Vol. 43 n. 3 May . June, 2017

Volume 43 | number 3 | May . June, 2017 – The May-June 2017 issue of the International Braz J Urol presents original contributions with a lot of interesting papers in different fields: Erectile Dysfunction…

Kidney anatomy: three dimensional (3D) printed pelvicalyceal system models of the collector system improve the diagnosis and treatment of stone disease

Vol. 43 (3): 381-382, May – June, 2017

doi: 10.1590/S1677-5538.2017.03.01

EDITORIAL in this Issue

Luciano A. Favorito
Professor Associado da Unidade de Pesquisa Urogenital da
Universidade do Estado de Rio de Janeiro
Urologista do Hospital da Lagoa Federal, Rio de Janeiro
Editor Associado da International Braz J Urol


The May-June 2017 issue of the International Braz J Urol presents original contributions with a lot of interesting papers in different fields: Erectile Dysfunction, Renal Stones, Prostate Cancer, Renal Cell Carcinoma, Prostate Biopsy, Ureteroscopy, Hemorragic Cystitis, Retrograde Ejaculation, Intermittent Urethral Catheterization, Ureteropelvic Junction Obstruction, Laparoscopy, Vaginal Prolapse, BPH, Vesicoureteral and Renal Anomalies. Papers came from many different countries such as Brazil, USA, UK, Turkey, Korea, France, Taiwan, Greece, China, Italy, Germany, Israel and India, and as usual the editor’s comment highlights some papers. We decided to comment the paper about a very interesting topic: The use of pelvicalyceal system models in percutaneous nephrolithotripsy surgery.

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PRISMA statement and PROSPERO

Vol. 43 (3): 383-384, May – June, 2017

doi: 10.1590/S1677-5538.2017.03.02


Wanderley Marques Bernardo
Faculdade de Medicina da Universidade de São Paulo (FMUSP),
Projeto Diretrizes – Associação Médica Brasileira (AMB),
São Paulo, SP, Brasil


Independent of who made the first Review in health literature, it is possible to state that the development of the fundamental concepts on Systematic Review and Meta-analysis is attributable to the Cochrane initiative, that signalized the need to gather scientific evidence based on the opinion of medical specialists (1). It is necessary to periodically organize a synthesis, by specialty, of all relevant randomized clinical trials, which stimulated, in 1993, the creation of collaboration, which has been at the forefront of the methodology and in the rigorous systematic review.

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PDE-5 inhibitors should be used post radical prostatectomy as erection function rehabilitation? | Opinion: Yes

Vol. 43 (3): 385-389, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2017.03.03


Laith M. Alzweri 1, Arthur L. Burnett 1
1 The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, USA

Keywords: Phosphodiesterase 5 Inhibitors; Erectile Dysfunction; Penile Erection; Prostatectomy


Despite significant improvement in surgical techniques of radical prostatectomy (RP) since the nerve-sparing approach was introduced in 1982 (1), erectile dysfunction (ED) post RP remains a challenge for patients and urologists (2). Although most patients experience some degree of ED post RP, erectile function recovery rates vary according to age, baseline erectile function, comorbidities, and extent of nerve-sparing techniques (3, 4). The concept of penile rehabilitation has been evolving over the last two decades, in parallel with a better understanding of the basic scientific basis for ED post RP. In a recent systematic review of 11 randomized, controlled clinical trials (RCTs) on erection rehabilitation post RP in general, there was no significant improvement in spontaneous erectile function (unassisted by erection aids) rate of 20-25%. This rate was obtained from data in the control arm of trials after nerve sparing radical prostatectomy (NSRP) over the last two decades (5).

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PDE-5 inhibitors should be used post radical prostatectomy as erection function rehabilitation? | Opinion: No

Vol. 43 (3): 390-393, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2017.03.04

Jonathan Clavell-Hernández 1, Run Wang 1,2
1 Division of Urology, Department of Surgery, University of Texas Medical School at Houston, Houston, Texas, USA; 2 University of Texas, MD Anderson Cancer Center, Houston, Texas, USA

Keywords: Phosphodiesterase 5 Inhibitors; Erectile Dysfunction; Penile Erection; Prostatectomy


The advancement and refinement in prostate cancer detection and treatment modalities have contributed to a younger patient population undergoing radical prostatectomy (RP) (1). Although it is effective in treating prostate cancer, radical prostatectomy has also been shown to compromise erectile function (EF), and therefore the patient’s quality of life and general well being (2). Alemozaffar et al. (3) attempted to predict erectile function after prostate cancer patients undergoing RP, external radiotherapy and brachytherapy. Pretreatment sexual health related quality of life score, age, serum prostate-specific antigen level, race/ethnicity, body mass index and intended treatment details were associated with functional erections 2 years after treatment. They found that 48% of patients (n=1027) with functional erections prior to treatment reported erectile dysfunction 2 years after treatment. In the prostatectomy cohort, 60% of patients with prior functional erections reported erectile dysfunction, along with 42% and 37% of the external radiotherapy and brachytherapy cohorts, respectively. The Prostate Cancer Outcomes study revealed 60% of men experienced self-reported erectile dysfunction 18 months after radical prostatectomy, and only 28% of men reported erections firm enough for intercourse at a 5-year follow-up (4). Many urologists believe more patients would be willing to undergo surgical treatment if it were not for the possibility of developing postoperative ED (2).

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Analgesia for patients undergoing shockwave lithotripsy for urinary stones – a systematic review and meta-analysis

Vol. 43 (3): 394-406, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0078


Omar M Aboumarzouk 1, Rami Hasan 2, Ali Tasleem 2, Martin Mariappan 2, Rachael Hutton 3, John Fitzpatrick 3, Laura Beatty 3, Gareth E Jones 2, Tarik Amer 2
1 North Bristol NHS Trust, United Kingdom; 2 NHS Greater Glasgow and Clyde, United Kingdom; 3 Ayr University Hospital, United Kingdom


Background: Shock wave lithotripsy (SWL) is the first line treatment modality for a significant proportion of patients with upper urinary tracts stones. Simple analgesics, opioids and non-steroidal anti-inflammatory drugs (NSAIDs) are all suitable agents but the relative efficacy and tolerability of these agents is uncertain.

Objectives: To determine the efficacy of the different types of analgesics used for the control of pain during SWL for urinary stones.

Materials and Methods: We searched the Cochrane Renal Group’s Specialised Register, MEDLINE, EMBASE and also hand-searched reference lists of relevant articles (Fig­ure-1). Randomised controlled trials (RCT’s) comparing the use of any opioid, simple analgesic or NSAID during SWL were included. These were compared with themselves, each-other or placebo. We included any route or form of administration (bolus, PCA). We excluded agents that were used for their sedative qualities. Data were extracted and assessed for quality independently by three reviewers. Meta-analyses have been performed where possible. When not possible, descriptive analyses of variables were performed. Dichotomous outcomes are reported as relative risk (RR) and measurements on continuous scales are reported as weighted mean differences (WMD) with 95% confidence intervals.

Keywords: Calculi; Lithotripsy; Urinary Tract

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First brazilian consensus of advanced prostate cancer: recommendations for clinical practice

Vol. 43 (3): 407-415, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0490


Andre Deeke Sasse 1, Evanius Garcia Wiermann 2, Daniel Herchenhorn 3, Diogo Assed Bastos 4, 5, Fabio A. Schutz 6, Fernando Cotait Maluf 6, 7, George Coura Filho 8, Igor Alexandre Protzner Morbeck 9, Juliano J. Cerci 10, Oren Smaletz 7, Volney Soares Lima 11, Ari Adamy Jr. 12, Franz Santos de Campos 3, Gustavo Franco Carvalhal 13, Leandro Casemiro Cezar 14, Marcos Francisco Dall´Oglio 15, Marcus Vinicius Sadi 16, Rodolfo Borges dos Reis 17, Lucas Nogueira 18
 1 Clínica Médica, Unicamp, Campinas, SP, Brasil; 2 Sociedade Brasileira de Oncologia Clinica, Belo Horizonte, MG, Brasil; 3 Instituto Nacional do Câncer, INCA, Rio de Janeiro, RJ, Brasil; 4 Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brasil; 5 Departamento de Oncologia, Hospital Sirio-Libanes, São Paulo, SP, Brasil; 6 Beneficiência Portuguesa de São Paulo, São Paulo, SP, Brasil; 7 Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; 8 Instituto do Câncer, Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil; 9 Universidade Católica de Brasilia, Taguatinga, DF, Brasil; 10 Universidade de São Paulo, USP, São Paulo, SP, Brasil; 11 Oncocentro, Belo Horizonte, MG, Brasil; 12 Departamento de Urologia, Hospital Santa Casa, Curitiba, PR, Brasil; 13 Departamento de Cirurgia e Departamento de Urologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil; 14 Hospital Federal Cardoso Fontes, Rio de Janeiro, RJ, Brasil; 15 Departamento de Urologia, Universidade de São Paulo, USP, São Paulo, SP, Brasil; 16 Universidade Federal de São Paulo, São Paulo, SP, Brasil; 17 Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil; 18 Departamento de Urologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte. MG, Brasil


Introduction: Prostate cancer still represents a major cause of morbidity, and still about 20% of men with the disease are diagnosed or will progress to the advanced stage with­out the possibility of curative treatment. Despite the recent advances in scientific and technological knowledge and the availability of new therapies, there is still considerable heterogeneity in the therapeutic approaches for metastatic prostate cancer.

Objectives: This article presents a summary of the I Brazilian Consensus on Advanced Prostate Cancer, conducted by the Brazilian Society of Urology and Brazilian Society of Clinical Oncology.

Materials and Methods: Experts were selected by the medical societies involved. Forty issues regarding controversial issues in advanced disease were previously elaborated. The panel met for consensus, with a threshold established for 2/3 of the participants.

Results and Conclusions: The treatment of advanced prostate cancer is complex, due to the existence of a large number of therapies, with different response profiles and toxici­ties. The panel addressed recommendations on preferred choice of therapies, indicators that would justify their change, and indicated some strategies for better sequencing of treatment in order to maximize the potential for disease control with the available therapeutic arsenal. The lack of consensus on some topics clearly indicates the absence of strong evidence for some decisions.

Keywords:  Prostatic Neoplasms; Practice Guideline [Publication Type]; Diagnosis

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Metastatic prostate cancer in the modern era of PSA screening

Vol. 43 (3): 416-421, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0340


Philip A. Fontenot Jr. 1, Avinash Nehra 1, William Parker 1, Hadley Wyre 1, Moben Mirza 1, David A. Duchene 1, Jeffrey Holzbeierlein 1, James Brantley Thrasher 1, Peter Van Veldhuizen 2, Eugene K. Lee 1
1 Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA; 2 Division of Hematology/Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA


Introduction: To characterize initial presentation and PSA screening status in a con­temporary cohort of men treated for metastatic prostate cancer at our institution.

Materials and methods: We reviewed records of 160 men treated for metastatic prostate cancer between 2008-2014 and assessed initial presentation, categorizing patients into four groups. Groups 1 and 2 presented with localized disease and received treatment. These men suffered biochemical recurrence late (>1 year) or earlier (<1 year), respec­tively, and developed metastases. Groups 3 and 4 had asymptomatic and symptom­atic metastases at the outset of their diagnosis. Patients with a first PSA at age 55 or younger were considered to have guideline-directed screening.

Results: Complete records were available on 157 men for initial presentation and 155 men for PSA screening. Groups 1, 2, 3 and 4 included 27 (17%), 7 (5%), 69 (44%) and 54 (34%) patients, respectively. Twenty (13%) patients received guideline-directed PSA screening, 5/155 (3%) patients presented with metastases prior to age 55 with their first PSA, and 130/155 (84%) had their first PSA after age 55, of which 122/130 (94%) had metastasis at the time of diagnosis.

Conclusion: Despite widespread screening, most men treated for metastatic prostate cancer at our institution presented with metastases rather than progressed after defini­tive treatment. Furthermore, 25 (16%) patients received guideline-directed PSA screen­ing at or before age 55. These data highlight that, despite mass screening efforts, patients treated for incurable disease at our institution may not have been a result of a failed screening test, but a failure to be screened.

Keywords: Prostate-Specific Antigen; Neoplasms; Prostate

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Predicting outcomes in partial nephrectomy: is the renal score useful?

Vol. 43 (3): 422-431, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0315


André Costa Matos 1, Marcos F. Dall´Oglio 2, José Roberto Colombo Jr. 2, 3, Alexandre Crippa 4, João A. Q. Juveniz 2, Felipe Coelho Argolo 1
1 Hospital São Rafael, Salvador, BA, Brasil; 2 Departamento de Urologia, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil; 3 Departamento de Uro-Oncologia,Instituto do Câncer do Estado de São Paulo, SP, Brasil; 4 Serviço de Urologia, Hospital do Servidor Público Municipal de São Paulo – HSPM, SP, Brasil


Introduction and Objective: The R.E.N.A.L. nephrometry system (RNS) has been validated in multiple open, laparoscopic and robotic partial nephrectomy series. The aim of this study was to test the accuracy of R.E.N.A.L. nephrometry system in predicting periop­erative outcomes in surgical treatment of kidney tumors <7.0cm in a prospective model.

Materials and Methods: Seventy-one patients were selected and included in this pro­spective study. We evaluate the accuracy of RNS in predicting perioperative outcomes (WIT, OT, EBL, LOS, conversion, complications and surgical margins) in partial nephrec­tomy using ROC curves, univariate and multivariate analyses. R.E.N.A.L. was divided in 3 groups: low complexity (LC), medium complexity (MC) and high complexity (HC).

Results: No patients in LC group had WIT >20 min, versus 41.4% and 64.3% MC and HC groups respectively (p=0.03); AUC=0.643 (p=0.07). RNS was associated with conver­tion rate (LC:28.6% ; MC:47.6%; HC:77.3%, p=0.02). Patients with RNS <8 were most often subjected to partial nephrectomy (93% x 72%, p=0.03) and laparoscopic partial nephrectomy (56.8% x 28%, p=0.02), AUC=0.715 (p=0.002). The RNS was also as­sociated with operative time. Patients with a score >8 had 6.06 times greater chance of having a surgery duration >180 min. (p=0.017), AUC=0.63 (p=0.059). R.E.N.A.L. score did not correlate with EBL, complications (Clavien >3), LOS or positive surgical margin.

Conclusion: R.E.N.A.L. score was a good method in predicting surgical access route and type of nephrectomy. Also was associated with OT and WIT, but with weak accuracy. Al­though, RNS was not associated with Clavien >3, EBL, LOS or positive surgical margin.

Keywords:  Nephrectomy; Operative Time; Patients

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Validation of preoperative variables and stratification of patients to help predict benefit of cytoreductive nephrectomy in the targeted therapy ERA

Vol. 43 (3): 432-439, May – June, 2017]

doi: 10.1590/S1677-5538.IBJU.2015.0118


Brandon J. Manley 1, Eric H. Kim 1, Joel M. Vetter 1, Aaron M. Potretzke 1, Seth A. Strope 1
1 Washington University School of Medicine, Division of Urology, St. Louis, Missouri, USA




Objectives: To further elucidate which patients with metastatic renal cell carcinoma (mRCC) may benefit from cytoreductive nephrectomy (CN) before targeted therapy (TT), and to assess the overall survival of patients undergoing CN and TT versus TT alone.

Materials and Methods: We identified 88 patients who underwent CN at our institu­tion prior to planned TT and 35 patients who received TT without undergoing CN. Preoperative risk factors described in the literature were assessed in our patient popu­lation (serum albumin, liver metastasis, symptomatic metastasis, clinical ≥T3 disease, retroperitoneal and supradiaphragmatic lymphadenopathy). Patients were stratified by number of pretreatment risk factors and overall survival (OS) was compared.

Results: TT patients had significantly more risk factors compared to CN patients (3.06 vs. 2.11, p<0.01). Patients who received TT alone had median OS of 5.8 months. All but one patient receiving TT alone had two or more risk factors. A comparison of the CN and TT groups was performed by constructing Kaplan-Meier curves. There was no significant difference in median OS for those patients with exactly two risk factors (447 vs. 389 days, p=0.24), and those with three or more risk factors (184 vs. 155 days, p=0.87).

Conclusions: Using previously described pretreatment risk factors we found that patients with two or more risk factors derived no significant survival advantage from CN in the TT era. These risk factors should be incorporated in the assessment of patients for CN.

Keywords: Carcinoma, Renal Cell; Kidney Neoplasms; Nephrectomy; Risk Factors; Comorbidity

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Analysis of various potential prognostic markers and survival data in clear cell renal cell carcinoma

Vol. 43 (3): 440-454, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2015.0521


Tastekin Ebru 1, Oz Puyan Fulya 1, Akdere Hakan 2, Yurut-Caloglu Vuslat 3, Sut Necdet 4, Can Nuray 1, Ozyilmaz Filiz 1
1 Department of Pathology, Faculty of Medicine, Trakya University, Edirne, Turkey; 2 Department of Urology, Faculty of Medicine, Trakya University, Edirne, Turkey; 3 Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey; 4 Department of Biostatistics, Faculty of Medicine, Trakya University, Edirne, Turkey



Purpose: Clear cell renal cell cancers frequently harbor Von Hippel-Lindau gene mutations, leading to stabilization of the hypoxia-inducible factors (HIFs) and their target genes. In this study, we investigated the relationship between vascular endotelial growth factor (VEGF), HIF-1α, HIF-2α, p53 positivity, microvessel density, and Ki-67 rates with prognostic histopathologic factors (Fuhrman nuclear grade, stage, and sarcomatoid differentiation) and survival in clear cell renal cell carcinomas.

Material and Methods: Seventy-two nephrectomy specimens diagnosed as clear cell renal cell carcinoma between 2000 and 2012 were reevaluated. Immunohistochemically VEGF, HIF-1α, HIF-2α, p53, CD34 (for microvessel density evaluation), and Ki-67 antibodies were applied to the tumor areas. The relationships of these antibodies with prognostic factors and survival rates were evaluated with statistical analyses.

Results: Mean survival time was 105.6 months in patients with ccRCC. Patients with high expression of VEGF, HIF-1α and HIF-2α positivity, a high Ki-67 proliferation index, and a high microvessel density evaluation score had a shorter survival time (p<0.05).

Conclusions: Our findings supported that with the use of these immunohistochemical markers, prognosis of renal cell carcinoma may be predicted at the first step of patient management. New treatment modalities targeted to HIF-1α and HIF-2α might be planned as well as VEGF-targeted therapies in the management of clear cell renal cell carcinomas.

Keywords: Carcinoma; Carcinoma, Renal Cell; Survival Rate

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The change in serum Thiol/Disulphide homeostasis after transrectal ultrasound guided prostate biopsy

Vol. 43 (3): 455-461, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0114


Hüsnü Tokgöz 1, Selim Taş 1, Özlem Giray 2, Soner Yalçınkaya 1, Özlem Tokgöz 3, Cemile Koca 4, Murat Savaş 1, Özcan Erel 4
1 Department of Urology, Antalya Training and Research Hospital, Antalya, Turkey; 2 Department of Biochemistry,  Antalya Training and Research Hospital, Antalya, Turkey; 3 Department of Radiology, Antalya Training and Research Hospital, Antalya, Turkey; 4 Department of Biochemistry, Yildirim Beyazit University, School of Medicine, Ankara, Turkey




Objectives: The aim of this prospective clinical study was to investigate variations in a novel oxidative stress marker (thiol/disulphide homeostasis) in men who underwent transrectal ultrasound guided prostate biopsy (TRUSB).

Materials and Methods: A total of 22 men undergoing TRUSB of the prostate were enrolled in the study. Patients with abnormal digital rectal examination and/or total prostate specific antigen (PSA) over 4ng/mL underwent TRUSB with 12 cores. Serum samples were obtained before and just after the procedure to evaluate the possible changes in thiol/disulphide homeostasis. Mean age, total PSA and free PSA, prostate volume and histopathological data were also recorded.

Results: Mean age of the study population was 65.05±8.89 years. Significant decreases in native and total thiol levels were documented after the biopsy procedure. However, serum disulphide levels and disulphide/native thiol, disulphide/total thiol and native/ total thiol ratios did not significantly change after TRUSB. No correlation was observed between oxidative parameters and total PSA and free PSA levels, prostate volume and histopathology of the prostate. However, mean patient age was significantly correlated with mean native and total thiol levels.

Conclusion: Significant decreases in serum native and total thiol levels related to the prostate biopsy procedure suggest that TRUSB causes acute oxidative stress in the human body. Since our trial is the first in the current literature to investigate these oxidative stress markers in urology practice, additional studies are warranted.

Keywords: Biopsy; Prostate; Oxidative Stress; Ultrasonography

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Lateral decubitus position vs. lithotomy position: which is the best way to minimize patient’s pain perception during transrectal prostate biopsy?

Vol. 43 (3): 462-469, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2015.0479


Phil Hyun Song 1, Young Hwii Ko 1
1 Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea


Introduction: Considering the distinctive nature in terms of psychological stress and anal tone of position which is generally selected between lithotomy and left lateral decubitus (LLD), we postulated its effect on pain perception during biopsy, and investigated their association.

Materials and Methods: A prospective study for comparison of two biopsy positions which were perform in a different working day was conducted for 208 men (lithotomy position=86, LLD=122). The decision on the position was made solely based on the patient’s preference for the biopsy day, and all procedures were performed according to the identical protocol (12-core biopsy with intrarectal lidocaine gel), probe, and needle.

The maximal degree of pain during the entire process was assessed using a visual analogue scale (VAS), immediately after biopsy. After propensity matching, a total of 152 patients were finally selected (lithotomy group=76, LLD=76), then peri-biopsy parameters were compared.

Results: Between groups, no differences were observed across all variables including age, obesity, prostate volume, serum PSA, international prostate symptom score, and cancer detection rate, except mean (±standard deviation) VAS score (3.89±2.01 vs. 4.58±2.22, p=0.049). VAS score showed significant association solely with patient’s position (Pearson’s coefficient=-0.165, p=0.042). In multiple linear regression models regarding the effect of clinical variables on VAS score, patient position was a single independent predictor favoring lithotomy position to decrease perceived pain (B=-0.928, p=0.024).

Conclusions: These data suggest lithotomy position as a proper way to perform transrectal prostate biopsy with routine use of topical lidocaine gel in comparison with conventional LLD position.

 Keywords: Pain measurement, Patient positioning, Biopsy

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Impact of personalized three-dimensional (3D) printed pelvicalyceal system models on patient information in percutaneous nephrolithotripsy surgery: a pilot study

Vol. 43 (3): 470-475, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0441


Hasan Anil Atalay 1, H. Lütfi Canat 1, Volkan Ülker 2, İlter Alkan 1, Ünsal Özkuvanci 3, Fatih Altunrende 1
1 Department of Urology, Okmeydani Training and Research Hospital, Sisli, Istanbul, Turkey; 2 Department of Urology, İzmir Tepecik Training and Research Hospital, Izmir, Istanbul, Turkey; 3 Department of Urology, Istanbul Medical School, Çapa, Istanbul, Turkey


Objective: To investigate the impact of personalized three dimensional (3D) printed pelvicalyceal system models on patient information before percutaneous nephrolithotripsy surgery.

Material and Methods: Patients with unilateral complex renal stones with indicatation of percutaneous nephrolithotripsy surgery were selected. Usable data of patients were obtained from CT scans as Digital Imaging and Communications in Medicine (DICOM) format.

Mimics software version 16.0 (Materialise, Belgium) was used for segmentation and extraction of pelvicalyceal systems. DICOM format were converted to Stereolithography file format. Finally, fused deposition modeling was used to create plasticine 3D models of pelvicalyceal systems. A questionnaire was designed for patients to assess personalized 3D models effect on patient’s understanding their conditions before percutaneous nephrolithotripsy surgery (PCNL). The day before surgery, each patient was seen by a urologist to deliver information about surgery. Questionnaire forms were asked to patients complete before and after presentation of 3D models and the results of the questions were compared.

Results: Five patient’s anatomically accurate models of the human renal collecting system were successfully generated. After the 3D printed model presentation, patients demonstrated an improvement in their understanding of basic kidney anatomy by 60% (p=0.017), kidney stone position by 50% (p=0.02), the planned surgical procedure by 60% (p=0.017), and understanding the complications related to the surgery by 64% (p=0.015). In addition, overall satisfaction of conservation improvement was 50% (p=0.02).

Conclusion: Generating kidney models of PCSs using 3D printing technology is feasible, and understandings of the disease and the surgical procedure from patients were well appreciated with this novel technology.

Keywords: Calculi; Technology; Lithotripsy

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Evaluation of the Spies™ modalities image quality

Vol. 43 (3): 476-480, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0324


Esteban Emiliani 1, Michele Talso 1, Mohammed Baghdadi 1, Aarón Barreiro 1, Andrea Orosa 1, Pol Serviàn 1, Pavel Gavrilov 1, Silvia Proietti 1, Olivier Traxer 1,2
1 Department of Urology, Hôpital Tenon, Université Pierre et Marie Curie – Paris VI, Paris, France; 2 GRC lithiase (Grouped Recherche Clinique) Université Paris VI, Pierre et Marie Curie, Paris, France



Introduction: The Spies™ system (Karl-Storz®) was introduced into digital ureteroscopy to improve endoscopic vision. To date, there is no data to either indicate which of the Spies modalities is better for improving diagnosis and treatment procedures, nor to compare the modalities in terms of image quality. The aim of this study was to evaluate and compare the image quality of five Spies™ modalities (SM) to the standard white light in an in-vitro model.

Materials and Methods: Two standardized grids and 3 stones of different composition were recorded in white light and the 5SM (Clara, Chroma, Clara+Chroma), Spectra A and B) using 4 standardized aqueous scenarios. Twelve templates were done in order to simultaneously compare the same objective in the different modalities. Six urologists, five medical students, five urology residents, and five persons not involved with urol­ogy evaluated each video on a scale of 1 (very bad) to 5 (very good).

Results: Comparing white light to SM, subjects scored better the quality of Clara and Clara+Chroma than white light (p=0.0139 and p<0.05) and scored worse Spectra A and B (p=0.0005 and p=0.0023)). When comparing Clara to the other SM, it was ranked equivalent to Clara+Chroma (p=0.67) and obtained a higher rank than Chroma, Spectra A and B (p<0.05, p=0.0001 and p=0.0001). In the multivariate analysis mean scores were higher among urologists.

Conclusion: In all analyzed scenarios, the subjects ranked Clara and Clara+Chroma as the modalities with better image quality compared to white light.

 Keywords: Ureteroscopy; Diagnosis; Lithotripsy; Technology

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Emergency percutaneous nephrostomy versus emergency percutaneous nephrolithotomy in patients with sepsis associated with large uretero-pelvic junction stone impaction: a randomized controlled trial

Vol. 43 (3): 481-488, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2015.0643


Chi-Sen Hsu 1, Chung-Jing Wang 2, Chien-Hsing Chang 2, Po-Chao Tsai 2, Hung-Wen Chen 3, Yi- Chun Su 3
1 Department of Infection, Saint Martin De Porres Hospital, Chiayi, Taiwan, R.O.C.; 2 Division of Urology, Department of Surgery, Saint Martin De Porres Hospital, Chiayi, Taiwan, R.O.C.; 3 Department of Emergency, Saint Martin De Porres Hospital, Chiayi, Taiwan, R.O.C.


Introduction: A randomized trial was conducted prospectively to evaluate the efficacy, related complications, and convalescence of emergency percutaneous nephrolithotomy compared to percutaneous nephrostomy for decompression of the collecting system in cases of sepsis associated with large uretero-pelvic junction stone impaction.

Materials and Methods: The inclusion criteria included a WBC count of 10.000/mm3 or more and/or a temperature of 38°C or higher. Besides, all enrolled patients should maintain stable hemodynamic status and proper organ perfusions. A total of 113 pa­tients with large, obstructive uretero-pelvic junction stones and clinical signs of sepsis completed the study protocol. Of those, 56 patients were placed in the emergency per­cutaneous nephrostomy group, while the other 57 patients were part of the percutane­ous nephrolithotomy group. The primary end point was the time until normalization of white blood cells (WBC) at a count of 10.000/mm3 or less, and a temperature of 37.4°C or lower. The secondary end points included the comparison of analgesic consump­tion, length of stay, and related complications. Statistical analysis was performed using SPSS® version 14.0.1. The Mann-Whitney U test, chi-square test, and Fisher’s exact test were used as appropriate.

Results: The length of hospital stays (in days) was 10.09±3.43 for the emergency per­cutaneous nephrostomy group and 8.18±2.72 for the percutaneous nephrolithotomy group. This set of data noted a significant difference between groups. There was no difference between groups in regard to white blood cell count (in mm3), time to nor­malization of white blood cell count (in days), body temperature (in ºC), time to nor­malization of body temperature (in days), C-reactive proteins (in mg/dL), time taken for C-reactive proteins to decrease over 25% (in days), procalcitonin (in ng/mL), or complication rates.

Conclusions: This study confirms that emergency percutaneous nephrolithotomy may be as safe as early percutaneous nephrolithotomy in a selected low risk patients with sepsis-associated large, obstructive stone.

Keywords: Sepsis; Nephrostomy, Percutaneous; complications [Subheading]

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Hyberbaric oxygen as sole treatment for severe radiation – induced haemorrhagic cystitis

Vol. 43 (3): 489-495, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0451


Athanasios Dellis 1, Athanasios Papatsoris 2, Vasileios Kalentzos 3, Charalambos Deliveliotis 2, Andreas Skolarikos 2
1 2nd Department of Surgery, National and Kapodistrian University of Athens, Aretaieion Academic Hospital, Greece; 2 2nd Department of Urology, University of Athens, Sismanoglio General Hospital, Athens, Greece; 3 Department of Diving and Hyperbaric Oxygen, Naval and Veterans Hospital, Athens, Greece


Purpose: To examine the safety and efficacy of hyperbaric oxygen as the primary and sole treatment for severe radiation-induced haemorrhagic cystitis.

Materials and methods: Hyperbaric oxygen was prospectively applied as primary treat­ment in 38 patients with severe radiation cystitis. Our primary endpoint was the in­cidence of complete and partial response to treatment, while the secondary endpoints included the duration of response, the correlation of treatment success-rate to the interval between the onset of haematuria and initiation of therapy, blood transfusion need and total radiation dose, the number of sessions to success, the avoidance of surgery and the overall survival.

Results: All patients completed therapy without complications with a mean follow-up of 29.33 months. Median number of sessions needed was 33. Complete and partial re­sponse rate was 86.8% and 13.2%, respectively. All 33 patients with complete response received therapy within 6 months of the haematuria onset. One patient needed cystec­tomy, while 33 patients were alive at the end of follow-up.

Conclusions: Our study suggests the early primary use of hyperbaric oxygen for radia­tion-induced severe cystitis as an effective and safe treatment option.

 Keywords: Urinary Bladder; Cystitis; Hema­turia; Oxygen Inhalation Therapy

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Randomized crossover trial of amoxapine versus vitamin B12 for retrograde ejaculation

Vol. 43 (3): 496-504, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0468


Jianlin Hu 1,2, Koichi Nagao 1, Toshihiro Tai 1, Hideyuki Kobayashi 1, Koichi Nakajima 1
1 Department of Urology, Reproduction Center, Toho University School of Medicine, Omori Hospital, Tokyo, Japan; 2 Department of Reproductive Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China


Objective: To compare the efficacy and safety of amoxapine and vitamin B12 for treating retrograde ejaculation (RE).

Materials and Methods: Between May 2009 and November 2012, this open-label, ran­domized, crossover study enrolled 26 men suffering with RE at Department of Reproductive Medicine, Omori Hospital. Patients were randomly allocated into two groups (n=13 each). The amoxapine-B12 group received amoxapine (50 mg daily for 4 weeks, orally) followed (after a 1-week washout period) by vitamin B12 (500 μg three-times daily for 4 weeks). The B12-amoxapine group received the opposite regimen. All pa­tients masturbated to ejaculation at least twice during each treatment period. The primary outcome was antegrade ejaculation of semen, as reported by the patient, on more than one occasion during either treatment period (defined as treatment success). Any adverse events were noted. Success rates were compared between treatments us­ing Fisher’s exact test.

Results: One patient (B12-amoxapine group) withdrew for personal reasons (breakdown of marital relations); all other patients completed the study. Overall success rate was 88% (22/25). Success rate was higher for amoxapine than for vitamin B12 (80%, 20/25 vs 16%, 4/25; P<0.0001). 18 patients were responsive to amoxapine but not to vita­min B12, 2 patients were responsive to vitamin B12 but not amoxapine, 2 patients were responsive to both drugs, and 3 patients had no response to either drug. One patient (4%) reported sleepiness and 2 (8%) reported constipation while receiving amoxapine. No adverse events were reported during vitamin B12 treatment.

Conclusions: Amoxapine may be an effective, safe and well-tolerated therapy for RE.

 Keywords: Ejaculation; Drug Therapy; Amoxapine; Infertility, Male

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Validation of self – confidence scale for clean urinary intermittent self – catheterization for patients and health – caregivers

Vol. 43 (3): 505-511, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2015.0468


Cintia Fernandes Baccarin Biaziolo 1, Alessandra Mazzo 2, José Carlos Amado Martins 3, Beatriz Maria Jorge 4, Rui Carlos Negrão Batista 5, Silvio Tucci Júnior 6, 7
1 Programa de Pós-Graduação em Mestrado Profissional de Tecnologia e Inovação em Enfermagem da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo – USP – Ribeirão Preto,SP, Brasil; 2 Departamento de Enfermagem Geral e Especializada da Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo – USP – Ribeirão Preto, SP, Brasil; 3 Departamento de Enfermagem Cirúrgica da Escola Superior de Enfermagem de Coimbra, Portugal; 4 Departamento de Enfermagem Fundamental da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo – USP – Ribeirão Preto (SP), Brasil; 5 Escola Superior de Enfermagem de Coimbra, Portugal; 6 Divisão de Urologia, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo- USP – Ribeirão Preto,SP, Brasil; 7 Departamento de Cirurgia e Anatomia da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo- USP – Ribeirão Preto (SP), Brasil


Objective: To validate a measurement instrument for clean intermittent self-catheter­ization for patients and health-caregivers.

Material and Methods: Methodological study of instrument validation performed at a Rehabilitation Center in a University hospital for patients submitted to clean intermit­tent self-catheterization and their health-caregivers. Following ethical criteria, data were collected during interview with nurse staff using a Likert question form contain­ing 16 items with 5 points each: “no confidence”=1, “little confidence”=2, “confi­dent”=3, “very confident”=4 and “completely confident”=5. Questionnaire called “Self- Confident Scale for Clean Intermittent Self-catheterization” (SCSCISC) was constructed based on literature and previously validated (appearance and content).

Results: The instrument was validated by 122 patients and 119 health-caregivers, in a proportion of 15:1. It was observed a good linear association and sample adequacy KMO 0.931 and X2=2881.63, p<0.001. Anti-image matrix showed high values at di­agonal suggesting inclusion of all factors. Screen plot analysis showed a suggestion of items maintenance in a single set. It was observed high correlation of all items with the total, alpha-Cronbach 0.944. The same results were obtained in subsamples of patients and health-caregivers.

Conclusion: The instrument showed good psychometric adequacy corroborating its use for evaluation of self-confidence during clean intermittent self-catheterization.

Keywords: Nursing; Intermittent Urethral Catheterization; Gestalt Therapy

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Laparoscopic management of recurrent ureteropelvic junction obstruction following pyeloplasty: a single surgical team experience with 38 cases

Vol. 43 (3): 512-517, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0198


Francesco Chiancone 1, Maurizio Fedelini 1, Luigi Pucci 1, Clemente Meccariello 1, Paolo Fedelini 1
1 Urologic Clinic, AORN Cardarelli Hospital, Naples, Italy


Purpose: To describe and analyze our experience with Anderson-Hynes transperitoneal laparoscopic pyeloplasty (LP) in the treatment of recurrent ureteropelvic junction obstruction (UPJO).

Materials and methods: 38 consecutive patients who underwent transperitoneal laparoscopic redo-pyeloplasty between January 2007 and January 2015 at our department were included in the analysis. 36 patients were previously treated with dismembered pyeloplasty and 2 patients underwent a retrograde endopyelotomy. All patients were symptomatic and all patients had a T1/2>20 minutes at pre-operative DTPA (diethylene-triamine-pentaacetate) renal scan. All data were collected in a prospectively maintained database and retrospectively analyzed. Intraoperative and postoperative complications have been reported according to the Satava and the Clavien-Dindo system. Treatment success was evaluated by a 12 month-postoperative renal scan.

Total success was defined as T1/2≤10 minutes while relative success was defined as T1/2between 10 to 20 minutes. Post-operative hydronephrosis and flank pain were also evaluated.

Results: Mean operating time was 103.16±30 minutes. The mean blood loss was 122.37±73.25mL. The mean postoperative hospital stay was 4.47±0.86 days. No intraoperative complications occurred. 6 out of 38 patients (15.8%) experienced postoperative complications. The success rate was 97.4% for flank pain and 97.4% for hydronephrosis. Post-operative renal scan showed radiological failure in one out of 38 (2.6%) patients, relative success in 2 out of 38 (5.3%) patients and total success in 35 out of 38 (92.1%) of patients.

Conclusion: Laparoscopic redo-pyeloplasty is a feasible procedure for the treatment of recurrent ureteropelvic junction obstruction (UPJO), with a low rate of post-operative complications and a high success rate in high laparoscopic volume centers.

 Keywords: Laparoscopy; Hydronephrosis; Recurrence; Kidney Pelvis

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Which intraperitoneal insufflation pressure should be used for less postoperative pain in transperitoneal laparoscopic urologic surgeries?

Vol. 43 (3): 518-524, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0366


Ali Akkoc 1, Ramazan Topaktas 1, Cemil Aydin 1, Selcuk Altin 1, Reha Girgin 1, Omer Faruk Yagli 2, Aykut Bugra Sentürk 3, Ahmet Metin 4
1 Department of Urology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey; 2 Department of Urology, Kartal Yavuz Selim State Hospital, Istanbul, Turkey; 3 Department of Urology, Hitit University, Training and Research Hospital, Corum, Turkey; 4 Department of Urology, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey


Purpose: To determine whether using different intraperitoneal insufflation pressures for transperitoneal laparoscopic urologic surgeries decreases postoperative pain.
Materials and Methods: 76 patients who underwent transperitoneal laparoscopic up¬per urinary tract surgery at different insufflation pressures were allocated into the following groups: 10mmHg (group I, n=24), 12mmHg (group II, n=25) and 14mmHg (group III, n=27). These patients were compared according to age, gender, body mass index (BMI), type and duration of surgery, intraoperative bleeding volume, postopera¬tive pain score and length of hospital stay. A visual analog scale (VAS) was used for postoperative pain.
Results: Demographic characteristics, mean age, gender, BMI and type of surgeries were statistically similar among the groups. The mean operation time was higher in group I than group II and group III but this was not statistically significant (P=0.810). The mean intraoperative bleeding volume was significantly higher in group I compared with group II and group III (P=0.030 and P=0.006). The mean length of postoperative hospital stays was statistically similar among the groups (P=0.849). The mean VAS score at 6h was significantly reduced in group I compared with group III (P=0.011). At 12h, the mean VAS score was significantly reduced in group I compared with group II and group III (P=0.009 and P<0.001). There was no significant difference in the mean VAS scores at 24h among three groups (P=0.920).
Conclusion: Lower insufflation pressures are associated with lower postoperative pain scores in the early postoperative period.

Keywords:  Pain, Postoperative; Pneumoperitoneum; Laparoscopy; Urology

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Anterior six arms prolene mesh for high stage vaginal prolapse: five years follow-up

Vol. 43 (3): 525-532, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0482


Luis Gustavo M. de Toledo 1,2, André Costa-Matos 2, Susane Mey Hwang 2, Raquel Dória Ramos Richetti 2, Silvia S. Carramão 1, Antônio P. F. Auge 1
1 Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil; 2 Serviço de Uroginecologia, Maternidade Cachoeirinha, São Paulo, SP, Brasil


Introduction: In high stage vaginal prolapse, recurrence risk patients, anterior and apical defects need to be addressed in the same procedure. The pre-molded commercial mesh kits are expensive and not always available. Alternative effective and safe treatment ways, with lower costs are desirable.
Objective: To present long term follow-up of patients treated with a homemade mesh shape to correct high stage prolapses.
Materials and Methods: We describe prospectively 18 patients with anterior and apical vaginal prolapses, stages III and IV, repaired using this specific design of mesh. All patients were submitted to pre-operative clinical evaluation and urodynamics. Prolapse was classified using the pelvic organ prolapse quantification (POP-Q). Intervention: Prolapse surgery, using a six arms prolene mesh, through a single anterior vaginal incision.
Outcome Measurements: POP-Q, patients satisfaction, descriptive statistical analysis.
Results: Between February 2009 and Oct 2010, 18 consecutive women underwent the above-mentioned surgery. Mean age was 68 years. At a mean follow-up of .,4 years (5 to 5.8 years), 16 (89%) patients were continent, mean Ba point came from +4.7cm to – 2.5cm, mean C point from +2.8cm to -6.6cm and mean Bp point from +1.3 to -1.7cm.
There were two (11%) objective failures, but all the patients were considered success subjectively. There were two cases of mesh vaginal extrusion.
Conclusions: The homemade six arms prolene mesh allows concomitant correction of anterior and apical prolapses, through a single anterior vaginal incision, being an effective, safe and affordable treatment option when mesh is needed.

Keywords: Surgical Mesh; Pelvic Organ Prolapse; Surgical Procedures, Operative

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Safety and short term outcomes of a new truly minimallyinvasive mesh-less and dissection-less anchoring system for pelvic organ prolapse apical repair

Vol. 43 (3): 533-539, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0356


Adi Y. Weintraub 1, Masha Ben Zvi 2, David Yohay 1, Joerg Neymeyer 3, Yonatan Reuven 4, Menahem Neuman 5,6, Alex Tsivian 2
1 Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel; 2 Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 3 Department of Urology, Charitè University, Berlin, Germany; 4 Siaal Research Center for Family Medicine and Primary Care, Division of Community Health, Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel; 5 Urogynecology, Department of Obstetrics and Gynecology, Galilee Hospital, and the Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel; 6 Assuta Medical Centers, Tel Aviv and Rishon Le-Zion, Israel



Objective: To evaluate the safety and short term outcomes of a new, truly minimallyinvasive, mesh-less and dissection-less anchoring system for pelvic floor apical repair.

Methods: A prospective study was conducted using the NeuGuide™ device system for pelvic floor apical repair. The primary effectiveness outcome was centro-apical pelvic floor prolapse by POP-Q after six months. The primary safety outcome was intra-operative, immediate (first 48 h) post-operative complications and adverse effects after six months. A standardized questionnaire (UDI-6) to assess quality of life at entry and during follow-up visits was used. Patients’ six months-follow-up and evaluation are reported.

Results: The mean age of the study population (n=10) was 63.8±12.0 years. All patients had a previous prolapse surgery. Five had a previous hysterectomy and two had stress urinary incontinence symptoms. During surgery six patients had a concurrent colporrhaphy.

There was no injury to the bladder, rectum, pudendal nerves, or major pelvic vessels and no febrile morbidity was recorded. At six months, no cases of centro-apical recurrence were noted. Patients were satisfied with the procedure and had favorable quality of life scores. Using the UDI-6 questionnaire an improvement, in all domains was seen.

Moreover, although the sample size was small, the improvement in urge and overflow incontinence related domains were demonstrated to be statistically significant.

Conclusions: This new NeuGuide™ device allows rapid and safe introduction of a suspending suture through the sacrospinous ligament and makes sacrospinous ligament fixation easy to perform, while avoiding dissection and mesh complications.

Keywords: Prolapse; Minimally Invasive Surgical Procedures; Pelvic Floor Disorders

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Surgical treatment of detrusor underactivity: a short term proof of concept study

Vol. 43 (3): 540-548, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0405


Jerry G. Blaivas 1, 2, 3, James C. Forde 1, 3, Jonathan L. Davila 2, 3, Lucas Policastro 2, 3, Michael Tyler 2, 3, Joshua Aizen 2, 3, Anand Badri 2, 3, Rajveer S. Purohit 1, 2, 3, Jeffrey P. Weiss 2, 3
1 Department of Urology, Weill Medical College of Cornell University, New York, NY, USA; 2 Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA; 3 Institute for Bladder and Prostate Research, New York, NY, USA



Objectives: To compare the surgical outcomes of men with bladder outlet obstruction (BOO) due to benign prostatic obstruction (BPO) to those with detrusor underactivity (DU) or acontractile detrusor (DA).

Materials and Methods: This retrospective, IRB approved study included men who un­derwent BPO surgery for refractory LUTS or urinary retention. Patients were grouped based on videourodynamic (VUDS) findings: 1) men with BOO, 2) men with DU and 3) men with DA. The primary outcome measure was the Patient Global Impression of Improvement (PGII). Secondary outcome measures included uroflow (Qmax), post-void residual volume (PVR) and the need for clean intermittent catheterization (CIC).

Results: One hundred and nineteen patients were evaluated: 1) 34 with BOO, 2) 62 with DU and 3) 23 with DA. Subjective success rate (PGII) was highest in the BOO group (97%) and those with DU (98%), while DA patients had a PGII success of 26%, (p<0.0001). After surgery, patients with BOO had the lowest PVR (68.5mL). Fifty-six patients (47%) performed CIC pre-operatively (47% of BOO, 32% of DU and 87% of DA patients). None of the patients in the BOO and DU groups required CIC post operatively compared to16/23 (69%) of patients in the DA group (p<0.0001).

Conclusions: BPO surgery is a viable treatment option in men with presumed BOO and DU while DA is a poor prognostic sign in men who do not void spontaneously pre-operatively.

 Keywords: Prostatic Hyperplasia; Urinary Bladder Neck Obstruction; Prostate

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Urinary excretion of EGF and MCP-1 in children with vesicoureteral reflux

Vol. 43 (3): 549-555, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2015.0132


Valentina Pastore 1, Fabio Bartoli 1
1 Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy


Purpose: The aim of this study was to investigate the urinary concentration of epidermal growth factor (EGF) and monocyte chemotactic protein-1 (MCP-1) as reflux nephropathy (RN) biomarkers before and after endoscopic treatment of moderate to severe vesico-ureteral reflux (VUR).

Materials and methods: A prospective study was carried out on 72 children with moderate to severe VUR. All patients underwent endoscopic treatment using Macroplastique ® or Deflux®. Vesico-ureteral reflux resolution was tested by post-operative voiding cystourethrography after 3 months and 2 years. Follow-up urinary samples were collected at that time. Control samples were taken from healthy children with no clinical evidence of renal and bladder disease and no history of UTI.

Results: In VUR patients, pre-operative urinary EGF levels had a down-regulation when compared to controls. Following successful VUR repair, urinary EGF levels of VUR children progressively increased only at long term follow-up but without returning to normal levels. Urinary MCP-1 levels were highly expressed in pre-operative samples and decreased markedly during early post-operative measurements. Urinary MCP-1 levels did not further decreased in late post-operative follow-up. In fact, these levels remained significantly higher when compared to controls.

Conclusions: Urinary levels of EGF and MCP-1 may become useful markers for monitoring the response to surgical treatment in VUR patients. Although endoscopic VUR treatment is effective in reducing the inflammatory response, the persistence of significant abnormal levels of inflammatory cytokines (such as urinary MCP-1) at long term follow-up suggests that surgery alone may not completely treat the chronic renal inflammation evidenced in these children.

 Keywords: Urinary Tract; EGF Family of Proteins; Vesico-Ureteral Reflux

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Unusual intravesical foreign body in young female migrated from vagina due to autoerotism

Vol. 43 (3): 556-560, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2016.0164


Ankur Bansal 1, Manoj Kumar 1, Gautam Kanodia 1, Ruchir Aeron 1, Sunny Goel 1
1 King George Medical University, Lucknow, Uttar Pradesh, India


No abstract available


Keywords: Urinary Bladder; Vagina; Urogenital System

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A rare case of supernumerary fused and malrotated kidney

Vol. 43 (3): 561-562, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2015.0420


Volkan Sen 1, Ibrahim Halil Bozkurt 1, Tarik Yonguc 1, Ozgu Aydogdu 1, Ismail Basmaci 1

1 Izmir Bozyaka Training and Research Hospital – Urology, Izmir, Turkey



No abstract available

[Full Text]


Metanephric Adenofibroma in a young adult

Vol. 43 (3): 563-565, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2015.0300


Feiya Yang 1, Canfeng Zhang 1, Mingshuai Wang 1, Xiquan Tian 1, Wenlong Wang 2, Nianzeng Xing 1
1 Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P.R. China; 2 Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P.R. China



No abstract available

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Laparoscopic resection of prescral and obturator fossa schwa

Vol. 43 (3): 566-566, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2015.0091


Marcos Tobias-Machado 1, Alexandre Kiyoshi Hidaka 1, Letícia Lumy Kanawa Sato 1, Igor Nunes Silva 1, Pablo Aloisio Lima Mattos 1, Antonio Carlos Lima Pompeo 1
1 Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil



Introduction: Pelvic Schwannoma is an extremely rare event. Laparoscopic approach for radical resection on pelvic region already has been described in the literature. However, with better image quality provided by optic in the laparoscopy we can assure an improvement in this kind of approach for tumor resection.

Objective: Our goal is to describe and evaluate the results of one laparoscopic resection of presacral and obturator fossa tumor.

Materials and Methods: We present a case of a 60-year-old man with progressive congestion in the right inferior member and CT scan revealing a mass with miscellaneous content located behind of the right iliac vessels and right obturator nerve. Exploratory transperitoneal laparoscopy was indicated. During laparoscopy it was possible to see the mass between the spermatic cord and external iliac artery. We made the identification and preservation of iliac vessels and obturator nerve. Resection of the tumor was performed carefully, allowing the safe removal of the specimen with complete preservation of the iliac vessels and obturator nerve.

Results: Mean operative time of 150 minutes. No perioperative complications occurred. Two days of hospital stay. Posterior histopathological exam confirmed that the mass was a Schwannoma.

Conclusion: The maximization of the image in the laparoscopic surgery offers dexterity and capacity of dissection required for complex mass dissection on pelvic region.

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Laparoscopic partial nephrectomy for multiple (four) tumors

Vol. 43 (3): 567-567, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2015.0648


Lessandro Curcio 1, Bruno Salama 1, Daniel Luis Pinto 1, Antonio Claudio Ahouagi 1
1 Hospital Federal Ipanema, RJ, Brasil



Background: Nephron sparing surgery (NSS) is well established as the standard of care for most surgical small renal tumors when technically feasible. While the majority of sporadic renal tumors are solitary, multifocal tumors have been reported in 5.4% to 25% of patients with tumors smaller than 5cm. We present a video where we approach, through laparoscopy, four tumors on the same kidney.

Case study: Male, 58y, went through a routine abdominal ultrasound which showed a 5cm left kidney nodule. His MRI pointed a total of 4 nodules on his left kidney. The aspect suggested a papillary cancer due to high cellularity and low vascularization. The patient was submitted to partial nephrectomy under ischemia to remove the two largest tumors (in­ferior pole) and a resection without clamping of the other two ipsilateral tumors.

Result: We performed the surgery in 2 stages. In the first one, we approached the 2 tumors located on the inferior pole inducing warm ischemia, whereas in the second stage we resected the 2 remaining tumors using the technique without clamping. The surgery lasted 220 minutes, with 800mL of blood loss, not requiring blood transfusion. Ischemia time was 35 minutes. The histopathological analysis confirmed that the 4 tumors were papillary cancer, with free margins.

Conclusion: NSS can be performed and should be tried in patients with multiple kidney tumors, preferably through lapa­roscopy or assisted by robot. It can be made either using or not clamping of the pedicle, depending on the RENAL score.

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Re: Artificial urinary sphincter for urinary incontinence after radical prostatectomy: a historical cohort from 2004 to 2015

Vol. 43 (3): 568-570, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2017.0074


José Carlos Truzzi 1, Carlos Alberto Ricetto Sacomani 1, José Antônio Prezzoti 1
1 Departamento de Uroneurologia, Sociedade Brasileira de Urologia, Rio de Janeiro, RJ, Brasil


No abstract available

[Full Text]

REPLY BY THE AUTHORS: Re: Artificial urinary sphincter for urinary incontinence after radical prostatec¬tomy: a historical cohort from 2004 to 2015

Vol. 43 (3): 571-571, May – June, 2017

doi: 10.1590/S1677-5538.IBJU.2017.0074.1


Augusto Cesar Soares dos Santos Junior 1,2, Luíza de Oliveira Rodrigues 1,2, Daniela Castelo Azevedo 1,2, Lélia Maria de Almeida Carvalho 1,2, Mariana Ribeiro Fernandes 1,2, Sandra de Oliveira Sapori Avelar 1,2, Maria da Glória Cruvinel Horta 1,2, Silvana Márcia Bruschi Kelles 1,2
1 Grupo de Avaliação de Tecnologia em Saúde, Unimed BH, MG, Brasil; 2 Núcleo de Avaliação de Tecnologia em Saúde, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), MG, Brasil


No abstract available

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