The median procedure time was 15.00 (12-22) minutes. None of the patients had a recurrence during a 12-month period of follow-up.
Conclusion: Urethral dilatation with amplatz renal dilators avoids the risks associated with blind dilatation techniques. This tecnique is a safe, easy, well-tolerated and cost-effective alternative for treatment of urethral strictures.

Keywords: Urethral Stricture; Dilatation; Surgical Procedures, Operative

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Impact of body mass index, age and varicocele on reproductive hormone profile from elderly men

Vol. 42 (2): 365-372, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0594


ORIGINAL ARTICLE

Impact of body mass index, age and varicocele on reproductive hormone profile from elderly men

K. G. R. Yamaçake 1,M. Cocuzza 2, F. C. M. Torricelli 1, B.C. Tiseo 1, R. Frati 3, G. C. Freire 1, A. A. Antunes 1, M. Srougi 1

1 Divisão de Urologia da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil; 2 Grupo no Centro de Reprodução Humana da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil; 3 Faculdade de Medicina de São Paulo, Universidade de São Paulo, Brasil


 

ABSTRACT

Objectives: To study the impact of obesity, age and varicocele on sexual hormones fof adult and elderly men.
Materials and Methods: 875 men who were screened for prostate cancer were enrolled in this study. Data recorded comprised age, body mass index (BMI), serum levels of total testosterone (TT), free testosterone (FT), sex hormone-binding globulin (SHBG), luteinizing hormone (LH) and follicular stimulating hormone (FSH). Patients were divided in groups according to their BMI in underweight, normal weight, overweight and obese grades 1, 2 or 3. First, it was studied the association between age, BMI, and hormone profile. Then, clinical varicocele was evaluated in 298 patients to assess its correlation to the others parameters.
Results: Obese patients had lower levels of TT, FT and SHBG (p<0.001) compared to underweight or normal weight patients. There were no differences in age (p=0.113), FSH serum levels (p=0.863) and LH serum levels (p=0.218) between obese and non-obese patients. Obese grade 3 had lower levels of TT and FT compared to obese grade 1 and 2 (p<0.05). There was no difference in the SHBG levels (p=0.120) among obese patients. There was no association between varicocele and BMI; and varicocele did not impact on testosterone or SHBG levels.
Conclusions: Men with higher BMI have a lower serum level of TT, FT and SHBG. The presence of clinical varicocele as well as its grade has no impact on hormone profile in elderly men.

Keywords: Aging; Receptors, FSH; Receptors, LH; Obesity; Gonadal Steroid Hormones; Varicocele

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Changes in mast cell infiltration: a possible mechanism in detrusor overactivity induced by visceral hypersensitivity

Vol. 42 (2): 373-382, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0025


ORIGINAL ARTICLE

Changes in mast cell infiltration: a possible mechanism in detrusor overactivity induced by visceral hypersensitivity

Nian-zhao Zhang 1, Lin Ma 1, Chen Jun 1, Yan-xia Guo 2, Hui-qing Yuan 2

1 Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China; 2 Department of Biochemistry and Molecular Biology, Shandong University School of Medicine, Shandong University, Jinan, P.R. China


 

ABSTRACT

Objective: To establish the detrusor overactivity (DO) model induced by visceral hypersensitivity (VH) and investigate the relationship between mast cell (MC) infiltration and DO.
Materials and Methods: Sixty rats are divided into 4 groups randomly: Group 1:Baseline group; Group 2: DO group; Group 3: CON group; Group 4: VH group. The colorectal distension (CRD) and abdominal withdral reflex (AWR) scores are performed to evaluate VH. The cystometric investigation and histological test of MC infiltration are assessed.
Results: The threshold pressure of CRD in the VH group is significantly lower than that in the CON group (P<0.001). At the distension pressure ≥20 mmHg, the AWR scores of the VH group are significantly higher than those of the CON group (10 mmHg: P=0.33; 20 mmHg: P=0.028; 40 mmHg: P<0.001; 60 mmHg: P<0.001; 80 mmHg: P<0.001). DO model is successfully established in the VH group (DO rate=100%). Compared with the CON group, the numbers of MC infiltration are significantly increased in the VH group, including submucosa of bladder (P<0.001), mucosa lamina propria/mesentery of small intestine (P<0.001), and mucosa lamina propria/mesentery of large intestine (P<0.001). Furthermore, more MC activation as well as degranulation are observed in the VH group.
Conclusions: It is indicated that DO model can be established in the VH rats. The MC infiltration may play an important role in DO induced by VH, and may be helpful to understand the mechanisms of DO in VH patients.

Keywords: Urinary Bladder, Overactive; Hypersensitivity; Mast-Cell Sarcoma

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Renal capsule for augmentation cystoplasty in canine model: a favorable biomaterial?

Vol. 42 (2): 383-388, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0680


ORIGINAL ARTICLE

Renal capsule for augmentation cystoplasty in canine model: a favorable biomaterial?

Mehdi Salehipour 1, Reza Mohammadian 1, Amir Malekahmadi 1, Massood Hosseinzadeh 2, Mahnaz Yadollahi 3, Mohammad Natami 1, Mahsa Mohammadian 1

1 Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran; 2 Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran; 3 Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran


ABSTRACT

Purpose: To evaluate effectiveness of canine renal capsule for augmentation cystoplasty.
Materials and Methods: Ten adult dogs participated in this study. After induction of anesthesia each animal underwent bed side urodynamic study, bladder capacity and bladder pressure was recorded. Then via mid line incision abdominal cavity was entered, right kidney was identified and its capsule was dissected. Bladder augmentation was done by anastomosing the renal capsule to the bladder. After 6 months bed side urodynamic was performed again and changes in bladder volume and pressure were recorded. Then the animals were sacrificed and the augmented bladders were sent for histopathology evaluation.
Results: Mean maximum anatomic bladder capacity before cystoplasty was 334.00±11.40cc which increased to 488.00±14.83cc post-operatively (p=0.039). Mean anatomic bladder pressure before cystoplasty was 19.00±1.58cmH2O which decreased to 12.60±1.14cmH2O post-operatively (p=0.039). Histopathology evaluation revealed epithelialization of the renal capsule with urothelium without evidence of fibrosis, collagen deposits or contracture.
Conclusions: Our data shows that renal capsule is a favorable biomaterial for bladder augmentation in a canine model.

Keywords: Urinary Bladder; Dogs; Biocompatible Materials

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Recurring priapism may be a symptom of voiding dysfunction – case report and literature review

Vol. 42 (2): 389-391, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0435


CHALLENGING CLINICAL CASES

Recurring priapism may be a symptom of voiding dysfunction – case report and literature review

Lisieux Eyer de Jesus 1, 2, Leonardo Teixeira 3, André Bertelli 3

1 Departamento de Cirurgia Pediatrica – Hospital Universitário Antônio Pedro, Niterói, RJ, Brasil; 2 Departamento de Cirurgia Pediatrica Hospital Federal dos Servidores do Estado do Rio de Janeiro, RJ, Brasil; 3 Departamento de Urologia – Hospital Universitário Antônio Pedro, Niterói, RJ, Brasil

ABSTRACT

Recurring priapism is rare in pre-pubertal children and may be attributed to multiple causes. We propose that voiding dysfunction (VD) may also justify this symptom and detail a clinical case of recurring stuttering priapism associated to overactive bladder that completely resolved after usage of anticholinergics and urotherapy. Sacral parasympathetic activity is responsible for detrusor contraction and for spontaneous erections and a relationship between erections and bladder status has been proved in healthy subjects (morning erections) and models of medullar trauma. High bladder pressures and/or volumes, voiding incoordination and posterior urethritis can potentially trigger reflex erections.

Keywords: Priapism; Child; Urinary Bladder, Overactive

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Chromophobe renal cell carcinoma mimicking cortical invasion by synchronous invasive urothelial carcinoma of the intra-renal collecting system on ct urography

Vol. 42 (2): 392-394, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2014.0596


RADIOLOGY PAGE

Chromophobe renal cell carcinoma mimicking cortical invasion by synchronous invasive urothelial carcinoma of the intra-renal collecting system on ct urography

Ryan Yu 1, Gabriella Gohla 1, 2, Ehsan A. Haider 2, 3

1 Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; 2 St. Joseph`s Hospital, Hamilton, Ontario, Canada; 3 Department of Diagnostic Imaging, McMaster University, St. Joseph’s Hospital, Hamilton, Ontario, Canada


 

CASE PRESENTATION

An 83-year-old man presented to hospital with gross hematuria. His medical history was remarkable for remote open left pyelolithotomy, chronic inflammatory demyelinating peripheral neuropathy, benign prostatic hyperplasia, and cerebrovascular accident for which he took aspirin-dipyridamole. Urine cytology was negative for malignant cells. Renal ultrasound showed a lobulated, hypoechoic lesion centered in an echogenic hilum of the upper pole of the left kidney. Preoperative CT urogram showed a large, round, heterogeneously-enhancing soft tissue filling defect, measuring 3.6cmx4.0cmx3.3cm, casting the major calyx of the upper pole of the left kidney (Figure-1). It showed definitive heterogeneous enhancement after contrast administration. On the delayed urographic phase, contrast was noted outlining the filling defect.

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Intravesical human papillomavirus (IHPV) infection–endoscopic resection

Vol. 42 (2): 395-396, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0016


VIDEO SECTION

Intravesical human papillomavirus (IHPV) infection–endoscopic resection

Silvio Henrique Maia Almeida 1, Marco Aurélio Cruciol Rodrigues 1, Daniele Mathiel 1, Susana Fonseca Alves 1

1 Departamento de Cirurgia – Universidade Estadual de Londrina, Londrina, PR, Brasil


INTRODUCTION

Although HPV infections are common, intravesical HPV is a rare condition, with only 20 reported cases (1).
Objectives: The aim of this video is to present a case treated with transurethral resection (TR).

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RE: The value of testicular ultrasound in the prediction of the type and size of testicular tumors

Vol. 42 (2): 397-398, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0728


LETTER TO THE EDITOR

RE: The value of testicular ultrasound in the prediction of the type and size of testicular tumors

Abraham Shtricker 1, David Silver 2, Elias Sorin 3, Letizia Schreiber 4, Nachum Katlowitz 5, Alexander Tsivian 1, Kalman Katlowitz 5, Shalva Benjamin 1, Abraham Ami Sidi 1

1 Department of Urologic Surgery, Edith Wolfson Medical Center, Sackler school of medicine, University of Tel Aviv, Israel; 2 Maimonidis Medical Center-NY – Department of Urologic Surgery, New York, NY, USA; 3 Department of Radiology, Edith Wolfson Medical Center, Sackler school of medicine, University of Tel Aviv, Israel; 4 Department of Pathology, Edith Wolfson Medical Center, Sackler school of medicine, University of Tel Aviv, Israel; 5 Staten Island University Hospital-NY – Department of Urologic Surgery, New York, NY, USA

Int Braz J Urol. 2014; 41: 655-60


To the editor,

We read with great interest the article “The value of testicular ultrasound in the prediction of the type and size of testicular tumors” by Shtricker A. et al (1). This article highlights an interesting role of testicular ultrasound finding in managing testicular tumor, particularly regarding the ability of testicular ultrasound to differentiate between these three lesions: benign lesion, seminomatous germ cell tumor (SGCT) and non-seminomatous germ tumor (NSGCT). The presence of necrosis is more suggestive of malignant tumors, whereas hypoechogeneity and fibrosis on testicular ultrasound are more suggestive of SGCT type (1). These finding will increase the ability to differentiate type of testicular tumor preoperatively in addition to traditionally use tumor markers. Hopefully in near future the characteristic of different type of cancers can be done to form risk stratification Table.

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RE: Efficacy of botulinum toxin type A 100 Units versus 200 units for treatment of refractory idiopathic overactive bladder

Vol. 42 (2): 399-399, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0726


LETTER TO THE EDITOR

RE: Efficacy of botulinum toxin type A 100 Units versus 200 units for treatment of refractory idiopathic overactive bladder

Osama Abdelwahab 1, Hammouda Sherif 1, Tark Soliman 1, Ihab Elbarky 1, Aly Eshazly 1

1 Urology department, Faculty of Medicine, Benha University, Egypt

Int Braz J Urol. 2015; 41: 1132-40


To the editor,
We read with great interest in the article “Efficacy of botulinum toxin type A 100 Units versus 200 units for treatment of refractory idiopathic overactive bladder”. Osama Abdelwahab, et al. (1) nicely presented the treatment outcomes in this well conducted randomized controlled study.

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RE: An easy, reproducible and cost-effective method for andrologists to improve the laboratory diagnosis of nonobstructive azoospermia: a novel microcentrifugation technique

Vol. 42 (2): 400-401, March – April, 2016

doi: 10.1590/S1677-5538.IBJU.2016.02.05


LETTER TO THE EDITOR

RE: An easy, reproducible and cost-effective method for andrologists to improve the laboratory diagnosis of nonobstructive azoospermia: a novel microcentrifugation technique

Rosa Alice Casemiro Monteiro 1, Juliana Risso Pariz, 1,2,3, Patrícia de Campos Pieri 1, Jorge Hallak 1,2,3
1 Androscience – Pesquisa Clínica de alta Complexidade e Laboratório de Andrologia, São Paulo, Brasil; 2 Seção de Andrologia – Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil; 3 Unidade de Reprodução Toxicologia – Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Basil

Int Braz J Urol. 2016; 42: 132-8


Reply by The Authors,
“What a piece of Work is a Man” quoted William Shakespeare (1564–1616 AC). The diagnosis or confirmation of azoospermia or cryptozoospermia with this nouvelle technique of microcentrifugation proposed and developed by our group is an answer to countless hours of attending difficult cases of men investigated or presenting with non-obstructive azoospermia (NOA) and having to give them a truthful perspective. It is amazing on how many false-positive or false-negative results of simplified “spermiograms” in the last 18 years we have had the difficult task to confront and disagree, unfortunately the majority of them performed in Clinical Analyses General Laboratories, so common in Brazil, not always familiarized with sperm physiology or andrology lab techniques widely disseminated by World Health Organization manuals. Surprisingly, wrongful results are not unusual from single semen analyses performed in “andrology” facilities located inside some Centers with eyes mainly focused in performing Intra-Cytoplasmic Sperm Injection (ICSI) as the silver-bullet for dealing with male infertility.

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