Vol. 43 n. 5 Sep . Oct, 2017

Volume 43 | number 5 | September . October, 2017 – The fate of some urologic innovations from the last century

The fate of some urologic innovations from the last century

Vol. 43 (5): 796-797, September – October, 2017 doi: 10.1590/S1677-5538.IBJU.2017.05.01 EDITORIAL in this Issue Stênio de Cássio Zequi Editor Associado, International Braz J Urol Divisão de Urologia do A.C. Camargo Cancer Center Fundação A. Prudente, São Paulo, Brasil Around the 1980’s the external shockwave lithotripsy (ESWL) promoted a revolution in the millenary open surgical approach of urinary stones. After the ESWL, the Endourology procedures and its devices progressed a lot, but several controversies persist in this area, as: What is the best approach during the flexible ureteroscopic lithotripsy, to promote stone fragmentation or dusting? These two visions were put underdebate in the Difference of Opinion Section (page 798), respectively by the doctors Meller and Lopes Neto, from Brazil. During this time, ESWL had expanded its applications in in Orthopedics and in Pain Medicine. More recently, new ESWL devices, were developed for new a urologic use: The treatment of erectile dysfunction, but this approach is subject of doubts and some skepticism. To help our readers in understanding this kind of treatment, a Chinese Group performed a review of 15 studies and a metanalisys of 4 controlled randomized trials, focusing in the early treatment results (30 days after intervention) They concluded that low intensity ESWL results in better improvement of erectile function in comparison with the sham treatment groups (page 805)… [Read...

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Which is the best way to treat a stone on a flexible ureterorrenoscopy? | Opinion: Fragmentation

Vol. 43 (5): 798-801, September – October, 2017 doi: 10.1590/S1677-5538.IBJU.2017.05.02 DIFFERENCE OF OPINION Alex Meller 1 1 Divisão de Endourologia e Litíase Renal e Disciplina de Urologia – Universidade Federal de São Paulo, UNIFESP/EPM, SP, Brasil Keywords: Calculi; Lasers, Solid-State; Kidney Since the introduction of Holmiun YAG (Ho-YAG) laser to treat kidney or ureteral stones, a dramatic change in techniques of stone treatment has occurred, especially how to adjust the ideal laser setting to achieve ideal fragmentation. First reports of Ho-YAG laser clinical application had been focused on tissue cutting or destruction (1), but few years later, the ability to fragment stones through a thermal mechanism was demonstrated (2). The laser emission superheats water surrounding the laser fiber tip, thus creating a microscopic vaporization bubble that is able to destabilize or vaporize tissue or a stone. Based on this mechanism, the ideal energy setting to treat a stone had been discussed and evaluated…. [Read...

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Which is the best way to treat a stone on a flexible ureterorrenoscopy? | Opinion: Dusting

Vol. 43 (5): 802-804, September – October, 2017 doi: 10.1590/S1677-5538.IBJU.2017.05.03 DIFFERENCE OF OPINION Antonio Correa Lopes Neto 1 1 Grupo de Litíase e Endourologia da Disciplina de Urologia da Faculdade de Medicina ABC, Santo André, SP, Brasil Keywords: Calculi; Lasers, Solid-State; Kidney Flexible ureterorenolithotripsy is rapidly developing and becoming the treatment of choice around the World for the invasive treatment of lithiasis (1). According to calculi dimensions, they can be removed integrated or by using an intracorporeal lithotripter. According to laser parameters adjustments, it is possible to vaporize calculi (“dusting”). In this case, it is necessary to use high frequency of impulses (>15HZ), low energy (<0.5J) and long pulses (800 ᶭsec), whenever the equipment allows for these options. Recently, it has been debated which is the best way to program the equipment at the moment of calculi lithotripsy. There are few evidences in literature to conclude, but it seems that dusting has some advantages in relation to fragmentation + basketing… [Read...

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Short-term efficacy and safety of low-intensity extracorporeal shock wave therapy in erectile dysfunction: a systematic review and meta-analysis

Vol. 43 (5): 805-821, September – October, 2017 doi: 10.1590/S1677-5538.IBJU.2016.0245 REVIEW ARTICLE Zi-jun Zou 1, Liang-you Tang 1, Zhi-hong Liu 1, Jia-yu Liang 1, Ruo-chen Zhang 1, Yu-jie Wang 1, Yong-quan Tang 1, Rui Gao 2 , Yi-ping Lu 1 1 Department of Urology, Institute of Urology , West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China; 2 Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P.R. China ABSTRACT Aim: The role of low-intensity extracorporeal shock wave therapy (LI-ESWT) in erec­tile dysfunction (ED) is not clearly determined. The purpose of this study is to investi­gate the short-term efficacy and safety of LI-ESWT for ED patients. Materials and Methods: Relevant studies were searched in Medline, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), WANFANG and VIP databas­es. Effective rate in terms of International Index of Erectile Function-Erectile Function Domain (IIEF-EF) and Erectile Hardness Score (EHS) at about 1month after LI-ESWT was extracted from eligible studies for meta-analysis to calculate risk ratio (RR) of effective treatment in ED patients treated by LI-ESWT compared to those receiving sham-treatment. Results: Overall fifteen studies were included in the review, of which four randomized controlled trials (RCTs) were for meta-analysis. Effective treatment was 8.31 [95% con­fidence interval (CI): 3.88-17.78] times more effective in the LI-ESWT group (n=176) than in the sham-treatment group (n=101) at about 1 month after the intervention in terms of EHS, while it was 2.50 (95% CI: 0.74-8.45) times more in the treatment group (n=121) than in the control group (n=89) in terms of IIEF-EF. Nine-week protocol with energy density of 0.09mJ/mm2 and 1500 pluses seemed to have better therapeutic ef­fect than five-week protocol. No significant adverse event was reported. Conclusion: LI-ESWT, as a noninvasive treatment, has potential short-term therapeutic effect on patients with organic ED irrespective of sensitivity to PDE5is. Owing to the limited number and quality of the studies, more large-scale, well-designed and long-term follow-up time studies are needed to confirm our analysis. Keywords: Erectile Dysfunction; Therapeutics; Meta-Analysis as Topic [Full...

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Update on complications of synthetic suburethral slings

Vol. 43 (5): 822-834, September – October, 2017 doi: 10.1590/S1677-5538.IBJU.2016.0250 REVIEW ARTICLE Cristiano Mendes Gomes 1, Fabrício Leite Carvalho 1, Carlos Henrique Suzuki Bellucci 1, Thiago Souto Hemerly 1, Fábio Baracat 1, Jose de Bessa Jr. 1, Miguel Srougi 1, Homero Bruschini 1 1 Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil ABSTRACT Synthetic suburethral slings have become the most widely used technique for the sur­gical treatment of stress urinary incontinence. Despite its high success rates, significant complications have been reported including bleeding, urethral or bladder injury, urethral or bladder mesh erosion, intestinal perforation, vaginal extrusion of mesh, urinary tract infection, pain, urinary urgency and bladder outlet obstruction. Recent warnings from important regulatory agencies worldwide concerning safety issues of the use of mesh for urogynecological reconstruction have had a strong impact on pa­tients as well as surgeons and manufacturers. In this paper, we reviewed the literature regarding surgical morbidity associated with synthetic suburethral slings. Keywords:  Urinary Incontinence; Polypropylenes; Postoperative Complications [Full...

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Management of prostate abscess in the absence of guidelines

Vol. 43 (5): 835-840, September – October, 2017 doi: 10.1590/S1677-5538.IBJU.2016.0472 ORIGINAL ARTICLE Haitham Abdelmoteleb 1, Fatima Rashed 1, Amr Hawary 1 1 Great Western Hospital, Swindon, United Kingdom  ABSTRACT  In contemporary practice, the number of patients presenting with prostatic abscess have significantly declined due to the widespread use of antibiotics. However, when faced with the pathology, prostatic abscess tends to pose a challenge to clinicians due to the difficulty of diagnosis and lack of guidelines for treatment. Treatment consists of an array of measures including parenteral broad-spectrum antibiotic administration and abscess drainage. Keywords: Prostate; Disease Management; Guidelines as Topic [Full...

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Adjuvant radiotherapy for the primary treatment of adrenocortical carcinoma: Are we offering the best?

Vol. 43 (5): 841-848, September – October, 2017 doi: 10.1590/S1677-5538.IBJU.2017.0095 ORIGINAL ARTICLE Victor Srougi 1, Jose Bessa Junior 2, Fabio Y. Tanno 1, Amanda M. Ferreira 3, Ana O. Hoff 4, João E. Bezerra 4, Cristiane M. Almeida 5, Madson Q. Almeida 3, 4, Berenice B. Mendonça 3, William C. Nahas 1, Jose L. Chambô 1, Miguel Srougi 1, Maria C. B. V. Fragoso 3, 4 1 Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil; 2 Divisão de Urologia, Universidade de Feira de Santana, BA, Brasil; 3 Unidade de Suprerrenal da Divisão de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, Brasil; 4 Divisão de Endocrinologia do Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil; 5 Divisão de Radioterapia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil   ABSTRACT Purpose: To evaluate the role of ARDT after surgical resection of ACC. Materials and Methods: Records of patients from our institutional ACC database were retrospectively assessed. A paired comparison analysis was used to evaluate the onco­logical outcomes between patients treated with surgery followed by ARDT or surgery only (control). The endpoints were LRFS, RFS, and OS. A systematic review of the literature and meta-analysis was also performed to evaluate local recurrence of ACC when ARDT was used. Results: Ten patients were included in each Group. The median follow-up times were 32 months and 35 months for the ARDT and control Groups, respectively. The re­sults for LRFS (p=0.11), RFS (p=0.92), and OS (p=0.47) were similar among subsets. The mean time to present with local recurrence was significantly longer in the ARDT group compared with the control Group (419±206 days vs. 181±86 days, respectively; p=0.03). ARDT was well tolerated by the patients; there were no reports of late toxicity. The meta-analysis, which included four retrospective series, revealed that ARDT had a protective effect on LRFS (HR=0.4; CI=0.17-0.94). Conclusions: ARDT may reduce the chance and prolong the time to ACC local recur­rence. However, there were no benefits for disease recurrence control or overall sur­vival for patients who underwent this complementary therapy.   Keywords: Adrenocortical Carcinoma; Radiotherapy, Adjuvant; Therapeutics [Full...

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Partial nephrectomy for T3aN0M0 renal cell carcinoma: shall we step forward?

Vol. 43 (5): 849-856, September – October, 2017 doi: 10.1590/S1677-5538.IBJU.2016.0598 ORIGINAL ARTICLE Ding Peng 1, Zhi-song He 1, Xue-song Li 1, Qi Tang 1, Lei Zhang 1, Kai-wei Yang 1, Xiao-teng Yu 1, Cui-jian Zhang 1, Li-qun Zhou 1 1 Department of Urology, Institute of Urology, Peking University First Hospital, Beijing, China ABSTRACT Objectives: To evaluate the prognosis of non-metastatic T3a renal cell carcinoma (RCC) with partial nephrectomy (PN). Patients and Methods: We retrospectively evaluated 125 patients with non-metastatic T3a RCC. Patients undergoing PN and radical nephrectomy (RN) were strictly matched by clinic-pathologic characteristics. Log-rank test and Cox regression model were used for univariate and multivariate analysis. Results: 18 pair patients were matched and the median follow-up was 35.5 (10-86) months. PN patients had a higher postoperative eGFR than RN patients (P=0.034). Cancer-specific survival (CSS) and recurrence-free survival (RFS) did not differ be­tween two groups (P=0.305 and P=0.524). On multivariate analysis, CSS decreased with positive surgical margin and anemia (both P <0.01) and RFS decreased with Furh­man grade, positive surgical margin, and anemia (all P<0.01). Conclusions: For patients with non-metastatic pT3a RCC, PN may be a possible option for similar oncology outcomes and better renal function. Keywords: Carcinoma, Renal Cell; Nephrectomy; Patients [Full Text]...

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Laparoscopic partial nephrectomy for tumors 7cm and above. Perioperative outcomes

Vol. 43 (5): 857-862, September – October, 2017 doi: 10.1590/S1677-5538.IBJU.2016.0642 ORIGINAL ARTICLE Matvey Tsivian 1, Efrat Tsivian 1, Yury Stanevsky 2, Roman Bass 2, A. Ami Sidi 2, Alexander Tsivian 2 1 Division of Urology and Department of Surgery, Duke University Medical Center Durham, NC; 2 Department of Urologic Surgery, The E. Wolfson Medical Center, Holon and Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel ABSTRACT Purpose: To assess and report the outcomes of laparoscopic partial nephrectomy )LPN) for T2 renal masses. Materials and Methods: Retrospective review of patients undergoing LPN for clinically localized renal masses ≥7cm between the years 2005-2016. Descriptive analyses were generated for demographics, lesion characteristics, perioperative variables (operative time, warm ischemia time (WIT), estimated blood loss (EBL), intra-operative and post-operative complications (IOC and POC) and pathologic variables (pathology, subtype and Fuhrman grade). Results: A total of 27 patients underwent LPN for a T2 renal mass at our institution be­tween 2005 and early 2016 of which 19 were males. The mean age was 66 (52-72). All procedures were transperitoneal with 16 on the right and 11 on the left. Median opera­tive time was 200 minutes (IQR 181-236) and median WIT 19 minutes (IQR 16-23). EBL was 125mL (IQR 75-175). One case was converted to laparoscopic radical nephrectomy due to suspected tumor thrombus in the renal vein. Surgical margins were positive in one renal tumor in a patient with multiple tumors. There was a total of 2 IOC (7.4%) and 3 POC (11%) classified as Clavien grade 3. Conclusions: To our knowledge, this series is the first to describe the outcomes of LPN for cT2 renal masses. In our series, LPN for larger renal masses appears feasible with favorable perioperative outcomes. Additional data are needed to further explore the benefits of minimally invasive surgical approaches to larger renal masses. Keywords:  Nephrectomy; Laparoscopy; Neoplasms [Full Text]...

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