Vol. 42 n. 5 Setember . October, 2016

Volume 42 | number 5 | September . October, 2016 The best therapeutic approach of bulbar urethral stenosis is debatable, with several challenging options. In this issue of Int Braz J Urol, we present an editorial (page 868) defending the excision of the stenotic area and the primary anastomotic urethroplasty, authored by Drs. Siegel and Morey…/span>

EDITORIAL In this Issue

Vol. 42 (5): 866-867, September – October, 2016

doi: 10.1590/S1677-5538.IBJU.2016.05.01

EDITORIAL In this Issue

Stênio de Cássio Zequi

Divisão de Urologia do A.C. Camargo Cancer Center Fundação A. Prudente, São Paulo, Brasil

No Abstract Available

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The case for excision and primary anastomotic urethroplasty for bulbar urethral stricture

Vol. 42 (5): 868-871, September – October, 2016

doi: 10.1590/S1677-5538.IBJU.2016.05.02


Jordan A. Siegel 1, Allen F. Morey 1

1 Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

No Abstract Available

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A missing vas deferens: practical implications for urologists performing vasectomies and managing infertile men

 Vol. 42 (5): 872-875, September – October, 2016

doi: 10.1590/S1677-5538.IBJU.2016.05.03


Sandro C. Esteves 1

1 ANDROFERT, Andrology & Human Reproduction Clinic, Campinas, SP, Brasil

No Abstract Available

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Radical prostatectomy in metastatic prostate cancer: is there enough evidence? | Opinion: Yes

Vol. 42 (5): 876-879, September – October, 2016

doi: 10.1590/S1677-5538.IBJU.2016.05.04


Walter Henriques da Costa 1, Gustavo Cardoso Guimarães 1

1 AC Camargo Cancer Center, SP, Brasil

Keywords: Prostatectomy; Prostate; Prostatic Neoplasms

Prostate cancer (PCa) is the most frequent and the second ranked cause of cancer deaths among men each year. The vast majority of patients are diagnosed with localized disease, however it is estimated that 35,000 American men were diagnosed with locally advanced or metastatic prostate cancer (mPCa) in 2015 (1). During the last few years we have seen notable advances in the treatment of mPCa with the introduction of several second-line hormonal therapy options, immunotherapy and cytotoxic chemotherapy in hormone sensitive disease (2). With newer therapies that prolong survival in patients relapsing with mPCa and the increasingly widespread use of prostate-specific antigen (PSA) testing, men with metastatic disease might have lower disease burden at diagnosis than in the past decades (3). Although recent data suggest a relative improvement in 2-year overall survival in mPCa patients treated with systemic therapy, the long-term survival still remains disappointing. Actually, patients with mPCa and non-metastatic PCa present 5-year cancer-specific survival (CSS) rates of 28% and 99%, respectively (4). Thus, there is clearly room for improvement in the treatment of mPCa patients.

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Radical prostatectomy in metastatic prostate cancer: is there enough evidence? | Opinion: No

Vol. 42 (5): 880-882, September – October, 2016

doi: 10.1590/S1677-5538.IBJU.2016.05.05


Benjamin T. Ristau 1, Marc C. Smaldone 1

1 Division of Urologic Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA

Keywords: Prostatectomy; Prostate; Prostatic Neoplasms

Despite an absence of level I data suggesting a survival benefit, interest in radical prostatectomy (RP) for patients with metastatic prostate cancer (PC) is rising (1). Traditionally, RP has been reserved for clinically localized PC, and good outcomes have been demonstrated in this population (2). While both retrospective and observational studies have reported improved survival outcomes for patients with metastatic (M1) disease who undergo primary tumor treatment relative to androgen deprivation therapy alone (1, 3), prospective data – particularly for surgery – is sparse. It would be unwise, then, to prematurely extrapolate these results to patients with metastatic disease until the merits of such an approach are carefully considered.

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The hOGG1 Ser326Cys gene polymorphism and susceptibility for bladder cancer: a meta-analysis

Vol. 42 (5): 883-896, September – October, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0446


Cao Wenjuan 1, Lu Jianzhong 1, Li Chong 1, Gao Yanjun 1, Lu Keqing 1, Wang Hanzhang 2, Wang Zhiping 1

1 Institute of Urology, The Second Hospital of Lanzhou University, Key Laboratory of Urological Diseases in Gansu Province, Gansu Nephro – Urological Clinical Center, Lanzhou, China; 2 Department of Urology, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA


Objective: To assess the susceptibility of the hOGG1 genetic polymorphism for bladder cancer and evaluate the impact of smoking exposure.

Materials and Methods: Articles included in PubMed, Medline and Springer databases were retrieved using the following key words: “human 8-oxoguanine DNA glycosylase”, “OGG”, “OGG1”, “hOGG1”, “genetic variation”, “polymorphism” , “bladder cancer”, and “bladder carcinoma” to Meta-analysis was performed to detect whether there were differences between the bladder cancer group and the control group about the distribution of genotypes of the hOGG1 gene.

Results: The results showed that there are no significant associations between the hOGG1 326Cys polymorphism and bladder cancer: GG vs. CC (OR: 1.09, 95% CI: 0.85-1.40, p=0.480); GC vs. CC (OR: 1.05, 95% CI: 0.85-1.28, p=0.662); GG+GC vs. CC (OR: 1.04, 95% CI: 0.89-1.21, p=0.619); GG vs. GC+CC(OR: 1.02, 95% CI: 0.78-1.33, p=0.888); G vs. C (OR: 1.01, 95% CI: 0.91-1.13, p=0.818). In the smoker population, no significant associations between the hOGG1 326Cys polymorphism and bladder cancer were observed for all the models. However, individuals carrying the hOGG1 Cys326Cys genotype have increased risk for bladder cancer compared to those carrying the hOGG1 Ser326Ser genotype in the non-smoker Asian population.

Conclusion: The hOGG1 326Cys polymorphisms aren’t a risk factor for bladder cancer, especially in the smoker population. But GG genotype is a risk factor for bladder cancer to the non-smoker Asian population compared with CC genotype.

Keywords: oxoguanine glycosylase 1, human [Supplementary Concept]; Polymorphism, Genetic; Urinary Bladder Neoplasms; Meta-Analysis as Topic

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Prostate cancer detection using multiparametric 3 – tesla MRI and fusion biopsy: preliminary results

Vol. 42 (5): 897-905, September – October, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0204


Thais Caldara Mussi 1, Rodrigo Gobbo Garcia 2, Marcos Roberto Gomes de Queiroz 2, Gustavo Caserta Lemos 3, Ronaldo Hueb Baroni 1

1 Departamento de Radiologia e Diagnóstico por Imagem do Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; 2 Departamento de Intervenção Guiada por Imagem do Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; 3 Departamento de Urologia do Hospital Israelita Albert Einstein, São Paulo, SP, Brasil


Objective: To evaluate the diagnostic efficacy of transrectal ultrasonography (US) biopsy with imaging fusion using multiparametric (mp) magnetic resonance imaging (MRI) in patients with suspicion of prostate cancer (PCa), with an emphasis on clinically significant tumors according to histological criteria.
Materials and Methods: A total of 189 consecutive US/MRI fusion biopsies were performed obtaining systematic and guided samples of suspicious areas on mpMRI using a 3 Tesla magnet without endorectal coil. Clinical significance for prostate cancer was established based on Epstein criteria.
Results: In our casuistic, the average Gleason score was 7 and the average PSA was 5.0ng/mL. Of the 189 patients that received US/MRI biopsies, 110 (58.2%) were positive for PCa. Of those cases, 88 (80%) were clinically significant, accounting for 46.6% of all patients. We divided the MRI findings into 5 Likert scales of probability of having clinically significant PCa. The positivity of US/MRI biopsy for clinically significant PCa was 0%, 17.6% 23.5%, 53.4% and 84.4% for Likert scores 1, 2, 3, 4 and 5, respectively.
There was a statistically significant difference in terms of biopsy results between different levels of suspicion on mpMRI and also when biopsy results were divided into groups of clinically non-significant versus clinically significant between different levels of suspicion on mpMRI (p-value <0.05 in both analyzes).
Conclusion: We found that there is a significant difference in cancer detection using US/MRI fusion biopsy between low-probability and intermediate/high probability Likert scores using mpMRI.

Keywords: Prostatic Neoplasms; Magnetic Resonance Imaging; Biopsy; Prostate

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Long term outcome and side effects in patients receiving low-dose I125 brachytherapy: a retrospective analysis

Vol. 42 (5): 906-917, September – October, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0542


Pieter Logghe 1, Rolf Verlinde 1, Frank Bouttens 2, Caroline Van den Broecke 3, Nathalie Deman 4, Koen Verboven 4, Dirk Maes 1, Luc Merckx 1

1 Department of Urology, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium; 2 Department of Radiotherapy-Oncology, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium; 3 Department of Pathology, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium; 4 Department of Physics, AZ St Lucas, Ghent, Oost-Vlaanderen, Belgium



Objectives: To retrospectively evaluate the disease free survival (DFS),disease specific survival (DSS),overall survival (OS) and side effects in patients who received low-dose rate (LDR) brachytherapy with I125 stranded seeds.

Materials and methods: Between july 2003 and august 2012, 274 patients with organ confined prostate cancer were treated with permanent I125 brachytherapy. The median follow-up, age and pretreatment prostate specific antigen (iPSA) was 84 months (12-120), 67 years (50-83) and 7.8 ng/mL (1.14-38), respectively. Median Gleason score was 6 (3-9). 219 patients (80%) had stage cT1c, 42 patients (15.3%) had stage cT2a, 3 (1.1%) had stage cT2b and 3 (1.1%) had stage cT2c. The median D90 was 154.3 Gy (102.7-190.2).

Results: DSS was 98.5%.OS was 93.5%. 13 patients (4.7%) developed systemic disease, 7 patients (2.55%) had local progression. In 139 low risk patients, the 5 year biochemical freedom from failure rate (BFFF) was 85% and 9 patients (6.4%) developed clinical progression. In the intermediate risk group, the 5 year BFFF rate was 70% and 5 patients (7.1%) developed clinical progression. Median nPSA in patients with biochemical relapse was 1.58 ng/mL (0.21 – 10.46), median nPSA in patients in remission was 0.51 ng/mL (0.01 – 8.5). Patients attaining a low PSA nadir had a significant higher BFFF (p<0.05). Median D90 in patients with biochemical relapse was 87.2 Gy (51 – 143,1). Patients receiving a high D90 had a significant higher BFFF (p<0.05).

Conclusion: In a well selected patient population, LDR brachytherapy offers excelente outcomes. Reaching a low PSA nadir and attaining high D90 values are significant predictors for a higher DFS.

Keywords: Brachytherapy; Survival; Prostate-Specific Antigen; Prostatic Neoplasms

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Impact of prior abdominal surgery on the outcomes after robotic – assisted laparoscopic radical prostatectomy: single center experience

Vol. 42 (5): 918-924, September – October, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0607



Impact of prior abdominal surgery on the outcomes after robotic – assisted laparoscopic radical prostatectomy: single center experience

 Nozomu Kishimoto 1, Tetsuya Takao 1, Gaku Yamamichi 1, Takuya Okusa 1, Ayumu Taniguchi 1, Koichi Tsutahara 1, Go Tanigawa 1, Seiji Yamaguchi 1

1 Osaka General Medical Center-Urology, Osaka, Japan


Purpose: To evaluate the influence of prior abdominal surgery on the outcomes after robotic-assisted laparoscopic radical prostatectomy (RALP).

Materials and Methods: We retrospectively analyzed patients with prostate cancer who underwent RALP between June 2012 and February 2015 at our institution. Patients with prior abdominal surgery were compared with those without prior surgery while considering the mean total operating, console, and port-insertion times; mean estimated blood loss; positive surgical margin rate; mean duration of catheterization; and rate of complications.

Results: A total of 203 patients who underwent RALP during the study period were included in this study. In all, 65 patients (32%) had a prior history of abdominal surgery, whereas 138 patients (68%) had no prior history. The total operating, console, and port-insertion times were 328 and 308 (P=0.06), 252 and 242 (P=0.28), and 22 and 17 minutes (P=0.01), respectively, for patients with prior and no prior surgery.

The estimated blood losses, positive surgical margin rates, mean durations of catheterization, and complication rates were 197 and 170 mL (P=0.29), 26.2% and 20.2% (P=0.32), 7.1 and 6.8 days (P=0.74), and 12.3% and 8.7% (P=0.42), respectively. Furthermore, whether prior abdominal surgery was performed above or below the umbilicus or whether single or multiple surgeries were performed did not further affect the perioperative outcomes.

Conclusions: Our results suggest that RALP can be performed safely in patients with prior abdominal surgery, without increasing the risk of complications.

Keywords: Surgical Procedures, Operative; Robotic Surgical Procedures; Laparoscopy

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Serum testosterone as a biomarker for second prostatic biopsy in men with negative first biopsy for prostatic cancer and PSA>4ng/mL, or with PIN biopsy result

Vol. 42 (5): 925-931, September – October, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0167


Alexandros Fiamegos 1, John Varkarakis 1, Michael Kontraros 1, Andreas Karagiannis 1, Michael Chrisofos 1, Dimitrios Barbalias 1, Charalampos Deliveliotis 1

1 2nd Department of Urology, University of Athens, Sismanoglio General Hospital, Athens, Greece


Introduction: Data from animal, clinical and prevention studies support the role of androgens in prostate cancer growth, proliferation and progression. Results of serum based epidemiologic studies in humans, however, have been inconclusive. The present study aims to define whether serum testosterone can be used as a predictor of a posi­tive second biopsy in males considered for re-biopsy.

Material and Methods: The study included 320 men who underwent a prostatic biopsy in our department from October 2011 until June 2012. Total testosterone, free testos­terone, bioavailable testosterone and prostate pathology were evaluated in all cases. Patients undergoing a second biopsy were identified and biopsy results were statisti­cally analyzed.

Results: Forty men (12.5%) were assessed with a second biopsy. The diagnosis of the second biopsy was High Grade Intraepithelial Neoplasia in 14 patients (35%) and Pros­tate Cancer in 12 patients (30%). The comparison of prostatic volume, total testoste­rone, sex hormone binding globulin, free testosterone, bioavailable testosterone and albumin showed that patients with cancer of the prostate had significantly greater levels of free testosterone (p=0.043) and bioavailable T (p=0.049).

Conclusion: In our study, higher free testosterone and bioavailable testosterone levels were associated with a cancer diagnosis at re-biopsy. Our results indicate a possible role for free and bioavailable testosterone in predicting the presence of prostate cancer in patients considered for re-biopsy.

Keywords:  Testosterone; Prostate; Neoplasms; Biopsy

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