Vol. 44 n. 5 Set . Oct, 2018

Volume 44 | number 5 | Set . Oct, 2018 -The September-October 2018 issue of the International Braz J Urol presents original contributions with a lot of interesting papers in different fields: Renal stones, Prostate Cancer, Renal Cell Carcinoma, Laparoscopy, Vaginal Prolapse, BPH…

Editorial Comment: Gastric Neobladders: surgical outcomes of 91 cases using different techniques

Vol. 44 (5): 920-921, September – October, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0563.1 EDITORIAL COMMENT 1 Richard Hautmann 1 Department of Urology, University of Ulm, Germany Not available [Full Text]   Related Post Prognostic role of preoperative albumin to globulin ratio in predictin... views 227 Gastric neobladders: surgical outcomes of 91 cases using different tec... views 199 Editorial Comment: Use of indocyanine green angiography in microsurgic... views 131 Dynamic 11C-Choline PET / CT for the primary diagnosis of prostate can... views...

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Localized chromophobe renal cell carcinoma: preoperative imaging judgment and laparoscopic simple enucleation for treatment

Vol. 44 (5): 922-932, September – October, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0519 ORIGINAL ARTICLE Wenbiao Ren 1, Bichen Xue 1, Jiandong Qu 1, Longfei Liu 1, Chao Li 1, Xiongbing Zu 1 1 Department of Urology, Xiangya Hospital, Central South University, Changsha, China ABSTRACT Objective: To evaluate the preoperative imaging manifestation and therapeutic effect of laparoscopic simple enucleation (SE) for localized chromophobe renal cell carcinoma (chRCC). Materials and Methods: Clinical data of 36 patients who underwent laparoscopic SE of localized chRCC at our institute were retrospectively analyzed. All patients underwent preoperative renal protocol CT (unenhanced, arterial, venous, and delayed images). CT scan characteristics were evaluated. After intraoperative occlusion of the renal artery, the tumor was free bluntly along the pseudocapsule and enucleated totally. The patients were followed up regularly after the operation. Results: Mean tumor diameter was 3.9±1.0 cm, 80% of tumors were homogeneous and all the tumors had complete pseudocapsule. The attenuation values were slightly lower than normal renal cortex and degree of enhancement of the tumors were significantly lower than normal renal cortex. Mean operation time was 104.3±18.2 min. Mean warm ischemia time (WIT) was 21.3±3.5 min. Mean blood loss was 78.6±25.4 mL. No positive surgical margin was identified. Mean postoperative hospital stay was 5.3±1.5 d. Hematuria occurred in 3 patients and all disappeared within 3 days. After a mean follow-up of 32.1±20.6 months, no patient had local recurrence or metastatic progression. Conclusion: Localized chRCCs have a great propensity for homogeneity and complete pseudocapsule. The attenuation values were slightly lower than normal renal cortex and small degree of enhancement. Laparoscopic SE is a safe and effective treatment for localized chRCC. The oncological results were satisfactory. Keywords: Carcinoma, Renal Cell; Laparoscopy; Therapeutics [Full Text]   Related Post Objective value on ADC map to categorize the intensity of DWI restrict... views 137 Impact on sexual function of surgical treatment in rectal cancer views 145 The influence of previous robotic experience in the initial learning c... views 139 Emergency percutaneous nephrostomy versus emergency percutaneous nephr... views...

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Prognostic role of preoperative albumin to globulin ratio in predicting survival of clear cell renal cell carcinoma

Vol. 44 (5): 933-946, September – October, 2018 doi: 10.1590/S1677-5538.IBJU.2018.0012 ORIGINAL ARTICLE Murat Yavuz Koparal 1, Fazlı Polat 2, Serhat Çetin 3, Ender Cem Bulut 4, Tevfik Sinan Sözen 2 1 Department of Urology, Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey; 2 Department of Urology, School of Medicine, Gazi University, Ankara, Turkey; 3 Urology Clinic, Viranşehir State Hospital, Şanliurfa, Turkey; 4 Department of Urology, Van Training and Research Hospital, Van, Turkey ABSTRACT   Purpose: To investigate the prognostic role of preoperative albumin/globulin ratio (AGR) in predicting disease-free survival (DFS) and overall survival (OS) in localized and locally advanced clear cell renal cell carcinoma (RCC) patients. Patients and Methods: 162 patients who met the criteria specified were included in the study. The DFS and OS ratios were determined using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the prognostic factors affecting DFS and OS. Results: Median follow-up period was 27.5 (6-89) months. There was a statistically significant relationship between low AGR and high pathological tumor (pT) stage, presence of collecting system invasion, presence of tumor necrosis, and a high platelet count (p = 0.012, p = 0.01, p = 0.001, and p = 0.004, respectively). According to the Kaplan-Meier survival analysis, both OS and DFS were found to be significantly lower in the low AGR group (p = 0.006 and p = 0.012). In the multivariate Cox regression analysis, collecting system invasion and tumor necrosis were found to be independent prognostic factors in predicting OS and pT stage was found to be an independent prognostic factor in predicting DFS (HR: 4.08, p = 0.043; HR: 8.64, p = 0.003 and HR: 7.78, p = 0.041, respectively). Conclusion: In our study, low AGR was found to be associated with increased mortality and disease recurrence in localized and locally advanced RCC. Keywords: Albumins; Globulins; Carcinoma, Renal Cell [Full Text]   Related Post Moderate or severe LUTS is associated with increased recurrence of non... views 108 Quality of Life after post-prostatectomy intensity modulated radiation... views 138 Current practice of antibiotic utilization for renal colic in the emer... views 135 Abobotulinum – a toxin injection in patients with refractory idi... views...

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Seasonal variations in urinary calcium, volume, and vitamin d in kidney stone formers

Vol. 44 (5): 947-951, September – October, 2018 doi: 10.1590/S1677-5538.IBJU.2018.0095 ORIGINAL ARTICLE Kyrollis Attalla 1, Shubha De 1, Carl Sarkissian 1, Manoj Monga 1 1 Glickman Urologic & Kidney Institute, Cleveland Clinic, OH, USA ABSTRACT Objectives: To investigate the seasonal variations in urinary calcium, serum vitamin D, and urinary volume in patients with a history of nephrolithiasis. Materials and Methods: Patients included were those who completed a 24-hour urine metabolic evaluation on two occasions; one in summer (June-Aug) and one in winter (Nov-Jan), and who had not started any medications or been instructed on dietary modifications in the interval between the two tests that may have impacted the results. Patients were excluded if they were on thiazide diuretics or were taking calcium and / or Vitamin D supplementation. Welch’s t-test was used to compare the difference in average summer and winter values. Unpaired Student t-test was used to compare baseline parameters (age, BMI), and Paired Student t-test was used to compare average seasonal measurements in men vs. women. Results: 136 patients were identified who were not taking calcium or vitamin D supple­ments or thiazide diuretics, and who were not instructed on dietary modifications in the interval between the two measured parameters. No significant differences were observed when comparing male to female baseline parameters of age or BMI (Table-1). Average 24-hour urine calcium was higher (226.60) in the winter than in summer (194.18) and was significant in males (p = 0.014) and females (p < 0.001). No signifi­cant seasonal difference was seen in 24-hour urine volume or serum vitamin D levels. Conclusions: Urinary calcium is higher in winter months compared to summer months. As such, tailoring medical preventative strategies to the time of year may be helpful. Keywords: Kidney; Calculi; Urinary Tract [Full Text]   Related Post Transperitoneal vs. extraperitoneal radical cystectomy for bladder can... views 191 Durasphere® EXP: a non-biodegradable agent for treatment of primary Ve... views 193 The prostate after castration and hormone replacement in a rat model: ... views 148 Effects of nitric oxide inhibitors in mice with bladder outlet obstruc... views...

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Personalized 3D kidney model produced by rapid prototyping method and its usefulness in clinical applications

Vol. 44 (5): 952-957, September – October, 2018 doi: 10.1590/S1677-5538.IBJU.2018.0162 ORIGINAL ARTICLE Hakmin Lee 1, Ngoc Ha Nguyen 2, Sung Il Hwang 3, Hak Jong Lee 3, Sung Kyu Hong 1, Seok-Soo Byun 1 1 Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea; 2 Department of Urology, Cho Ray hospital, Ho Chi Minh city, Vietnam; 3 Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea ABSTRACT Background: Three-dimensional (3D) printing has been introduced as a novel technique to produce 3D objects. We tried to evaluate the clinical usefulness of 3D-printed renal model in performing partial nephrectomy (PN) and also in the education of medi­cal students. Materials and Methods: We prospectively produced personalized renal models using 3D-printing methods from preoperative computed tomography (CT) images in a total of 10 patients. Two different groups (urologist and student group) appraised the clinical usefulness of 3D-renal models by answering questionnaires. Results: After application of 3D renal models, the urologist group gave highly positive responses in asking clinical usefulness of 3D-model among PN (understanding per­sonal anatomy: 8.9 / 10, preoperative surgical planning: 8.2 / 10, intraoperative tumor localization: 8.4 / 10, plan for further utilization in future: 8.3 / 10, clinical usefulness in complete endophytic mass: 9.5 / 10). The student group located each renal tumor correctly in 47.3% when they solely interpreted the CT images. After the introduction of 3D-models, the rate of correct answers was significantly elevated to 70.0% (p < 0.001). The subjective difficulty level in localizing renal tumor was also significantly low (52% versus 27%, p < 0.001) when they utilized 3D-models. Conclusion: The personalized 3D renal model was revealed to significantly enhance the understanding of correct renal anatomy in patients with renal tumors in both urologist and student groups. These models can be useful for establishing the perioperative planning and also education program for medical students. Keywords: Printing, Three-Dimensional; Kidney Neoplasms; Nephrectomy [Full Text]   Related Post Validation of the urgency questionnaire in Portuguese: A new instrumen... views 165 Assessment of hormonal activity in patients with premature ejaculation views 125 The influence of previous robotic experience in the initial learning c... views 139 Objective measurements of the penile angulation are significantly diff... views...

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Simultaneous treatment of parapelvic renal cysts and stones by flexible ureterorenoscopy with a novel four-step cyst localization strategy

Vol. 44 (5): 958-964, September – October, 2018 doi: 10.1590/S1677-5538.IBJU.2018.0074 ORIGINAL ARTICLE Ning Kang 1, Xing Guan 1, Liming Song 1, Xiaodong Zhang 1, Junhui Zhang 1 1 Department of Urology, Institute of Urology, Capital Medical University, University Beijing Chaoyang Hospital  ABSTRACT Objective: To assess the safety, feasibility, and efficacy of simultaneous treatment of parapelvic renal cysts and stones by flexible ureterorenoscopy with a novel four-step cyst localization strategy in selected patients. Patients and Methods: We retrospectively reviewed 11 consecutive cases of parapelvic renal cysts with concomitant calculi treated by flexible ureterorenoscopy and laser lithotripsy (FURSL). Marsupialization was performed subsequently with holmium: YAG laser in our institution. Fragmentation was used to manage renal stones and a novel four-step cyst localization strategy was applied in each case for marsupialization. Results: There were no intraoperative complications. Two cases of cystitis were reported postoperatively. The mean operative times of FURSL and marsupialization were 23.6 ± 3.9 minutes and 29.1 ± 9.7 minutes, respectively. During marsupialization, seven patients underwent the first two steps of the new strategy, two patients underwent three steps and two patients underwent all four steps. The mean reduction in hemoglobin level was 4.7 ± 1.7 g / L (range 3-8 g / L). The mean length of hospital stay was 1.2 ± 0.4 days. During a mean follow-up duration of 18 months, all cases remained stonefree and there was no stone recurrence. Parapelvic cysts became undetectable in eight cases and decreased in size by at least half in three cases. Conclusion: With appropriate patient selection, FURSL and marsupialization with a four-step cyst localization strategy is feasible, safe, and effective in treating parapelvic renal cysts with concomitant calculi. Keywords: Calculi; Lithotripsy; Renal Colic [Full Text]   Related Post Risk factors for urinary tract infection in children with urinary urge... views 254 What is the quickest scoring system to predict percutaneous nephrolith... views 147 A neural network – based algorithm for predicting stone – ... views 160 HPV vaccination is fundamental for reducing or erradicate penile cance... views...

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Impact of patient position on the outcomes of percutaneous neprolithotomy for complex kidney stones

Vol. 44 (5): 965-971, September – October, 2018 doi: 10.1590/S1677-5538.IBJU.2018.0163 ORIGINAL ARTICLE Fabio Carvalho Vicentini 1, Rodrigo Perrella 1, Vinicius M. G. Souza 1, Marcelo Hisano 1, Claudio Bovolenta Murta 1, Joaquim Francisco de Almeida Claro 1 1 Departamento de Urologia, Setor de Endourologia e Litíase, Hospital Brigadeiro, São Paulo, SP, Brasil ABSTRACT Purpose: To evaluate the impact of the patient position on the outcomes of PCNL among patients with complex renal stones. Material and Methods: From July 2011 to July 2014, we collected prospective data of consecutive patients who underwent PCNL. We included all patients with complex stones (Guy’s Stone Score 3 or 4 (GSS) based on a CT scan) and divided them based on the position used during PCNL (prone or supine). The variables analyzed were gender, age, body mass index, ASA score, stone diameter, GSS, number of punctures, calyx puncture site, intercostal access and patient positioning. Complications were graded according to the modified-Clavien Classification. Success was considered if fragments ≤ 4mm were observed on the first postoperative day CT scan. Results: We analyzed 240 (46.4%) of 517 PCNL performed during the study period that were classified as GGS 3-4. Regarding patient positions, 21.2% were prone and 79.8% were supine. Both groups were comparable, although intercostal access was more com­mon in prone cases (25.5% vs 10.5%; p=0.01). The success rates, complications, blood transfusions and surgical times were similar for both groups; however, there were sig­nificantly more visceral injuries (10.3% vs 2.6%; p=0.046) and sepsis (7.8% vs 2.1%; p=0.042) in prone cases. Conclusion: Supine or prone position were equally suitable for PCNL with complex stones and did not impact the success rates. However, supine position was associated with fewer sepsis cases and visceral injuries. Keywords: Kidney Calculi; Nephrolithotomy, Percutaneous; Supine Position; Prone Position [Full Text]   Related Post Durasphere® EXP: a non-biodegradable agent for treatment of primary Ve... views 193 Localized chromophobe renal cell carcinoma: preoperative imaging judgm... views 170 Is urotherapy alone as effective as a combination of urotherapy and bi... views 128 Costs analysis of surgical treatment of stress urinary incontinence in... views...

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Impact of overactive bladder on retrograde ejaculation

Vol. 44 (5): 972-980, September – October, 2018 doi: 10.1590/S1677-5538.IBJU.2018.0225 ORIGINAL ARTICLE Ahmet Salvarci 1, Mehmet Karabakan 2, Aliseydi Bozkurt 3, Erkan Hirik 3, Binhan Kagan Aktaş 4 1 Department of Urology, Novafertile IVF Centers and Konya Hospital, Konya, Turkey; 2 Department of Urology, Mersin Toros State Hospital, Mersin, Turkey; 3 Department of Urology, Erzincan University, Mengücek Gazi Research and Training Hospital, Erzincan, Turkey; 4 Department of Urology, Ankara Numune Research and Training Hospital, Ankara, Turkey ABSTRACT Purpose: To evaluate the impact of overactive bladder disorder on patients diagnosed with retrograde ejaculation. Materials and Methods: Retrospective analysis of prospective collected database made. Questionnaires conducted in urology polyclinics in five different centers. Main Outcome Measure(s): International Index of Erectile Function – 5 (IIEF – 5), Overactive Bladder 8 – Question Awareness Tool (OAB – V8), urodynamics, semen analysis. The participants of the study were n = 120 patients. There was retrograde ejaculation (RE) in only n = 47 patients (non / minimal symptomatic patients), n = 73 patients had RE and overactive (OAB) complaints (symptomatic patients) and received anticholinergic treatment (trospium), n = 37 control group patients who only had OAB and received an anticholinergic. Results: While no difference was observed in overactive bladder examination and urodynamic values between the non / minimal symptomatic group and the symptomatic group (p > 0.05), sperm was detected and identified as fructose positive in post – ejaculation urine in the symptomatic group. Thus, it was possible to demonstrate the differences between symptomatic patients and non – symptomatic patients. Consequently, following three – month daily treatment with trospium 30 mg 2 x 1 in the control group and the symptomatic group, it was observed that an evident increase was observed in the sperm count and ejaculate volume in the symptomatic group and that no change was observed in the control group (p < 0.05). Conclusion: This clinical study is the first of its kind in terms of revealing the coexistence of RE with OAB upon performing urodynamics and showing that treatment is possible in selected patients. Keywords: Urinary Bladder, Overactive; Ejaculation; Urodynamics [Full Text]   Related Post Artificial urinary sphincter for urinary incontinence after radical pr... views 150 Myiasis associated with penile carcinoma: a new trend in developing co... views 158 Single perineal incision placement of artificial urinary sphincter wit... views 130 Transition to adulthood with a bladder augmentation: histopathologic c... views...

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Does total testicular volume predict testicular volume difference in adolescent males with varicocele?

Vol. 44 (5): 981-986, September – October, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0652 ORIGINAL ARTICLE Ari P. Bernstein 1, Ethan B. Fram 1, 2, Amanda North 1, 2, Anthony Casale 1, 2, Beth A. Drzewiecki 1, 2 1 Albert Einstein College of Medicine, NY, USA and 2 Montefiore Medical Center, NY, USA ABSTRACT Introduction: We evaluated the relationship between total testicular volume (TTV) and testicular volume differential (TVD) in adolescent males with varicocele. Both low TTV and high TVD have been independently associated with higher incidences of infertility later in life, but a predictive relationship between TTV and TVD directly has yet to be described. Materials and Methods: We retrospectively analyzed a database of Tanner 5 boys ages 16-21 who presented with varicocele at a single institution between 2009 and 2017. All patients had a scrotal sonogram prior to surgical intervention. TTV and TVD were calculated for each individual and four non-exclusive groupings of patients were cre¬ated for statistical analysis. We chose 30 cc as a cut off value for low TTV based on prior studies. Results: 209 patients met our inclusion criteria. Mean age was 18.3 years (16-21, SD 1.7) with a mean total testicular volume of 36 cc (13.5-78.2, SD 11.1). Cut off points of TVD of 20% and TTV of 30 cc were used to separate patients. There were 65 boys (31%) with TTV < 30 cc and 58 boys (28%) with TVD ≥ 20%. Among males with TTV < 30 cc, 23 (35%) had a TVD ≥ 20%. Among males with TTV ≥ 30 cc, 35 (24%) had a TVD ≥ 20%. The relationship between TVD and TTV was found to be non-significant (p > 0.05). Discussion: Adolescent varicoceles continue to pose a challenge to pediatric urologists. The dilemma of over-aggressive treatment has proven difficult to balance with the risk of infertility. We hoped that elucidating the relationship between TTV and TVD could be useful in identifying patients who are at greater risk for infertility while decreasing the need for more intrusive testing, such as semen analysis, in an adolescent popula¬tion. We looked at the direct relationship between low TTV and high TVD. In our popu¬lation, there was a non-significant relationship between TTV < 30 cc and TVD ≥ 20% (p > 0.05) indicating that in adolescents with varicocele, TTV and TVD are independent variables. Our study limitations include the inherent user dependent bias of ultrasound measurements and data collection at a single institution with high ethnic diversity, possibly not comparable to all patient populations. Conclusions: Low TTV (< 30 cc) itself is not predictive of high TVD (≥ 20%) in ado¬lescent boys with varicocele, despite their reported independent associations with im¬paired fertility in other studies. Keywords: Varicocele; Adolescent; Infertility [Full Text]   Related Post Erectile dysfunction in ankylosing spondylitis patients views 159 Lowering positive margin rates at radical prostatectomy by color codin... views 214 First brazilian consensus of advanced prostate cancer: recommendations... views 871 On thin ice: barriers to adoption of surveillance for patients with st... views...

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Is urotherapy alone as effective as a combination of urotherapy and biofeedback in children with dysfunctional voiding?

Vol. 44 (5): 987-995, September – October, 2018 doi: 10.1590/S1677-5538.IBJU.2018.0194 ORIGINAL ARTICLE Adem Altunkol 1, Deniz Abat 2, Nevzat Can Sener 1, Mehmet Gulum 3, Halil Ciftci 4, Murat Savas 5, Ercan Yeni 6 1 Department of Urology, Adana City Teaching and Research Hospital, University of Healthy Sciences, Adana, Turkey; 2 Department of Urology, Ministry of Health, Iskenderun State Hospital, Hatay, Turkey; 3 Department of Urology, Ankara Keçiören Teaching and Research Hospital, University of Healthy Sciences, Ankara, Turkey; 4 Department of Urology, Faculty of Medicine, Harran University, Şanliurfa, Turkey; 5 Department of Urology, Antalya Teaching and Research Hospital, University of Healthy Sciences, Antalya, Turkey; 6 Department of Urology, Ankara Numune Teaching and Research Hospital, University of Healthy Sciences, Ankara, Turkey ABSTRACT Objective: To compare standard urotherapy with a combination of urotherapy and biofeedback sessions and to determine the changes that these therapies promote in children with dysfunctional voiding. Patients and Methods: The data of 45 patients who participated in the study from January 2010 to March 2013 were evaluated. All patients underwent urinary system ultrasonography to determine post-void residual urine volumes and urinary system anomalies. All patients were diagnosed using uroflowmetry – electromyography (EMG). The flow pattern, maximum flow rate, and urethral sphincter activity were evaluated in all patients using uroflowmetry – EMG. Each patient underwent standard urotherapy, and the results were recorded. Subsequently, biofeedback sessions were added for all patients, and the changes in the results were recorded and statistically compared. Results: A total of forty – five patients were included, of which 34 were female and 11 were male and the average age of the patients was 8.4 ± 2.44 years (range: 5 – 15 years). After the standard urotherapy plus biofeedback sessions, the post-void residual urine volumes, incontinence rates and infection rates of patients were significantly lower than those with the standard urotherapy (p < 0.05). A statistically significant improvement in voiding symptoms was observed after the addition of biofeedback sessions to the standard urotherapy compared with the standard urotherapy alone (p < 0.05). Conclusions: Our study showed that a combination of urotherapy and biofeedback was more effective in decreasing urinary incontinence rates, infection rates and post – void residual urine volumes in children with dysfunctional voiding than standard urotherapy alone, and it also showed that this combination therapy corrected voiding patterns significantly and objectively. Keywords: Biofeedback, Psychology; Child; Urinary Tract Infections [Full Text]   Related Post Assessment of satisfaction and Quality of Life using self -reported qu... views 125 Impact on sexual function of surgical treatment in rectal cancer views 145 Current trends of percutaneous nephrolithotomy in a developing country views 171 Does index tumor predominant location influence prognostic factors in ... views...

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