Volume 43 | number 2 | March . April, 2017 Kidney anatomy: three dimensional (3D) printed pelvicalyceal system models of the collector system improve the diagnosis and treatment of stone disease The May-June 2017 issue of the International Braz J Urol presents original contributions…
Vol. 43 (2): 180-181, March – Abril, 2017
EDITORIAL in this Issue
Professor Titular Disciplina de Urologia da Faculdade de Medicina do ABC, Santo André, SP, Brasil
Peer review system is like democracy: it is absolutely imperfect, but the best available.
It allows criticism to articles, suggestions for improvement under different perspectives and allows the editor to make a fairer decision about the future of an article.
The reviewer is the soul of a medical journal like International Brazilian Journal of Urology. He/she dictates the quality of publishing, the velocity by which each article reaches the reader, being a voluntary job that takes time. A good reviewer is rapidly identified by different magazines and is overloaded by many requests.
Vol. 43 (2): 182-183, March – Abril, 2017
Philippe E Spiess,
Video Section Editor, International Brazilian of Urology
Associate member, Department of GU Oncology Moffitt Cancer Center
Associate Professor, Department of Urology University of South Florida Tampa, Florida, USA
Dear esteemed colleagues and friends, As we begin a new year, I would like to take this opportunity to thank each of you for your commitment in supporting our journal and expanding its readership.
This past year has been truly exceptional in the quality of submissions we have received within the video section of the International Brazilian Journal of Urology.
We are committed in publishing the highest quality videos detailing novel surgical techniques and approaches by leading surgical teams from across the world. Similarly, we encourage groups pushing the envelope in terms of how we can continually
refine the art of surgery and ultimately improve the outcomes of our patients. In this regard, I am pleased to share with you this year’s selection for best videos of the year for 2016. Many individual criteria were taken into account in making this selection
including novelty, superior quality in terms of video depiction and narration, and lastly vides that best depict re-defining surgical approaches to urological diseases.
On that note, here are the selections:
Radical Cystectomy is the best choice for most patients with muscle-invasive bladder cancer? Opinion: Yes
Vol. 43 (2): 184-187, March – April, 2017
DIFFERENCE OF OPINION
Leonardo L. Monteiro 1, Wassim Kassouf 1
1 Division of Urology, McGill University Health Center, Montreal, Quebec, Canada
Keywords: Urinary Bladder Neoplasms; Cystectomy; Chemoradiotherapy, Adjuvant; Neoadjuvant Therapy
Around the World, radical cystectomy (RC) with bilateral pelvic lymphadenectomy (PLND) and perioperative chemotherapy is regarded as the standard treatment for patients with muscle-invasive bladder cancer (MIBC). This management approach is supported by numerous renowned organizations and guidelines, such as the National Comprehensive Cancer Network (NCCN), as well as by the European Association of Urology (EAU) guidelines.
In fact, the latter has assigned RC a grade A recommendation for treating MIBC (T2-T4aN0M0) and high-risk non-muscle invasive bladder cancer.
Radical Cystectomy is the best choice for most patients with muscle-invasive bladder cancer? Opinion: No
Vol. 43 (2): 188-191, March – April, 2017
DIFFERENCE OF OPINION
Timur Mitin 1
1 Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon
Keywords: Urinary Bladder Neoplasms; Cystectomy; Chemoradiotherapy, Adjuvant; Neoadjuvant Therapy
Progress is a hallmark of human civilization. Over the past centuries, it became easier, faster and safer to travel from point A to point B, and the choices of transportation are now numerous, making it at times challenging for travelers to make their selection and forcing them to buy guidebooks, research travel websites and sometimes even contact the travel agents. Perhaps sailing was once the only way of crossing the ocean, but with advent of aviation it is no longer the case. Similarly, upfront radical surgeries were once patients’ only hope for cure – radical mastectomy for patients with breast cancer, amputation for patients with extremity sarcoma, laryngectomy for patients with laryngeal cancer, radical prostatectomy for patients with prostate cancer, abdominoperineal resection for patients with anal carcinoma. However, over the past 40 years the field of oncology has embraced organ preservation, often, but not always, through randomized clinical trials showing equivalent outcomes with smaller surgeries and adjuvant radiation therapy, or replacement of upfront surgery with definitive chemoradiation therapy, reserving organ extirpation for salvage in case of local recurrences. The management of muscle-invasive bladder cancer (MIBC) is no different (1).
Vol. 43 (2): 192-201, March – April, 2017
Walter Henriques da Costa 1, George Jabboure Netto 2, Isabela Werneck da Cunha 3
1 Departamento de Urologia, AC Camargo Cancer Center, São Paulo, SP, Brasil; 2 Department of Pathology, Department of Urology and Department of Oncology, Johns Hopkins University – Baltimore, Maryland, United States; 3 Departamento de Patologia, AC Camargo Cancer Center, São Paulo, SP, Brasil
Cancer related to hereditary syndromes corresponds to approximately 5-10% of all tumors. Among those from the genitourinary system, many tumors had been identified to be related to genetic syndromes in the last years with the advent of new molecular genetic tests. New entities were described or better characterized, especially in kidney cancer such as hereditary leiomyomatosis renal cell carcinoma (HLRCC), succinate dehydrogenase kidney cancer (SDH-RCC), and more recently BAP1 germline mutation related RCC. Among tumors from the bladder or renal pelvis, some studies had reinforced the role of germline mutations in mismatch repair (MMR) genes, especially in young patients. In prostate adenocarcinoma, besides mutations in BRCA1 and BRCA2 genes that are known to increase the incidence of high-risk cancer in young patients, new studies have shown mutation in other gene such as HOXB13 and also polymorphisms in MYC, MSMB, KLK2 and KLK3 that can be related to hereditary prostate cancer. Finally, tumors from testis that showed an increased in 8 – 10-fold in siblings and 4 – 6-fold in sons of germ cell tumors (TGCT) patients, have been related to alteration in X chromosome. Also genome wide association studies GWAS pointed new genes that can also be related to increase of this susceptibility.
Keywords: Urinary Tract; Syndrome; Neoplastic Syndromes, Hereditary
Diagnostic relevance of metastatic renal cell carcinoma in the head and neck: An evaluation of 22 cases in 671 patients
Vol. 43 (2): 202-208, March – April, 2017
Anja Lieder 1, Thomas Guenzel 2, Steffen Lebentrau 3, Constanze Schneider 4, Achim Franzen 1
1 Department of Otorhinolaryngology, Ruppiner Kliniken and Brandenburg Medical School Theodor-Fontane, Neuruppin, Germany; 2 Department of Otorhinolaryngology, Head and Neck Surgery, Borromaeus-Hospital Leer Germany; 3 Department of Urology and Pediatric Urology, Ruppiner Kliniken and Brandenburg Medical School Theodor-Fontane, Neuruppin, Germany; 4 Clinical Cancer Registry Brandenburg, Neuruppin, Germany
Purpose: Renal cell carcinoma (RCC) is a malignant tumor that metastasizes early, and patients often present with metastatic disease at the time of diagnosis. The aim of our evaluation was to assess the diagnostic and differential diagnostic relevance of metastatic renal cell carcinoma (RCC) with particular emphasis on head and neck manifestations in a large patient series.
Patients and methods: We retrospectively evaluated 671 consecutive patients with RCC who were treated in our urology practice between 2000 and 2013.
Results: Twenty-four months after diagnosis, 200/671 (30%) of RCC had metastasized. Distant metastases were found in 172 cases, with 22 metastases (3.3%) in the head and neck. Cervical and cranial metastases were located in the lymph nodes (n=13) and in the parotid and the thyroid gland, tongue, the forehead skin, skull, and paranasal sinuses (n=9). All head and neck metastases were treated by surgical excision, with 14 patients receiving adjuvant radiotherapy and 9 patients receiving chemotherapy or targeted therapy at some point during the course of the disease. Five patients (23%) survived. The mean time of survival from diagnosis of a head and neck metastasis was 38 months, the shortest period of observation being 12 months and the longest 83 months.
Discussion and conclusion: Our findings show that while RCC metastases are rarely found in the neck, their proportion among distantly metastasized RCC amounts to 13%. Therefore, the neck should be included in staging investigations for RCC with distant metastases, and surgical management of neck disease considered in case of resectable metastatic disease. Similarly, in patients presenting with a neck mass with no corresponding tumor of the head and neck, a primary tumor below the clavicle should be considered and the appropriate staging investigations initiated.
Keywords: Carcinoma, Renal Cell; Neoplasm Metastasis; Carcinoma, squamous cell of head and neck [Supplementary Concept]
Open partial nephrectomy for entirely intraparenchymal tumors: a matched case-control study of oncologic outcome and complication rate
Vol. 43 (2): 209-215, March – April, 2017
Piotr Zapala 1, Bartosz Dybowski 1, Nina Miązek 1, Piotr Radziszewski 1
1 Department of Urology, Medical University of Warsaw, Poland
Purpose: To compare the oncologic and clinical outcomes for open partial nephrectomy (OPN) performed in patients with entirely intraparenchymal tumors versus casematched controls, with exophytic lesions.
Material and methods: Patients having undergone OPN between 2007 and 2012 were investigated. Exclusion criteria included patients with a benign tumor, advanced malignancy, malignancies other than renal cell carcinoma, end-stage renal failure, or 3 or more co-existing chronic diseases. Individuals with tumors that were invisible at the renal surface were identified, and then matched with 2 controls chosen for tumor size, pathology, age, follow-up period, and presence of a solitary kidney. Oncological status, perioperative, and postoperative data were collected and compared between groups.
Results: 17 individuals with entirely endophytic RCC tumors and available oncologic status were identified. For five patients, only one suitable control could be identified, bringing the control group number to 29. All tumors were clear cell carcinomas staged at pT1a. Median tumor size was 25mm for endophytic lesions, and 27mm for exophytic masses (P=0.32). The operative period was extended by 20 minutes for intrarenal tumors (P=0.03), with one case of a positive surgical margin in each group (P=0.7).
There were no significant differences in perioperative or postoperative complications.
Median follow-up was 47 and 43 months for patients with endophytic and exophytic tumors respectively. Disease recurrence was recorded in one patient after endophytic tumor resection, and in four controls (P=0.4).
Conclusions: OPN shows equivalent safety and efficacy for both intrarenal RCC tumors and exophytic tumors of the same size and type.
Keywords: Kidney; Neoplasms; Nephrectomy
Comparative analysis of short – term functional outcomes and quality of life in a prospective series of brachytherapy and Da Vinci robotic prostatectomy
Vol. 43 (2): 216-223, March – April, 2017
Cristina García-Sánchez 1, Ana A. Román Martín 1, J. Manuel Conde-Sánchez 1, C. Belén Congregado-Ruíz 1, Ignacio Osman-García 1, Rafael A. Medina-López 1
1 Virgen del Rocío Universitary Hospital, Seville, Spain
Introduction: There is a growing interest in achieving higher survival rates with the lowest morbidity in localized prostate cancer (PC) treatment. Consequently, minimally invasive techniques such as low-dose rate brachytherapy (BT) and robotic-assisted prostatectomy (RALP) have been developed and improved.
Comparative analysis of functional outcomes and quality of life in a prospective series of 51BT and 42Da Vinci prostatectomies DV.
Materials and Methods: Comparative analysis of functional outcomes and quality of life in a prospective series of 93 patients with low-risk localized PC diagnosed in 2011. 51patients underwent low-dose rate BT and the other 42 patients RALP. IIEF to assess erectile function, ICIQ to evaluate continence and SF36 test to quality of life wee employed.
Results: ICIQ at the first revision shows significant differences which favour the BT group, 79% present with continence or mild incontinence, whereas in the DV group 45% show these positive results. Differences disappear after 6 months, with 45 patients (89%) presenting with continence or mild incontinence in the BT group vs. 30 (71%) in the DV group.
65% of patients are potent in the first revision following BT and 39% following DV. Such differences are not significant and cannot be observed after 6 months.
No significant differences were found in the comparative analysis of quality of life.
Conclusions: ICIQ after surgery shows significant differences in favour of BT, which disappear after 6 months.
Both procedures have a serious impact on erectile function, being even greater in the DV group. Differences between groups disappear after 6 months.
Keywords: Prostatectomy; Quality of Life; Brachytherapy; Robotic Surgical Procedures
Overexpression of UHRF1 gene correlates with the major clinicopathological parameters in urinary bladder cancer
Vol. 43 (2): 224-229, March – April, 2017
Skender Saidi 1, Zivko Popov 1, Vesna Janevska 2, Sasho Panov 3
1 University Clinic of Urology in Skopje, Republic of Macedonia; 2 Institute of Pathology, Medical Faculty, Ss. Cyril and Methodius University, Republic of Macedonia; 3 Molecular Biology and Genetics Department, Institute of Biology, Faculty of Natural Sciences and Mathematics, Ss. Cyril and Methodius University, Skopje, Republic of Macedonia
Introduction: Recently, expression of the UHRF1 gene was found to be up-regulated in numerous neoplasms, including the urinary bladder transitional cell carcinoma (TCC).
Objective: The aim of our study was to determine if the expression levels of UHRF1 gene correlates with the major pathological characteristics of the tumor and patients’ clinical outcome.
Materials and Methods: In our study, we have analyzed the tissue samples derived from group of 70 patients with histologically confirmed TCC of the urinary bladder, while normal urinary bladder mucosa obtained from 40 patients with nonmalignant diseases was used as a negative control group. Expression of UHRF1 gene in each patient sample was determined using reverse transcriptase-polymerase chain reaction.
Results: UHRF1 gene expression was found to be app. 2.5 times higher in samples from patients with TCC in comparison with normal epithelium derived from control group patients. Analysis show that gene expression correlates with the malignancy of the tumor. A highly significant differences were found between the expression values of samples from low and high grade TCC, as well as between the high grade and control group. UHRF1 expression was higher in patients with non-muscle invasive disease than in those with muscle invasive disease.
Conclusions: The result of this study indicates that UHRF1 gene expression levels correlates with the major pathological characteristics of TCC samples and with the clinical outcome of those patients. Determination of UHRF1 gene expression could have a potential to be used as a sensitive molecular marker in patients with urinary bladder cancer.
Keywords: Urinary Bladder Neoplasms; Carcinoma, Transitional Cell; RING Finger Domains
Vol. 43 (2): 230-238, March – April, 2017
Simon Robinson 1, Marc Laniado 1, Bruce Montgomery 1
1 Frimley Park Foundation Trust, United Kingdom
Background: Prostate-specific antigen densities have limited success in diagnosing prostate cancer. We emphasise the importance of the peripheral zone when considered with its cellular constituents, the “prostatocrit”.
Objective: Using zonal volumes and asymmetry of glandular acini, we generate a peripheral zone acinar volume and density. With the ratio to the whole gland, we can better predict high grade and all grade cancer. We can model the gland into its acinar and stromal elements. This new “prostatocrit” model could offer more accurate nomograms for biopsy.
Materials and Methods: 674 patients underwent TRUS and biopsy. Whole gland and zonal volumes were recorded. We compared ratio and acinar volumes when added to a “clinic” model using traditional PSA density. Univariate logistic regression was used to find significant predictors for all and high grade cancer. Backwards multiple logistic regression was used to generate ROC curves comparing the new model to conventional density and PSA alone.
Outcome and results: Prediction of all grades of prostate cancer: significant variables revealed four significant “prostatocrit” parameters: log peripheral zone acinar density; peripheral zone acinar volume/whole gland acinar volume; peripheral zone acinar density/whole gland volume; peripheral zone acinar density. Acinar model (AUC 0.774), clinic model (AUC 0.745) (P=0.0105).
Prediction of high grade prostate cancer: peripheral zone acinar density (“prostatocrit”) was the only significant density predictor. Acinar model (AUC 0.811), clinic model (AUC 0.769) (P=0.0005).
Conclusion: There is renewed use for ratio and “prostatocrit” density of the peripheral zone in predicting cancer. This outperforms all traditional density measurements.
Keywords: Acinar Cells; Prostatic Neoplasms; Diagnosis; PSA
Vol. 43 (2): 239-244, March – April, 2017
Bryan Hinck 1, Benjamin Larson 1, Shubha De 2, Manoj Monga 1
1 Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA; 2 Alberta Urology Institute, Edmonton, Alberta, Canada
Introduction: Urinalysis (UA) in the emergency setting for patients with nephrolithiasis produces potentially confusing results leading to treatment of presumed urinary tract infections (UTIs). Our objective was to evaluate the use of antibiotics in patients with nephrolithiasis in a large network of emergency departments (EDs).
Methods: A retrospective analysis of all ED visits associated with an ICD-9 diagnosis of nephrolithiasis and a CT scan between 2010 and 2013 was performed. Urinalysis data, the use of IV and PO antibiotics during the ED visit and at discharge were assessed. The presence of fever, elevated serum WBCs, >5 WBCs per hpf, and/or dip positive nitrites were used as appropriate criteria for antibiotic use.
Results: Urinalysis data were available for 3,518 (70%) of 5,035 patients with an ED diagnosis of nephrolithiasis and CT imaging. Of these visits, 237 patients had positive nitrites (6.7%) and 864 had >5 WBCs per hpf (24.6%) with 158 (4.5%) having both findings for a total of 943 patients. Intravenous antibiotics were given to 244 patients (25.9%) and oral antibiotics were given to 629 patients (66.7 %) with positive UA findings. Of the 2,440 patients with a negative UA and no leukocytosis or fever, 86 patients (3.5%) received IV antibiotics and 533 patients (21.8%) received PO antibiotics upon discharge.
Conclusions: Proper treatment of nephrolithiasis in the ED includes the screening and diagnosis of concomitant UTIs. However, correct interpretation of UA studies is vital to the correct implementation of antibiotic therapy. This study suggests that 1/3 of patients were undertreated and 21.8% were over-treated.
Keywords: Antibiotic Prophylaxis; Renal Colic; Emergencies
Evaluation of the Learning Curve for Transurethral Plasmakinetic Enucleation and Resection of Prostate Using a Mentor-based Approach
Vol. 43 (2): 245-255, March – April, 2017
Lang Feng 1, Jian Song 1, Daoxin Zhang 1, Ye Tian 1
1 Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
Objective: To analyze the mentor-based learning curve of one single surgeon with transurethral plasmakinetic enucleation and resection of prostate (PKERP) prospectively.
Materials and Methods: Ninety consecutive PKERP operations performed by one resident under the supervision of an experienced endourologist were studied. Operations were analyzed in cohorts of 10 cases to determine when a plateau was reached for the variables such as operation efficiency, enucleation efficiency and frequency of mentor advice (FMA). Patient demographic variables, perioperative data, complications and 12-month follow-up data were analyzed and compared with the results of a senior urologist.
Results: The mean operative efficiency and enucleation efficiency increased from a mean of 0.49±0.09g/min and 1.11±0.28g/min for the first 10 procedures to a mean of 0.63±0.08g/min and 1.62±0.36g/min for case numbers 31-40 (p=0.003 and p=0.002).
The mean value of FMA decreased from a mean of 6.7±1.5 for the first 10 procedures to a mean of 2.8±1.2 for case numbers 31-40 (p<0.01). The senior urologist had a mean operative efficiency and enucleation efficiency equivalent to those of the senior resident after 40 cases. There was significant improvement in 3, 6 and 12 month’s parameter compared with preoperative values (p<0.001).
Conclusions: PKERP can be performed safely and efficiently even during the initial learning curve of the surgeon when closely mentored. Further well-designed trials with several surgeons are needed to confirm the results.
Keywords: Prostate; Transurethral Resection of Prostate
Correlation between overactive bladder symptom score and neuropsychological parameters in Alzheimer’s disease patients with lower urinary tract symptom
Vol. 43 (2): 256-263, March – April, 2017
Ha Bum Jung 1, Don Kyoung Choi 1, Seong Ho Lee 1, Sung Tae Cho 1, Hae Ri Na 2, Moon Ho Park 3
1 Department of Urology, College of Medicine, Hallym University, Seoul, Korea Seoul, Korea; 2 Department of Neurology, Bobath Memorial Hospital, Seongnam-si, Korea; 3 Department of Neurology, College of Medicine, Korea University, Seoul, Korea
Purpose: To examine an association between the overactive bladder symptom score (OABSS) and neuropsychological parameters. Moreover, we investigate the factors that affect each item in the questionnaire.
Materials and Methods: A total of 376 patients (males: 184; females: 192) with probable Alzheimer’s disease (AD) were recruited. Cognitive testing was conducted using the Mini Mental Status Examination (MMSE), Clinical Dementia Rating (CDR) scale, Global Deterioration Scale (GDS), and Barthel Activities of Daily Living (ADL). Lower urinary tract symptom (LUTS) was assessed using OABSS and voiding diary.
Results: The prevalence of overactive bladder (OAB) (defined as OABSS ≥3 with na urgency score of ≥2) in patients with AD was 72.6%. Among the OAB subjects, the most common severity of symptom was moderate (72.6%), followed by mild (21.2%), and severe (5.8%). It was found that OABSS had a very high correlation with aging (r=0.75; p<0.001). When compared with neuropsychological parameters, it was found that OABSS was highly correlated with the CDR scores (r=0.446; p<0.001). However, no significant correlation was found between the changes in OABSS scores and those in other neuropsychological parameters. Based on the individual symptom scores, urgency incontinence was highly correlated with the CDR scores (r=0.43; p<0.001).
Conclusions: OABSS is a useful tool in assessing AD patients with LUTS. There was a consistent positive association between OABSS severity, including urgency incontinence, and CDR scores.
Keywords: Neuropsychological Tests; Urinary Bladder; Lower Urinary Tract Symptoms
Artificial urinary sphincter revision for urethral atrophy: Comparing single cuff downsizing and tandem cuff placement
Vol. 43 (2): 264-270, March – April, 2017
Brian J. Linder 1, Boyd R. Viers 1, Matthew J. Ziegelmann 1, Marcelino E. Rivera 1, Daniel S. Elliott 1
1 Department of Urology, Mayo Clinic, Rochester, MN, USA
Objective: To compare outcomes for single urethral cuff downsizing versus tandem cuff placement during artificial urinary sphincter (AUS) revision for urethral atrophy.
Materials and Methods: We identified 1778 AUS surgeries performed at our institution from 1990-2014. Of these, 406 were first AUS revisions, including 69 revisions for urethral atrophy. Multiple clinical and surgical variables were evaluated for potential association with device outcomes following revision, including surgical revision strategy (downsizing a single urethral cuff versus placing tandem urethral cuffs).
Results: Of the 69 revision surgeries for urethral atrophy at our institution, 56 (82%) were tandem cuff placements, 12 (18%) were single cuff downsizings and one was relocation of a single cuff. When comparing tandem cuff placements and single cuff downsizings, the cohorts were similar with regard to age (p=0.98), body-mass index (p=0.95), prior pelvic radiation exposure (p=0.73) and length of follow-up (p=0.12). Notably, there was no difference in 3-year overall device survival compared between single cuff and tandem cuff revisions (60% versus 76%, p=0.94). Likewise, no significant difference was identified for tandem cuff placement (ref. single cuff) when evaluating the risk of any tertiary surgery (HR 0.95, 95% CI 0.32-4.12, p=0.94) or urethral erosion/device infection following revision (HR 0.79, 95% CI 0.20-5.22, p=0.77).
Conclusions: There was no significant difference in overall device survival in patients undergoing single cuff downsizing or tandem cuff placement during AUS revision for urethral atrophy.
Keywords: Urinary Sphincter, Artificial; Urinary Incontinence; Male
Editorial Comment: Artificial urinary sphincter revision for urethral atrophy : Comparing single cuff downsizing and tandem cuff placement
Vol. 43 (2): 271-271, March – April, 2017
Márcio Augusto Averbeck 1
1 Hospital Moinhos de Vento Hospital, Porto Alegre, Brasil
NO ABSTRACT available
Urethral Pressure Variation: A neglected contributing factor in patients with overactive bladder syndrome?
Vol. 43 (2): 272-279, March – April, 2017
Ruth Kirschner-Hermanns 1, Ralf Anding 1, Nariman Gadzhiev 2, Ing Goping 3, Adele Campbell 3, Nadine Huppertz 1
1 Departament of Neuro-urology, University Hospital Friederich Wilhelms, University Bonn, Germany; ² Department of Urology, The Federal State Institute of Public Health, The Nikiforov Russian Center of Emergency and Radiation Medicine, Saint-Petersburg, Russian Federation; ³ Laborie, Mississauga, ON, Canada
Objective: To study urethral pressure variations during the whole filling phase among different groups of patients.
Material and Methods: We investigated 79 consecutive patients from January 2011 to June 2012. All patients were recruited within our routine practice in our continence clinic and were evaluated with urodynamic exam according to the standards of the International Continence Society (ICS) with an additional continuous measurement of the urethral pressure profile (cUPP) that was done in a supine position. Patients with genital prolapse >grade I, as well as patients with impaired cognitive function or neurogenic disorders were excluded. Bacteriuria at the time of investigation was excluded by urine analysis. Urethral pressure changes higher than 15cmH2O were considered as ‘urethral instability’.
Results: From 79 investigated patients, 29 were clinically diagnosed with OAB syndrome, 19 with stress urinary incontinence (SUI) and 31 with mixed (OAB and SUI) incontinence.
The prevalence of ‘urethral instability’ as defined in this study was 54.4% (43/79). The mean Δp in patients with OAB (36.5cmH2O) was significantly higher (p<0.05) than in groups with pure stress (14.9cmH2O) and mixed urinary incontinence (19.3cmH2O).
Conclusions: Etiology of ‘urethral instability’ is unknown, but high prevalence among patients with overactive bladder syndrome, especially concomitant with detrusor activity can raise a fair question and direct further diagnostic as well as treatment efforts.
Keywords: Urinary Bladder, Overactive; Urodynamics; Urethra
Minimally invasive treatment of female stress urinary incontinence with the adjustable single-incision sling system (AJUST ™) in an elderly and overweight population
Vol. 43 (2): 280-288, March – April, 2017
Ralf Anding 1, Manuel Schoen 2, Ruth Kirschner-Hermanns 1, Christian Fisang 1, Stefan C. Müller 1, Stefan Latz 1
1 Department of Urology and Neuro-Urology, University Hospital Bonn, Germany; 2 Department of Urology, Klinikum Ibbenbueren GmbH, Germany
Introduction: The prevalence of urinary incontinence is increasing. Two major risk factors are overweight and age. We present objective and subjective cure rates of elderly and overweight patients treated with an adjustable single-incision sling system (AJUST™, C.R. BARD, Inc.).
Materials and Methods: Between 04/2009 and 02/2012 we treated 100 female patients with the single incision sling. Patients were retrospectively evaluated by Stamey degree of incontinence, cough test, pad use, and overall satisfaction. The primary outcomes of the study were objective and subjective cure rates, secondary outcomes were the safety profile of the sling and complications.
Results: The overall success rate in this population was 84.6% with a mean follow-up of 9.3 months. The average usage of pads per day decreased from 4.9 to 1.6 and was significantly lower in patients with a BMI <30 (p=0.004). Postoperative residual SUI was also lower in patients with a BMI <30 (p=0.006). Postoperative satisfaction was better in patients with a lower BMI, but this difference did not reach a level of significance (p=0.055).
There were no complications such as bleeding, bladder injury, or tape infection.
Conclusions: In elderly and obese patients a considerable success rate is achievable with this quick and minimal invasive procedure. However, the success rate shows a clear trend in favor of a lower body-mass-index. The cut-off point has been identified at a BMI of 30.
The AJUST™ system can be regarded as safe and beneficial for elderly and obese patients.
Keywords: Body Mass Index; Obesity; Suburethral Slings; Urinary Incontinence, Stress
Vol. 43 (2): 289-303, March – April, 2017
Tyler Okland 1, Chante Karimkhani 2, Hannah Pederson 1, Lindsay N. Boyers 3, Mark D. Sawyer 4, Kyle O. Rove 5, McCabe C. Kenny 5, Steven Steinberg 4,5, Mohsen Naghavi 6, Robert P. Dellavalle 7,8,9
1 University of Colorado School of Medicine, Aurora, Colorado, USA; 2 College of Physicians and Surgeons, Columbia University, New York, NY, USA; 3 School of Medicine, Georgetown University, Washington, District of Columbia, USA; 4 Urology Service, Unites States Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, Colorado, USA; 5 Department of Urology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; 6 Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA; 7 Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; 8 Dermatology Service, Unites States Department of Veterans, Eastern Colorado Health Care System, Denver, Colorado, USA; 9 Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
Objectives: We sought to determine whether disease representation in the Cochrane Database of Systematic Reviews (CDSR) reflects disease burden, measured by the Global Burden of Disease (GBD) Study as disability-adjusted life-years (DALYs).
Materials and Methods: Two investigators performed independent assessment of ten men’s health and urologic diseases (MHUDs) in CDSR for systematic review and protocol representation, which were compared with percentage of total 2010 DALYs for the ten conditions. Data were analyzed for correlation using Spearman rank analysis.
Results: Nine of ten MHUDs were represented by at least one CDSR review. There was a poor and statistically insignificant positive correlation between CDSR representation and disease burden (rho = 0.42, p = 0.23). CDSR representation was aligned with disease burden for three conditions, greater than disease burden for one condition, and less than disease burden for six conditions.
Conclusions: These results yield high-quality estimates to inform future research prioritization for MHUDs. While prioritization processes are complex and multi-faceted, disease burden should be strongly considered. Awareness of research priority setting has the potential to minimize research disparities on a global scale.
Keywords: Men’s Health; Urologic Diseases; Neoplasms; Infertility, Male
Assessment of satisfaction and Quality of Life using self -reported questionnaires after urethroplasty: a prospective analysis
Vol. 43 (2): 304-310, March – April, 2017
Eduardo Terra Lucas 1, Walter José Koff 1, Tiago Elias Rosito 1, Milton Berger 1, Tiago Bortolini 1, Brasil Silva Neto 1
1 Departamento de Urologia, Hospital das Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, RS, Brasil
Objectives: To assess patient satisfaction and quality of life after urethroplasty using two different self-reported outcome measures and to compare it with objective clinical data.
Materials and Methods: We prospectively collected data from 35 consecutive patients who underwent urethroplasty from January 2013 to September 2014. Patient demographics, International Prostate Symptom Score (IPSS), quality of life score, urethral stricture surgery patient-reported outcome measure (USS-PROM), maximum flow rate (Qmax) and post-void residual urine were collected before, two and eight months after surgery. Failure occurred when any postoperative instrumentation was performed.
General estimation equation was used to compare the results and linear regression analysis to correlate both questionnaires with objective data.
Results: Mean age was 61 years. Urethroplasties were equally divided between anastomotic and buccal mucosa grafts and 19 patients (59.3%) had a previous urethral procedure. Overall success rate was 87.5%. IPSS improved from a mean 19 at baseline to 5.32 at 8 months (p <0.001). The mean USS-PROM score also improved from 13.21 preoperatively to 3.36 after surgery (p <0.001) and 84.3% of patients were satisfied or very satisfied with surgical results. Mean Qmax increased from 4.64mL/s to 11mL/s (p <0.001). Strong negative correlation was found respectively between flow rate and USS-PROM (r=-0.531, p <0.001) and with IPSS (r=-0.512, p <0.001).
Conclusions: Significant improvements in urinary symptoms and in quality of life are expected after urethroplasty and they are correlated with objective measures.
Keywords: Urethral Stricture; Surveys and Questionnaires; Quality of Life; Cost-Benefit Analysis
Vol. 43 (2): 311-316, March – April, 2017
Lütfi Canat 1, Akif Erbin 2, Masum Canat 3, Mehmet Dinek 4, Turhan Çaşkurlu 5
1 Department of Urology, Okmeydani Training and Research Hospital, Istanbul, Turkey; 2 Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey; 3 Department of Endocrinology, Bayburt State Hospital, Bayburt, Turkey; 4 Department of Urology, Kastamonu State Hospital, Kastamonu, Turkey; 5 Department of Urology, Istanbul Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
Purpose: Premature ejaculation is considered the most common type of male sexual dysfunction. Hormonal controls of ejaculation have not been exactly elucidated. The aim of our study is to investigate the role of hormonal factors in patients with premature ejaculation.
Materials and Methods: Sixty-three participants who consulted our outpatient clinics with complaints of premature ejaculation and 39 healthy men as a control group selected from volunteers were included in the study. A total of 102 sexual active men aged between 21 and 76 years were included. Premature ejaculation diagnostic tool questionnaires were used to assessment of premature ejaculation. Serum levels of follicle stimulating hormone, luteinizing hormone, prolactin, total and free testosterone, thyroid-stimulating hormone, free triiodothyronine and thyroxine were measured.
Results: Thyroid-stimulating hormone, luteinizing hormone, and prolactin levels were significantly lower in men with premature ejaculation according to premature ejaculation diagnostic tool (p=0.017, 0.007 and 0.007, respectively). Luteinizing hormone level (OR, 1.293; p=0.014) was found to be an independent risk factor for premature ejaculation.
Conclusions: Luteinizing hormone, prolactin, and thyroid-stimulating hormone levels are associated with premature ejaculation which was diagnosed by premature ejaculation diagnostic tool questionnaires. The relationship between these findings have to be determined by more extensive studies.
Keywords: Hormones; Erectile Dysfunction; Premature Ejaculation
Effect of tadalafil 5mg daily treatment on the ejaculatory times, lower urinary tract symptoms and erectile function in patients with erectile dysfunction
Vol. 43 (2): 317-324, March – April, 2017
Mehmet Karabakan 1, Ercument keskin 2, Serkan Akdemir 3, Aliseydi Bozkurt 2
1 Department of Urology, Mersin Toros State Hospital, Mersin, Turkey; 2 Department of Urology, Mengucek Gazi Research and Training Hospital, Erzincan University, Erzincan, Turkey; 3 Department of Urology, Faculty of Medicine, Izmir University, Izmir, Turkey
Objective: To investigate the effect of a 5mg daily tadalafil treatment on the ejaculation time, erectile function and lower urinary tract symptoms (LUTS) in patients with erectile dysfunction.
Materials and Methods: A total of 60 patients diagnosed with erectile dysfunction were retrospectively evaluated using the international index of erectile function questionnaire-5 (IIEF-5), intravaginal ejaculatory latency time (IELT) and international prostate symptoms scores (IPSS). After the patients were treated with 5mg tadalafil once a day for three months, their erection, ejaculation and LUTS were assessed again. The fasting levels of blood glucose, total testosterone, low-density lipoprotein cholesterol, highdensity lipoprotein cholesterol and total cholesterol were measured. The independentsamples t-test was used to compare the pre- and post-treatment scores of the patients.
Results: The mean age of the 60 participants was 50.4±7.9 and the mean baseline serum total testosterone, total cholesterol, and fasting blood sugar were 444.6±178.6ng dL-1, 188.7±29.6mg/dL-1,104 (80-360) mg dL-1, respectively. The mean baseline scores were 2.2±1.4 min for IELT, 9.5±3.7 for IIEF-5 and 14.1±4.5 for IPSS. Following the three-month daily 5mg tadalafil treatment, the scores were found to be 3.4±1.9 min, 16.1±4.7, and 10.4±3.8 for IELT, IIEF and IPSS, respectively. When the baseline and post-treatment scores were compared, a statistically significant increase was observed in the IELTs and IIEF-5 values whereas there was a significant decrease in IPSS (p<0.01).
Conclusion: A daily dose of 5mg tadalafil can be safely used in the treatment of erectile dysfunction and LUTS, that prolongs the ejaculatory latency time.
Keywords: Tadalafil; Ejaculation; Erectile Dysfunction; Therapeutics
ECLAMC Study: Prevalence patterns of hypospadias in South America: Multi-national analysis over a 24-year period
Vol. 43 (2): 325-334, March – April, 2017
Nicolás Fernández 1,2, Jaime Pérez 1, Pedro Monterrey 3, Fernando A. Poletta 4, Darius J. Bägli 5, Armando J. Lorenzo 5, Ignacio Zarante 2
1 Departamento de Urología, Pontificia Universidad Javeriana, Departamento de Urología, Hospital Universitario San Ignacio, Bogotá, Colombia; 2 Instituto de Genética Humana, Pontificia Universidad Javeriana, Bogotá, Colombia; 3 Departamento de matemáticas, Rosario University, Bogotá, Colombia; 4 ECLAMC (Estudio Colaborativo Latinoamericano de Malformaciones Congénitas) at Centro de Educación Médica e Investigaciones Clínicas (CEMIC-CONICET), Buenos Aires, Argentina and Instituto Nacional de Genética Médica Populacional (INaGeMP), Rio de Janeiro, Brasil; 5 Division of Urology, Department of Surgery, Hospital for Sick Children and University of Toronto, Toronto, Ontario
Objective: To evaluate prevalence trends of hypospadias in South-America it is essential to perform multicenter and multinational studies with the same methodology. Herein we present systematic data as part of an international multicenter initiative evaluating congenital malformations in South America over a 24-year period.
Materials and Methods: A nested case-control study was conducted using the Latin American Collaborative Study of Congenital Malformations (ECLAMC), between January 1989 and December 2012. Cases were stratified as isolated (IH) and non-isolated hypospadias (NIH). Global prevalence was calculated and discriminated by country. Associations between birth weight and gestational age, and NIH distribution by associated abnormality and severity of hypospadias, were analyzed.
Results: A total of 159 hospitals from six countries participated, reporting surveillance on 4.020.384 newborns. A total of 4.537 hypospadias cases were detected, with a global prevalence of 11.3/10.000 newborns. Trend analyses showed in Chile, Brazil and Uruguay a statistically significant increase in prevalence. Analysis of severity and associated anomalies did not to find an association for distal cases, but did for proximal (RR=1.64 [95% CI=1.33-2.03]).
Conclusion: This is one of only a few Latin American multicenter studies reporting on the epidemiology of hypospadias in South America in the last two decades. Our data adds to evidence suggesting an increase in some countries in the region at different times. There were also variations in prevalence according to severity. This study adds to literature describing associated anomalies at a hospital-based level.
Keywords: Hypospadias; Prevalence; Epidemiology
A new material to prevent urethral damage after implantation of artificial devices: an experimental study
Vol. 43 (2): 335-344, March – April, 2017
Salvador Vilar Correia Lima 1, Marcilio Romero Machado 2, Flávia Cristina Morone Pinto 1, Mariana Montenegro de Melo Lira 3, Amanda Vasconcelos de Albuquerque 4, Eugênio Soares Lustosa 2, Jaiurte Gomes Martins da Silva 1, Olávio Campos Jr. 5
1 Núcleo de Cirurgia Experimental, Programa de Pós-Graduação em Cirurgia do Departamento de Cirurgia do Centro de Ciências da Saúde da Universidade Federal de Pernambuco, UFPE, Brasil; 2 Serviço de Urologia do Hospital das Clínicas, Departamento de Cirurgia do Centro de Ciências da Saúde da Universidade Federal de Pernambuco, UFPE, Brasil; 3 Departamento de Patologia, Centro de Ciências da Saúde da Universidade Federal de Pernambuco, UFPE, Brasil; 4 Departamento de Cirurgia do Centro de Ciências da Saúde da Universidade Federal de Pernambuco, UFPE, Brasil; 5 Departamento de Biologia Aplicada à Saúde, Laboratório de Imunopatologia Keizo Asami (LIKA), Universidade Federal de Pernambuco, UFPE, Brasil
Objective: To validate the application of the bacterial cellulose (BC) membrane as a protecting bar-rier to the urethra.
Materials and Methods: Forty female Wistar rats (four groups of 10): Group 1 (sham), the urethra was dissected as in previous groups and nothing applied around; Group 2, received a 0.7cm strip of the BC applied around the urethra just below the bladder neck; Group 3, received a silicon strip with the same dimensions as in group 2; Group 4, had a combination of 2 and 3 groups being the silicon strip applied over the cellulosic material. Half of the animals in each group were killed at 4 and 8 months. Bladder and urethra were fixed in formalin for histological analysis.
Results: Inflammatory infiltrates were more intense at 4 months at lymphonodes (80% Grade 2), statistically different in the group 2 compared with groups 1 (p=0.0044) and 3 (p=0.0154). At 8 months, all samples were classified as grade 1 indicating a less intense inflammatory reaction in all groups. In group 2, at 8 months, there was a reduction in epithelial thickness (30±1μm) when com-pared to groups 1 (p=0.0001) and 3 (p<0.0001). Angiogenesis was present in groups 2 and 4 and absent in group 3. In BC implant, at 4 and 8 months, it was significant when comparing groups 4 with 1 (p=0.0159).
Conclusion: BC membrane was well integrated to the urethral wall promoting tissue remodeling and strengthening based on morphometric and histological results and may be a future option to prevent urethral damage.
Keywords: Urinary Incontinence; Urethra; ethyl-2-hydroxyethylcellulose [Supplementary Concept]; Polysaccharides, Bacterial; Biocompatible Materials
The effect of tadalafil therapy on kidney damage caused by sepsis in a polymicrobial septic model induced in rats: a biochemical and histopathological study
Vol. 43 (2): 345-355, March – April, 2017
Erdal Benli 1, Sema Nur Ayyildiz 2, Selma Cirrik 3, Sibel Koktürk 4, Abdullah Cirakoglu 1, Tevfik Noyan 2, Ali Ayyildiz 1, Cankon Germiyanoglu 5
1 Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey; 2 Department of Biochemistry, Faculty of Medicine, Ordu University, Ordu, Turkey; 3 Department of Physiology, Faculty of Medicine, Ordu University, Ordu, Turkey; 4 Department of Histolology, Faculty of Medicine, Ordu University, Ordu, Turkey; 5 Department of Urology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
Introduction: Sepsis is an inflammatory reaction to bacteria involving the whole body and is a significant cause of mortality and economic costs. The purpose of this research was to determine whether tadalafil exhibits a preventive effect on sepsis in a septic model induced in rats with cecal ligation and puncture (CLP).
Materials and Methods: Rats were randomly separated into groups, 10 rats in each: (i) a sham (control) group, (ii) an untreated sepsis group, (iii) a sepsis group treated with 5mg/kg tadalafil and (iv) a sepsis group treated with 10mg/kg tadalafil. A polymicrobial sepsis model was induced in rats using CLP. Rats were sacrificed after 16h, and blood and kidney tissues were collected for biochemical and histopathological study.
Results: Levels of the inflammatory parameter IL-6 decreased significantly in the sepsis groups receiving tadalafil in comparison with the untreated sepsis group (p<0.05). In terms of histopathology, inflammation scores investigated in kidney tissues decreased significantly in the sepsis groups receiving tadalafil compared to the untreated sepsis group (p<0.05). In addition, levels of creatinine and cystatin C measured in septic rats receiving tadalafil were lower by a clear degree than in septic rats (p<0.05).
Conclusion: In this study, tadalafil exhibited a preventive effect for sepsis-related damage by suppressing inflammation in serum and kidney tissue of septic rats in a polymicrobial sepsis model induced with CLP.
Keywords: Acute Kidney Injury; Tadalafil; Kidney Failure, Chronic; Renal Insufficiency
Vol. 43 (2): 356-366, March – April, 2017
Marcy Lancia Pereira 1, Carlos Arturo Levi D’ancona 2, Julio Alejandro Rojas-Moscoso 3, Antonio Celso Saragossa Ramos Filho 3, Fabiola Zakia Mónica 3, Edson Antunes 3
1 Departamento de Cirurgia, Faculdade de Ciências Médicas – UNICAMP, Campinas, SP, Brasil; 2 Departamento de Urologia, Faculdade de Ciências Médicas – UNICAMP, Campinas, SP, Brasil; 3 Departamento de Farmacologia, Faculdade de Ciências Médicas – UNICAMP, Campinas, SP, Brasil
Purpose: To investigate the lower urinary tract changes in mice treated with L-NAME, a non-selective competitive inhibitor of nitric oxide synthase (NOS), or aminoguanidine, a competitive inhibitor of inducible nitric oxide synthase (iNOS), after 5 weeks of partial bladder outlet obstruction (BOO), in order to evaluate the role of constitutive and non-constitutive NOS in the pathogenesis of this experimental condition.
Materials and Methods: C57BL6 male mice were partially obstructed and randomly allocated into 6 groups: Sham, Sham + L-NAME, Sham + aminoguanidine, BOO, BOO + L-NAME and BOO + aminoguanidine. After 5 weeks, bladder weight was obtained and cystometry and tissue bath contractile studies were performed.
Results: BOO animals showed increase of non-voiding contractions (NVC) and bladder capacity, and also less contractile response to Carbachol and Electric Field Stimulation.
Inhibition of NOS isoforms improved bladder capacity and compliance in BOO animals.
L-NAME caused more NVC, prevented bladder weight gain and leaded to augmented contractile responses at muscarinic and electric stimulation. Aminoguanidine diminished NVC, but did not avoid bladder weight gain in BOO animals and did not improve contractile responses.
Conclusion: It can be hypothesized that chronic inhibition of three NOS isoforms in BOO animals leaded to worsening of bladder function, while selective inhibition of iNOS did not improve responses, what suggests that, in BOO animals, alterations are related to constitutive NOS.
Keywords: NG-Nitroarginine Methyl Ester; Nitric Oxide; Urinary Bladder; Ureteral Obstruction
Vol. 43 (2): 367-370, March – April, 2017
CHALLENGING CLINICAL CASES
Sedat Yahsi 1, Senol Tonyali 1, Cavit Ceylan 1, Kenan Y. Yildiz 1, Levent Ozdal 1
1 Turkey Yuksek Ihtisas Training and Research Hospital, Urology Clinic, Ankara, Turkey
A 34 year-old woman was admitted to our hospital with left flank pain. A non-contrast enhanced computerized tomography (NCCT) revealed a 1.5x2cm left proximal ureter stone. Patient was scheduled for ureterorenoscopy (URS) and stone removal. She was submitted to retrograde intrarenal surgery (RIRS). At the postoperative 1st day, the patient began to suffer from left flank pain. A NCCT was taken, which revealed a subcapsular hematoma and perirenal fluid. The patient was managed conservatively with intravenous fluid, antibiotic and non-steroidal anti-inflammatory drug therapy and was discharged at the postoperative 6th day. Two weeks after the discharge the patient was admitted to emergency department with severe left flank pain, palpitation and malaise. KUB (kidney-ureter-bladder) radiography showed double-J stent (DJS) to be repositioned to the proximal ureter. Patient was evaluated with contrast enhanced CT which revealed an 8cm intraparenchymal hematoma/abscess in the middle part of the kidney. A percutaneous drainage catheter was inserted into the collection. The percutaneous drainage catheter and the DJS were removed at the 10th day of second hospitalization. RIRS surgery is an effective and feasible choice for renal stones with high success and acceptable complication rates. However, clinician should be alert to possible complications.
Keywords: Hematoma; Intrarenal Surgery; RIRS; urolithiasis; computed tomography
Vol. 43 (2): 371-372, March – April, 2017
Rajat Arora 1, Arun Jacob Philip George 1, Anu Eapen 2, Antony Devasia 1
1 Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India; 2 Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
No abstract available
Vol. 43 (2): 373-373, March – April, 2017
Fernando Korkes 1, Marcel Silveira 2, Oseas Castro Neves-Neto 2, Luiz Franco Brandão 1, Marcos Tobias-Machado 2, Nelson Wolosker 3, Felipe Nasser 4, Alexandre Maurano 5
1 Serviço de Urologia, Hospital Israelita Albert Einstein, SP, Brasil; 2 Departamento de Urologia, Faculdade de Medicina ABC, SP, Brasil; 3 Serviço de Cirurgia Vascular, Hospital Israelita Albert Einstein, SP, Brasil; 4 Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein; 5 Departamento de Radiologia, Hospital Israelita Albert Einstein
Nutcracker syndrome refers to the complex of clinical symptoms caused by the compression of the left renal vein (LRV) between the abdominal aorta and the superior mesenteric artery, leading to stenosis of the aortomesenteric portion of the LRV and dilatation of the distal portion. Hematuria, proteinuria, flank pain, varicocele and pelvic congestion may occur, occurring more frequently in young adults. Conservative management, might be the option whenever it is possible.
When surgical treatment is required, classically open surgery have been performed, with major surgeries as LRV transposition or bypass techniques. The main caveats regards the fact that these are large and risky surgeries. Endovascular surgery with venous stent placement has gained some space as it is minimally invasive alternative. However, venous stents are associated with a high number of trombotic complications and in many cases requirement of life-long anticoagulants. External stenting of the LRV with this “shield technique” is a minimally invasive alternative, with good medium term results. We herein demonstrate our second experience with the technique of this surgery in a patient with 12 months.
Robotic pyelolithotomy in a congenital pelvic kidney: side docking and robotic prostatectomy port – site approach
Vol. 43 (2): 374-374, March – April, 2017
Rawan Al-Yousef 1, Ahmad Almarzouq 2, Saad Aldousari 3
1 Faculty of Medicine, Kuwait University, Kwait; 2 Urology Unit, Department of Surgery, Mubarak Alkabir Hospital, Kuwait; 3 Urology Unit, Department of Surgery, Faculty of Medicine, Kuwait University, Kwait
Introduction and Objectives: Ectopic pelvic kidneys with renal stones are challenging to treat. We report our experience in managing a case of ectopic pelvic kidney with a pelvic stone by robotic pyelolithotomy after failure of flexible ureteroscopy.
Materials and Methods: A 46-year old male with 2 months history of vague lower abdominal pain was found to have on Computed Tomography scan a left ectopic pelvic kidney with a 12mm stone in an anomalous renal pelvis. Flexible ureteroscopy failed to reach the stone twice and a 4.7 French ureteric stent was placed.
Results: Side docking was utilized with the patient in supine Trendelenburg position. Port placements were similar to robotic assisted laparoscopic prostatectomy. Docking time was 35 minutes and console time was 150 minutes. Multiple attempts failed to follow the course of the ureter to the renal pelvis. Subsequently the renal pelvis was directly opened through the mesocolon and a flexible cystoscope was used to basket the stone out. Estimated Blood Loss was <100ml. The patient was discharged 2 days postoperatively.
Conclusion: Robotic pyelolithotomy is safe and feasible for management of ectopic pelvic kidneys with pelvic stones. The use of flexible cystoscopy helped in localizing and extracting the stone in our case. Detailed understanding of patient’s anatomy helps in the success of this procedure.
Vol. 43 (2): 375-375, March – April, 2017
Paulo Renato Marcelo Moscardi 1, Roberto Iglesias Lopes 1, Marcos Figueiredo Mello 1, Cristovao Machado Barbosa Neto 1, Bruno Nicolino Cezarino 1, Lorena Marçalo Oliveira 1, Francisco Tibor Dénes 1, Miguel Srougi 1
1 Divisão de Urologia do Departamento de Cirurgia, Universidade de São Paulo, SP, Brasil
Introduction: Horseshoe kidney occurs in 1 per 400-800 live births and are more frequently observed in males (M:F 2:1). Ureteropelvic junction obstruction (UPJO) is commonly associated with horseshoe kidneys. The variable blood supply, presence of the isthmus and high insertion of the ureter contribute to this problem.
Case report: An asymptomatic 6 year-old boy presented with antenatal hydronephrosis. Ultrasonography and CT scan demonstrated left UPJO associated with a horseshoe kidney.
DMSA showed 33% of function on the left side. DTPA showed a flat curve and lack of washout. A left dismembered laparoscopic pyeloplasty was performed after identification of crossing vessels and abnormal implantation of the ureter. After one year, the child is asymptomatic. DTPA demonstrated a good washout curve.
Results: Our cohort consisted of six patients, five males and one female, with a mean age of 6 years (range 6m-17 years) and a mean follow-up of 3 years. Ureteropelvic junction obstruction was more common on the left side. Symptoms appeared only in 34% of the cases.
Mean operative time was 198 minutes (range 120-270 minutes). Crossing vessels were common (observed in 50% patients). High implantation of ureter was seen in 67% patients and intrinsic obstruction in 83%. Surgical difficulties were found in two cases. Hospital stay was 4.3 days (3 to 6 days), with only one patient having a mild complication (pyelonephritis). All cases had clinical and radiologic improvement.
Conclusion: Laparoscopic pyeloplasty is safe and feasible in children with UPJO in horseshoe kidneys, with good results and minimal morbidity.