Vol. 44 n. 3 May . Jun, 2018

Volume 44 | number 3 | May . June, 2018 – Urological myriad – The internationality and diversity of subjects have been remarkable characteristics of International
Braz J Urol, an open free access urological journal, as is this issue

Urological myriad

Vol. 44 (3): 420-421, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2018.03.01 EDITORIAL In this issue Stênio de Cássio Zequi 1 1 Divisão de Urologia do A.C. Camargo Cancer Center Fundação A. Prudente, São Paulo, Brasil The internationality and diversity of subjects have been remarkable characteristics of International Braz J Urol, an open free access urological journal, as is this issue. Collaborative multicenter studies in Urology are lacking in Latin American; efforts in this way are welcome by International Braz J Urol. Colleagues from Mexican centers and Sao Paulo University (Manzo and Vicentini, respectively), found differences in the management of kidney stones with percutaneous nephrolitotomy when compared trained and non-trained urologists. In that survey, they evaluated data from 331 urologists from 15 Latin American countries, that answered a 27-item questionnaire, easily accessed by mobile phones. Patel and Monga, from Cleveland Clinic, present in this issue, the distinct physical and mechanical properties of different ureteral sheaths, that are commercially used in their country, reiterating the possible impact in clinical practice. [Full Text]   Related Post Kidney anatomy: three dimensional (3D) printed pelvicalyceal system mo... views 150 Editorial Comment: Lack of evidence of HPV etiology of prostate cancer... views 105 Salvage surgical procedure for artificial sphincter extrusion views 130 The protective effect of Papaverine and Alprostadil in rat testes afte... views...

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Network meta-analysis, a new statistical technique at urologists’ disposal to improve decision making

Vol. 44 (3): 422-428, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2018.03.02 EDITORIAL Herney Andres Garcia-Perdomo 1, 2 1 Universidad del Valle, Cali, Colombia, CO; 2 Urological Research Group, UROGIV, Cali, Colombia, CO INTRODUCTION Systematic reviews have been determined to be fundamental tools for establishing the magnitude of an effect, with adequate rigor, methodology and scientific quality (1-4). A meta-analysis is a statistical analysis used in medical investigation, to synthesize information, and compare at least two interventions at a time, regarding an appropriate investigative question (4). Additionally, the available comparisons have to be made, in at least two studies, between intervention A and B otherwise, it is not possible to make it; nonetheless we lack of studies which make all the possible comparisons feasible nowadays (5). Due to the lack of direct evidence, tools as network meta-analysis and indirect comparisons have been developed, considering all the available studies, and allowing comparisons regarding a common element, to estimate the effect of an intervention in an indirect way (6, 7). Network meta-analysis has also been called multiple-treatment comparison or mixed-treatment comparison meta-analysis (8). The aim of this review is to expose the introductory concepts of network meta-analyses, and indirect comparisons. [Full Text]   Related Post Urethral stricture: the oldest urologic disease in 2017 views 134 Laparoscopic transperitoneal repair of retrocaval (circumcaval) ureter views 139 Selection of best videos of the year for 2016 views 125 Best videos of the year in 2017 views...

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Prostate Cancer – Local Treatment after Radiorecurrence: HIFU – High-Intensity Focused Ultrasound

Vol. 44 (3): 429-432, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2018.03.03 DIFFERENCE OF OPINION Stenio de Cassio Zequi 1, Thiago Camelo Mourao 2, Gustavo Cardoso Guimaraes 1 1 Divisão de Urologia, AC Camargo Cancer Center, Fundação A. Prudente, São Paulo, SP, Brasil; 2 Departamento de Urooncologia, Laparoscopia e Robótica, AC Camargo Cancer Center, Fundação A. Prudente, São Paulo, SP, Brasil Keywords: High-Intensity Focused Ultrasound Ablation; Prostatic Neoplasms; Radiotherapy Currently, about one third of all newly diagnosed prostate cancer patients select radiotherapy or brachytherapy (BT) as their primary treatment (1). Primary external beam radiation therapy (EBRT) in localized prostate cancer has a risk of biochemical recurrence about 30-60% (1, 2). The most widely utilized criteria for EBRT biochemical relapse is the Phoenix definition (2006). It is established as a PSA elevation of ≥ 2 ng/mL above the nadir PSA (3).There are a variety of treatment options, like watchful waiting, androgen deprivation therapy (ADT) and local salvage therapies. None of them are accepted as gold standard salvage treatments. Another important point is that recurrences are associated with an increased risk of death, metastases and local complications, such as ureteral obstruction, hematuria and pelvic pain (1). [Full Text]   Related Post BPH treatment: laser for everyone | Opinion: YES views 163 Comparison of perioperative outcomes with or without renorrhaphy durin... views 162 Evaluation of apoptosis indexes in currently used oral alpha-blockers ... views 161 Positive surgical margins are predictors of local recurrence in conser... views...

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Prostate Cancer – Local Treatment after Radiorecurrence: Surgery – Back to the future?

Vol. 44 (3): 433-434, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2018.03.04 DIFFERENCE OF OPINION Leonardo O. Reis 1,2 Paul L. Nguyen 3 1 Departamento de Oncologia Urológica (UroScience), Pontifícia Universidade Católica de Campinas, PUC – Campinas, SP, Brasil; 2 Universidade Estadual de Campinas, Unicamp, Campinas, SP, Brasil; 3 Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA Keywords: Prostatic Neoplasms; Salvage Therapy; Radiation As radiotherapy advances, inadequate deliveries decrease and salvage radical prostatectomy, when necessary, tends to be less challenging with improving oncological and functional results. It treats cancer foci in regions such as apex or periurethral tissue, often spared in ablative approaches to minimize side effects; adds the clear goal of an undetectable PSA; and the opportunity for pelvic lymph-node dissection to potentially treat loco regional micrometastasis. Up to 50% of men may develop recurrence after definitive radiation for prostate cancer, and about one-third of these men will have a biopsy-proven local radiorecurrence, which occurs due to either inadequate delivery of the prescribed radiation dose or inherent biologic resistance of prostate cancer clones to radiation. Standard of care for these patients has been classically observation followed by androgen deprivation (ADT), which adds substantial morbidity and doesn’t offer the possibility of cure. [Full Text]   Related Post Ureteral access sheaths: a comprehensive comparison of physical and me... views 230 Testicular versus ejaculated sperm should be used for intracytoplasmic... views 144 On thin ice: barriers to adoption of surveillance for patients with st... views 124 Radical Cystectomy is the best choice for most patients with muscle-in... views...

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Prostate Cancer – Local Treatment after Radiorecurrence: Salvage Cryoablation

Vol. 44 (3): 435-439, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2018.03.05 DIFFERENCE OF OPINION Rodrigo Donalisio da Silva1, 2, Fernando J. Kim 1,2 1 Division of Urology, Denver Health Medical Center, Denver, CO, USA; 2 Division of Urology, University of Colorado Denver, Denver, CO, USA   Keywords: Radiation; Prostatic Neoplasms; Radiotherapy   Radiation therapy (RT) is an effective treatment for localized prostate cancer and approximately 45% of patients diagnosed with localized prostate cancer choose radiotherapy as initial treatment (1). Novel RT technology is evolving, allowing more targeted and higher doses of radiation in the prostate such as three-dimensional conventional RT and intensity-modulated conformal RT. [Full Text]   Related Post Re: Dipyridamole reduces penile apoptosis in a rat model of post-prost... views 181 Urological myriad views 148 Surgical repair in case of covered exstrophy of bladder with complete ... views 145 Testicular versus ejaculated sperm should be used for intracytoplasmic... views...

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Clinical and pathologic factors predicting reclassification in active surveillance cohorts

Vol. 44 (3): 440-451, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0320 REVIEW ARTICLE Pablo S. Sierra 1, Shivashankar Damodaran 2, David Jarrard 2, 3 1 Fundacion Valle del Lili -Universidad Icesi, Cali, Colombia; 2 Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; 3 University of Wisconsin Carbone Cancer Center, Madison, WI, USA ABSTRACT The incidence of small, lower risk well-differentiated prostate cancer is increasing and almost half of the patients with this diagnosis are candidates for initial conservative management in an attempt to avoid overtreatment and morbidity associated with sur¬gery or radiation. A proportion of patients labeled as low risk, candidates for Active Surveillance (AS), harbor aggressive disease and would benefit from definitive treat¬ment. The focus of this review is to identify clinicopathologic features that may help identify these less optimal AS candidates. A systematic Medline/PubMed Review was performed in January 2017 according to PRISMA guidelines; 83 articles were selected for full text review according to their relevance and after applying limits described. For patients meeting AS criteria including Gleason Score 6, several factors can assist in predicting those patients that are at higher risk for reclassification including higher PSA density, bilateral cancer, African American race, small prostate volume and low testosterone. Nomograms combining these features improve risk stratification. Clinical and pathologic features provide a significant amount of information for risk stratification (>70%) for patients considering active surveillance. Higher risk patient subgroups can benefit from further evaluation or consideration of treatment. Recom¬mendations will continue to evolve as data from longer term AS cohorts matures. Keywords: Prostatic Neoplasms; Neoplasm Grading [Full Text]   Related Post Positive surgical margins are predictors of local recurrence in conser... views 171 Efficacy of targeted therapy for advanced renal cell carcinoma: a syst... views 219 Urological myriad views 148 Analgesia for patients undergoing shockwave lithotripsy for urinary st... views...

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On thin ice: barriers to adoption of surveillance for patients with stage I testicular seminoma. Survey of US radiation oncologists

Vol. 44 (3): 452-460, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0454 ORIGINAL ARTICLE Aditya Jain 1,2, Catherine Degnin 2, Yiyi Chen 2, Mike Craycraft 3, Arthur Hung 2, Jerry Jaboin 2, Charles R. Thomas, Jr. 2, Timur Mitin 2 1 Boston University, Boston, MA, USA; 2 Oregon Health and Science University, Portland, OR, USA. 3 Testicular Cancer Society, Cincinnati, OH, USA ABSTRACT Purpose: Most men with stage I testicular seminoma are cured with surgery alone, which is a preferred strategy per national guidelines. The current pattern of practice among US radiation oncologists (ROs) is unknown. Materials and Methods: We surveyed practicing US ROs via an online questionnaire. Respondent’s characteristics, self-rated knowledge, perceived patient compliance rates with observation were analyzed for association with treatment recommendations. Results: We received 353 responses from ROs, of whom 23% considered themselves experts. A vast majority (84%) recommend observation as a default strategy, however this rate drops to 3% if the patient is believed to be noncompliant. 33% of respondents believe that survival is jeopardized in case of disease recurrence, and among these respondents only 5% support observation. 22% of respondents over-estimate the likeli­hood of noncompliance with observation to be in the 50-80% range. Responders with a higher perceived noncompliance rate are more likely to recommend adjuvant therapy (Fisher’s exact p<0.01). Only 7% of respondents recommend observation for stage IS seminoma and 45% administer adjuvant RT in patients with elevated pre-orchiectomy alpha-fetal protein levels. Conclusions: Many US ROs over-estimate the likelihood that stage I testicular semi­noma patients will be noncompliant with surveillance and incorrectly believe that overall survival is jeopardized if disease recurs on surveillance. Observation is quickly dismissed for patients who are not deemed to be compliant with observation, and is generally not accepted for patients with stage IS disease. There is clearly an oppor­tunity for improved physician education on evidence-based management of stage I testicular seminoma. Keywords: Seminoma; Chemotherapy, Adjuvant; Radiotherapy; Health Care Surveys [Full Text]   Related Post Comparison of the Kelly’s plication and TOT simultaneously with vagina... views 180 Management of long segment anterior urethral stricture (≥ 8cm) using b... views 240 Comparative analysis of short – term functional outcomes and qua... views 130 The demographic features, clinical outcomes, prognosis and treatment o... views...

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Can preoperative neutrophil lymphocyte ratio predict malignancy in patients undergoing partial nephrectomy because of renal mass?

Vol. 44 (3): 461-466, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0225 ORIGINAL ARTICLE Sacit Nuri Gorgel 1, Kutan Ozer 1, Osman Kose 1, Ahmet Selçuk Dindar 1 1 Department of Urology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, , Izmir,Turkey ABSTRACT Purpose: To evaluate the importance of preoperative neutrophil lymphocyte ratio (NLR) predicting malignancy in patients who undergo partial nephrectomy due to renal mass. Materials and Methods: Seventy nine patients who underwent open partial nephrec­tomy for renal masses were included in this retrospective study. In preoperative routine blood tests, renal ultrasonography and contrast-enhanced computed tomography were performed for all patients. Preoperative neutrophil lymphocyte ratio were compared in patients with clear cell renal cell carcinoma (Group1, 65 patients) and benign lesions (Group 2, 14 patients). The predictive ability of NLR was analyzed by ROC curves and Youden Index method was used to identify the cut-off value for NLR. Results: The mean age of patients was 59.8±11.7 years in Group1 and 57.4±12.6 years in Group 2 (p=0.493). The mean tumor size was 3.8±1.2 cm in Group 1 and 3.3±1.0 cm in Group 2 (p=0.07). The median NLR was 2.48 (1.04) in Group 1 and 1.63 (0.96) in Group 2 (p<0.001). The area under a ROC curve was 0.799 (p<0.001). Conclusions: Preoperative neutrophil lymphocyte ratio may predict renal masses that can not be distinguished radiologically. Our results must be confirmed by large and properly designed prospective, randomized trials. Keywords: Carcinoma, Renal Cell; Neutrophils; Lymphocytes [Full Text] Related Post Comparing the short – term outcomes and complications of monopol... views 148 Urethral Pressure Variation: A neglected contributing factor in patien... views 114 Effects of Copaiba oil in the healing process of urinary bladder in ra... views 123 Predicting outcomes in partial nephrectomy: is the renal score useful? views...

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Comparison of perioperative outcomes with or without renorrhaphy during open partial nephrectomy: A propensity score-matched analysis

Vol. 44 (3): 467-474, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2016.0581 ORIGINAL ARTICLE Hidekazu Tachibana 1, Toshio Takagi 1, Tsunenori Kondo 1, Hideki Ishida 1, and Kazunari Tanabe 1 1 Department of Urology, Tokyo Women’s Medical University, Tokyo, Japan ABSTRACT Purpose: Renorrhaphy in partial nephrectomy may damage intraparenchymal vessels and compress the renal parenchyma, which may lead to the formation of renal artery pseudoaneurysms or vascularized parenchymal volume reduction. Using propensity score matching, we compared surgical outcomes following non-renorrhaphy and renorrhaphy techniques for open partial nephrectomy (OPN) for T1a renal tumors. Materials and Methods: We retrospectively analyzed data from 159 patients with normal contralateral kidneys who underwent OPN for T1a renal tumors and pre- and postoperative enhanced computed tomography between 2012 and 2015. Patient variables were adjusted using 1:1 propensity score matching between the two Groups: renorrhaphy (inner and outer layer sutures) and non-renorrhaphy (inner layer sutures only). Postoperative complications and renal function were compared between the two groups. Results: We matched 43 patients per Group. Operative time, estimated blood loss, cold ischemic time, and postoperative hospital stay were not significantly different between the two Groups. Urine leakage (Clavien-Dindo grade ≥3) occurred in 0 renorrhaphy cases and 2 non-renorrhaphy cases (0% versus 4.6%, P=0.49). Renal artery pseudoaneurysm (RAP) occurred in 6 renorrhaphy cases and in 0 non-renorrhaphy cases (13% versus 0%, P=0.02). Conclusions: The non-renorrhaphy technique may result in a lower risk of RAP but a greater risk of urine leakage. This technique needs further refinement to become a standard procedure for OPN. Keywords: Complications, non-renorrhaphy, partial nephrectomy, renal cell carcinoma, renal function [Full Text] Related Post Which intraperitoneal insufflation pressure should be used for less po... views 120 Anterior six arms prolene mesh for high stage vaginal prolapse: five y... views 142 Effect of tadalafil 5mg daily treatment on the ejaculatory times, lowe... views 145 Serum tissue factor as a biomarker for renal clear cell carcinoma views...

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Positive surgical margins are predictors of local recurrence in conservative kidney surgery for pT1 tumors

Vol. 44 (3): 475-482, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0039 ORIGINAL ARTICLE Patricio Garcia Marchiñena 1, Sebastián Tirapegui 1, Ignacio Tobia Gonzalez 1, Alberto Jurado 1, Guillermo Gueglio 1 1 Department of Urology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina ABSTRACT Objectives: The clinical significance of positive surgical margin (PSM) after a Nephron Sparing Surgery (NSS) is controversial. The aim of this study is to evaluate the association between PSM and the risk of disease recurrence in patients with pT1 kidney tumors who underwent NSS. Materials and Methods: Retrospective cohort study. A total of 314 patients submitted to a NSS due to stage pT1 renal tumor between January 2010 and June 2015 were included. Recurrence-free survival was estimated. The Cox model was used to adjust the tumor size, histological grade, pathological stage, age, surgical margins and type of approach. Results: Overall PSM was 6.3% (n=22). Recurrence was evidenced in 9.1% (n=2) of patients with PSM and 3.5% (n=10) for the group of negative surgical margin (NSM). The estimated local recurrence-free survival rate at 3 years was 96.4% (95% CI 91.9 to 100) for the NSM group and 87.8% (95% CI 71.9 to 100) for PSM group (p=0.02) with no difference in metastasis-free survival. The PSM and pathological high grade (Fuhrman grade III or IV) were independent predictors of local recurrence in the multivariate analysis (HR 12.9, 95%CI 1.8-94, p=0.011 / HR 38.3, 95%CI 3.1-467, p=0.004 respectively). Fuhrman grade proved to be predictor of distant recurrence (HR 8.1, 95%CI 1.6-39.7, p=0.011). Conclusions: The PSM in pT1 renal tumors showed to have higher risk of local recurrence and thus, worse oncological prognosis.   Keywords: Kidney; Surgical Procedures, Neoplasms; Prognosis [Full Text]   Related Post Pro – inflammatory cytokines and metalloproteinase activation in... views 130 Ureteral access sheaths: a comprehensive comparison of physical and me... views 230 An unanswered question in pediatric urology: the post pubertal persist... views 169 Hyberbaric oxygen as sole treatment for severe radiation – induc... views...

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