Vol. 44 n. 2 Mar . Apr, 2018

Volume 44 | number 2 | March . April, 2018 -Lower pole renal stone: flexible ureteroscopy or shockwave lithotripsy? The anatomy is the key

Lower pole renal stone: flexible ureteroscopy or shockwave lithotripsy? The anatomy is the key

Vol. 44 (2): 211-212, March – Abril, 2018 doi: 10.1590/S1677-5538.IBJU.2018.02.01 EDITORIAL in This Issue The March-April 2018 issue of the International Braz J Urol presents original contributions with many interesting papers in different fields: BPH, Renal stones, Prostate Cancer, Renal Cell Carcinoma, Bladder Cancer, Uretrhal Strictures, Prostatitis, Urinary Incontinence, Urinary Tract Infections, Ureteropelvic Junction Obstruction, Laparoscopy and Renal Anomalies. The papers come from many different countries such as Brazil, USA, Turkey, China, Italy, Lebanon, Argentina, Spain, Canada, Thailand and India, and as usual the editor´s comment highlights some papers. We decided to comment the paper about a very interesting topic: The treatment of the lower pole stones. [Read more] Related Post Best videos of the year in 2017 views 29 Editorial Comment: Lack of evidence of HPV etiology of prostate cancer... views 19 Editorial Comment: Antioxidant enzyme profile and lipid peroxidation p... views 20 Editorial Comment: The protective effect of Papaverine and Alprostadil... views...

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BPH treatment: laser for everyone | Opinion: YES

Vol. 44 (2): 213-214, March – Abril, 2018 doi: 10.1590/S1677-5538.IBJU.2018.02.02 DIFFERENCE OF OPINION Carlos A. R. Sacomani 1, Ricardo Vita Nunes 2 1 Departamento de Urologia, AC Camargo Cancer Center, SP, Brasil; 2 Divisão de Urologia, Universidade de São Paulo, USP, São Paulo, SP, Brasil Keywords: Lasers; Therapeutics; Prostatic Hyperplasia; Transurethral Resection of Prostate During the past decades, transurethral resection of the prostate (TURP) has been the gold­-standard procedure for surgical treatment of benign prostatic hyperplasia (BPH) and became the second most common surgery in men in the Western world (1). A number of other techniques were developed through the years, trying to replace TURP, including vaporization, microwave thermotherapy, transurethral needle ablation (TUNA) and various types of laser therapies. The rational of looking for new therapies for BPH lies on the intention of delivering the same results with less complications and adequate length of stay at the hospital or even as an outpatient pro­cedure. Indeed, morbidity and mortality following TURP are continuous issues. Reich et al. (2) evaluated 10,654 patients that underwent TURP in state of Bavaria, Germany. [Read more] Related Post Effects of Copaiba oil in the healing process of urinary bladder in ra... views 25 Transperitoneal laparoscopic pyeloplasty in children: does upper urina... views 23 Left ureteral appendiceal interposition: Exercise caution and do not b... views 25 Radical Cystectomy is the best choice for most patients with muscle-in... views...

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BPH treatment: laser for everyone | Opinion: NO

Vol. 44 (1): 215-218, March – Abril, 2018 doi: 10.1590/S1677-5538.IBJU.2018.02.03 DIFFERENCE OF OPINION Fernando G. Almeida 1, 2, Luciano Teixeira Silva 2 1 Departamento de Disfunções Urinárias, Urologia Feminina e Urodinâmica, 2 Departamento de Urologia, Universidade Federal de São Paulo, UNIFESP, Escola Paulista de Medicina, São Paulo, SP, Brasil Keywords: Lasers; Therapeutics; Prostatic Hyperplasia; Transurethral Resection of Prostate Benign prostate enlargement (BPE) is a highly prevalent pathology (1). The main consequence of BPE is Bladder Outlet Obstruction (BOO). Patients with BOO may be bothered by voiding lower urinary tract symptoms (LUTS). Those men with BOO and significant LUTS which did not respond to clinical approaches may be candidate to surgical procedures. In patients with prostate volume inferior to 80-100 grams, monopolar transurethral resection of prostate (TURP) has been considered the gold standard for decades. The American Urological Association (AUA) considered TURP as standard treatment for BPH (2) and The European Urological Association considered TURP “the treatment of choice” for prostates sized 30 to 80 cm3 (3). [Read more] Related Post Efficacy of targeted therapy for advanced renal cell carcinoma: a syst... views 58 Radical Cystectomy is the best choice for most patients with muscle-in... views 25 Validation of the urgency questionnaire in Portuguese: A new instrumen... views 29 Focal therapy will be the next step on prostate cancer management? | O... views...

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Efficacy of targeted therapy for advanced renal cell carcinoma: a systematic review and meta-analysis of randomized controlled trials

Vol. 44 (2): 219-237, March – Abril, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0315 REVIEW ARTICLE Chao Wei 1, 2, Shen Wang 1 ,2, Zhangqun Ye 1, 2, Zhiqiang Chen 1, 2 1 Department of Urology and 2 Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China ABSTRACT We conducted a systematic review and meta-analysis of the literature on the efficacy of the targeted therapies in the treatment of advanced RCC and, via an indirect com­parison, to provide an optimal treatment among these agents. A systematic search of Medline, Scopus, Cochrane Library and Clinical Trials unpublished was performed up to Jan 1, 2015 to identify eligible randomized trials. Outcomes of interest assessing a targeted agent included progression free survival (PFS), overall survival (OS) and ob­jective response rate (ORR). Thirty eligible randomized controlled studies, total twenty-fourth trails (5110 cases and 4626 controls) were identified. Compared with placebo and IFN-α, single vascular epithelial growth factor (receptor) tyrosine kinase inhibitor and mammalian target of rapamycin agent (VEGF(r)-TKI & mTOR inhibitor) were as­sociated with improved PFS, improved OS and higher ORR, respectively. Comparing sorafenib combination vs sorafenib, there was no significant difference with regard to PFS and OS, but with a higher ORR. Comparing single or combination VEGF(r)-TKI & mTOR inhibitor vs BEV + IFN-α, there was no significant difference with regard to PFS, OS, or ORR. Our network ITC meta-analysis also indicated a superior PFS of axitinib and everolimus compared to sorafenib. Our data suggest that targeted therapy with VEGF(r)-TKI & mTOR inhibitor is associated with superior efficacy for treating advanced RCC with improved PFS, OS and higher ORR compared to placebo and IFN-α. In summary, here we give a comprehensive overview of current targeted therapies of advanced RCC that may provide evidence for the adequate targeted therapy selecting. Keywords:  Carcinoma, Renal Cell; Therapeutics; Meta-Analysis as Topic; Interferons [Full Text] Related Post High-intensity Focused Ultrasound (HIFU) as salvage therapy for radio-... views 30 Incidentally detected tuberculous prostatitis with microabscess views 35 BPH treatment: laser for everyone | Opinion: NO views 39 Flexible ureterorenoscopy is associated with less stone recurrence rat... views...

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The association between the outcomes of extraperitoneal laparoscopic radical prostatectomy and the anthropometric measurements of the prostate by magnetic resonance imaging

Vol. 44 (2): 238-247, March – Abril, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0260 ORIGINAL ARTICLE Sompol Permpongkosol 1, Supanun Aramay 2, Thawanrat Vattanakul 2, Sith Phongkitkarun 2 1 Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; 2 Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand Introduction and objective: To determine the association between the anthropometric measurements by magnetic resonance imaging (MRI) and perioperative outcomes of extraperitoneal laparoscopic radical prostatectomy (ELRP). Materials and Methods: From 2008 to June 2016, 86 patients underwent preoperative MRI prior to undergoing ELRP for localized prostate cancer. We analyzed the associa­tions between anthropometric measurements of MRI and the perioperative outcomes of patients who underwent ELRP. Results: The mean patient age was 69.61±8.30 years. The medians of operating time and blood loss were 2.30 hours and 725.30ml, respectively. The total post-surgical complication rate was 1.16%. The median hospital stay was 6.50 days. The pathologi­cal stages for T2 and T3 were 45.74% and 34.04%, respectively. The rate as positive surgical margins (PSMs) was 18.09% (pT2 and pT3; 6.38% and 9.57%). The angles between pubic bone and prostate gland (angle 1&2), were significantly associated with operative time and hospital stay, respectively (p<0.05). There was no correlation be­tween the pelvimetry and positive surgical margin. Conclusions: The findings of the present study suggest that anthropometric measure­ments of the MRI are related to operative difficulties in ELRP. This study confirmed that MRI planning is the key to preventing complications in ELRP. Keywords: Prostatectomy; Prostatic Neoplasms; Magnetic Resonance Imaging, Laparoscopy [Full Text] Related Post Efficacy and safety of Elevate® system on apical and anterior compartm... views 21 Laparoscopic management of recurrent ureteropelvic junction obstructio... views 16 Analysis of various potential prognostic markers and survival data in ... views 22 The effect of tadalafil therapy on kidney damage caused by sepsis in a... views...

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High-intensity Focused Ultrasound (HIFU) as salvage therapy for radio-recurrent prostate cancer: predictors of disease response

Vol. 44 (2): 248-257, March – Abril, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0025 ORIGINAL ARTICLE Shawn Dason 1, Nathan C. Wong 1, Christopher B. Allard 1, Jen Hoogenes 1, William Orovan 1 and Bobby Shayegan 1 1 Division of Urology, McMaster University, Hamilton, ON, Canada   ABSTRACT Background: Some men with localized radio-recurrent prostate cancer may benefit from salvage high-intensity focused ultrasound (HIFU). Herein, we describe oncologic outcomes and predictors of disease response after salvage whole gland HIFU from our prospective cohort. Materials and Methods: Patients with localized radio-recurrent prostate cancer were prospectively enrolled from January 2005 to December 2014. Participants had to meet both biochemical and histological definitions of recurrence. Exclusion criteria included the receipt of prior salvage therapy, presence of metastatic disease, and administration of ADT in the 6-months prior to enrollment. Participants were treated with a single session of whole-gland HIFU ablation with the AblathermTM device (EDAP, France). The primary endpoint was recurrence-free survival (RFS), defined as a composite endpoint of PSA progression (Phoenix criteria), receipt of any further salvage therapy, receipt of ADT, clinical progression, or death. Kaplan-Meier survival analysis was used to deter­mine the primary end-point and stratifications were used to determine the significance of 6 pre-specified predictors of improved RFS (TRUS biopsy grade, number of study entry TRUS biopsy cores positive, palpable disease at study enrollment, pre-HIFU PSA, an undetectable post-HIFU PSA nadir, and receipt of prior hormone therapy). Survival analysis was performed on participants with a minimum of 1-year follow-up. Results: Twenty-four participants were eligible for study inclusion with a median fol­low-up of 31.0 months. Median PSA at study entry was 4.02ng/ml. Median time to PSA nadir was 3 months after treatment and median post-HIFU PSA nadir was 0.04ng/ ml. Median 2-year and 5-year RFS was 66.3% and 51.6% respectively. Of our 6 pre-specified predictors, an undetectable PSA nadir was the only significant predictor of improved RFS (HR 0.07, 95% CI 0.02-0.29, log-rank P<0.001). One participant under­went an intervention for a urethral stricture. No participants developed osteitis pubis or rectourethral fistulae. Conclusions: Salvage HIFU allows for disease control in selected patients with localized radio-recurrent prostate cancer. An undetectable PSA nadir serves as an early predictor of disease response. Keywords: High-Intensity Focused Ultrasound Ablation; Prostatic Neoplasms; Erectile Dysfunction [Full Text] Related Post Novel penile circumcision suturing devices versus the shang ring for a... views 38 Ultrasound detection of prostatic calculi as a parameter to predict th... views 29 Transperitoneal vs. extraperitoneal radical cystectomy for bladder can... views 38 Predictive value of propsa (p2psa) and its derivatives for the prostat... views...

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Prostate cancer incidentally discovered at the time of radical cystoprostatectomy does not decrease overall survival: Results from a large Chinese medical center

Vol. 44 (2): 258-266, March – Abril, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0430 ORIGINAL ARTICLE Shiying Tang 1, Han Hao 1, Dong Fang 1, Wei Zheng 1, Peng Ge 1, Xiaohong Su 1, Qun He 1, Xinyu Yang 1, Qi Shen 1, Xuesong Li 1, Wei Yu 1, Jian Lin 1, Liqun Zhou 1 1 Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China ABSTRACT Purpose: To investigate the incidence and pathologic characteristics of prostate can­cer (PCa) incidentally discovered at the time of radical cystectomy and its impact on overall survival. Materials and Methods: A single center retrospective study of 762 male patients who underwent radical cystoprostatectomy from Jan 1994 to Dec 2012. Results: Of all included patients, 132 (17.3%) were found to have PCa. Patients with in­cidental PCa had a significantly higher mean age (69.2 vs. 62.2 years, P=0.015). Among the 132 patients with PCa, prostate specific antigen (PSA) analysis was available in 76 patients (57.6%), with a median value of 1.06ng/mL, and 61 (80.3%) patients had a PSA value below 4ng/mL. Four hundred and thirty-six patients (57.1%) were successfully followed, with a median duration of 46.5 months. The overall 5-year survival rate was 62.1%, and the 5-year cancer–specific survival rate was 72%. PCa recurrence was de­fined by two consecutive PSA values of >0.2 ng/mL and rising, and no PCa recurrence occurred. According to a univariate analyses, incidental PCa was not associated with cancer-specific survival (P=0.192) or overall survival (P=0.493). According to univari­ate analyses, the overall survival of patients with PCa was not associated with prostate cancer staging, PSA value, or Gleason score (All P values>0.05). Conclusions: Prostate cancer incidentally discovered at the time of radical cystectomy does not decrease overall survival. Patients with incidental PCa were older than those without. The PSA value before operation is not helpful for predicting incidental pros­tate cancers. Keywords: Urinary Bladder Neoplasms; Prostatic Neoplasms; Carcinoma [Full Text] Related Post Long-term results of the implantation of the AMS 800 artificial sphinc... views 36 Flexible ureterorenoscopy is associated with less stone recurrence rat... views 30 Bilateral testicular torsion in an adolescent: a case with challenging... views 27 The effect of AST/ALT (De Ritis) ratio on survival and its relation to... views...

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Comparative differences between T1a/b and T1e/m as substages in T1 urothelial carcinoma of the bladder

Vol. 44 (2): 267-272, March – Abril, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0424 ORIGINAL ARTICLE Turgay Turan 1, Özgür Efiloğlu 1, Bilal Günaydin 1, Şeyma Özkanli 2, Emrah Nikerel 3, Gökhan Atiş 1, Turhan Çaşkurlu 1, Asif Yildirim 1 1 Department of Urology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey; 2 Istanbul Medeniyet University, Faculty of Medicine, Department of Pathology, Istanbul, Turkey; 3 Yeditepe Universitesi, Genetics and Bioengineering Istanbul, Turkey ABSTRACT Objective: To evaluate the prognostic value of the depth of lamina propria invasion in patients with T1 bladder cancer and to display comparative differences between the T1a/b and T1e/m substaging systems. Patients and Methods: This study included 106 patients with primary stage T1 urothelial bladder tumours who underwent surgery between January 2009 and December 2014. Pathologic specimens were re-evaluated to confirm the diagnosis of T1 and substaging by the same pathologist using two systems: T1a and T1b, and T1m and T1e. Age, tumour size, multiplicity, associated carcinoma in situ, tumour grade, and T1 substaging system were investigated to detect the relation between disease progression and recurrence. Results: The recurrence rate was 52% for T1a (n=42) vs. 76% for T1b (n=20) (p=0.028) and 55% for T1m (n=32) vs. 62% for T1e (n=30), respectively (p=0.446). There was no significant difference between the substaging groups for disease progression: T1a (n=12, 15%) vs. T1b (n=7, 27%), and T1m (n=8, 13.8%) vs. T1e (n=11, 23%) (p>0.05). In the multivariate analysis, tumour size >3 cm (p=0.008), multiplicity (p=0.049), and substaging T1b (p=0.043) were independent predictive factors for tumour recurrence. According to the Kaplan-Meier actuarial method, recurrence-free survival was significantly different in patients with pT1a tumours compared with those with pT1b tumours (p=0.033). Conclusions: Substaging T1 provides a prediction of disease recurrence. Regarding recurrence, T1a/b substaging can provide better knowledge of disease behaviour because it is predicted as more superior than T1 m/e, and it can help in determining the requirement for early cystectomy. Keywords: Carcinoma; Urinary Bladder; Urinary Bladder Neoplasms [Full Text] Related Post Attenuation of partial unilateral ureteral obstruction -induced renal ... views 17 The history of varicocele: from antiquity to the modern ERA views 52 Validation of the urgency questionnaire in Portuguese: A new instrumen... views 29 Open partial nephrectomy for entirely intraparenchymal tumors: a match... views...

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A Safe teaching protocol of LRP (laparoscopic radical prostatectomy)

Vol. 44 (2): 273-279, March – Abril, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0137 ORIGINAL ARTICLE Marcos Tobias-Machado 1, Cristiano Linck Pazeto 1, Oseas Castro Neves-Neto 1, Igor Nunes-Silva 2, Hamilton de Campos Zampolli 2 1 Departamento de Urologia, Faculdade de Medicina ABC, Santo André, SP, Brasil; 2 Instituto do Câncer Arnaldo Vieira de Carvalho – IAVC , São Paulo, SP, Brasil Purpose: The LRP has a steep learning curve to obtain proficiency during which patient safety may be compromised. We present an adapted modular training system which purpose to optimize the learning curve and perform a safe surgery. Materials and Methods: A retrospective analysis of the LRP safe learning protocol ap­plied during a fellowship program over eight years (2008-2015). The surgery was divided in 12 steps and 5 levels of difficulty. A maximum time interval was stipulated in 240 minutes. After an adaptation, the fellows had 120 minutes to perform all the corresponding modules to its accumulated skill. The participants gradually and safely pass through the steps and difficulty levels. Surgeries performed by fellows were analyzed as a single group and compared to a prior series performed by tutor. Results: In eight years, 250 LRP were performed (25 per apprentice) during fellowship program and 150 procedures after completion. The baseline characteristics were com­parable. Most cases operated were of intermediate risk. Mean operative time was longer in the fellow group when compared to the tutor (150 min). Mean estimated blood loss were similar among the groups. Functional and oncological outcomes were better in the Tutor´s group. No conversion to open surgery was performed. Conclusions: The LRP safe learning protocol proved to be an effective method to opti­mize the learning curve and perform safe surgery. However, the tutor’s functional and oncological results were better, showing that this is a procedure with a steep learning curve and proficiency demands more than 25 cases. Keywords: Prostatectomy; Education; Surgical Procedures, Operative [Full Text] Related Post The history of varicocele: from antiquity to the modern ERA views 52 Effect of Mitomycin – C and Triamcinolone on Preventing Urethral... views 28 Can hydrophilic coated catheters be beneficial for the public healthca... views 25 Positive surgical margins are predictors of local recurrence in conser... views...

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Laparoscopic nephrectomy outside gerota fascia and En bloc ligation of the renal hilum for management of inflammatory renal diseases

Vol. 44 (2): 280-287, March – Abril, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0363 ORIGINAL ARTICLE Liang Ma 1, Yanlan Yu 1, Guangju Ge 1, Gonghui Li 1 1 Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China   ABSTRACT Objectives: This study aims to improve laparoscopic nephrectomy techniques for inflammatory renal diseases (IRD) and to reduce complications. Materials and Methods: Thirty-three patients underwent laparoscopic nephrectomy for IRD, with a method of outside Gerota fascia dissection and en-bloc ligation and division of the renal pedicle. Operative time, blood loss, complications, analgesia requirement, post-operative recovery of intestinal function and hospital stay were recorded. The degrees of perinephric adhesion were classified based on the observation during operation and post-operative dissection of the specimen, and the association of different types of adhesion with the difficulty of the procedures was examined. Results: Among 33 cases, three were converted to hand-assisted laparoscopy, and one was converted to open surgery. Mean operative time was 99.6±29.2min, and blood loss was 75.2±83.5 mL. Postoperative recovery time of intestinal function was 1.6±0.7 days and average hospital stay was 4.8±1.4 days. By classification and comparison of the perinephric adhesions, whether inflammation extending beyond Gerota fascia or involving renal hilum was found to be not only an important factor influencing the operative time and blood loss, but also the main reason for conversion to hand-assisted laparoscopy or open surgery. Conclusions: In laparoscopic nephrectomy, outside Gerota fascia dissection of the kidney and en-bloc ligation of the renal pedicle using EndoGIA could reduce the difficulty of procedure and operative time, with satisfactory safety and reliability. Inflammation and adhesion extending beyond Gerota fascia or involving renal hilum is an important predictor of the difficulty related to laparoscopic nephrectomy for IRD. Keywords: Kidney Diseases; Laparoscopy; Nephrectomy [Full Text] Related Post Overactive bladder syndrome and bladder wall thickness in patients wit... views 29 New concept for treating female stress urinary incontinence with radio... views 30 Vitamin C inhibits crystallization of struvite from artificial urine i... views 39 Stage effect of chronic kidney disease in erectile function views...

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