Ahead of print

Visit our section with articles published as Ahead of Print. Improving the dissemination of our articles giving more visibility to the authors.

Second brazilian consensus on the treatment of advanced prostate cancer – a SBOC-SBU-SBRT panel review

Vol. 45 (x): 2019 April 4.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0798


ORIGINAL ARTICLE

Andre Deeke Sasse 1, Rodolfo Borges dos Reis 2, Lucas Mendes Nogueira 3, Fernando Cotait Maluf 4, Daniel Herchenhorn 5, Oren Smaletz 6, Volney Soares Lima 7, Fabio Schutz 4, Diogo Bastos 8, Evanius Garcia Wiermann 9, Igor Alexandre Protzner Morbeck 10, Leo-nardo Fontes Jardim 8, Vinicius Carrera Souza 9, Icaro Thiago Carvalho 6, Elton Trigo Tei-xeira Leite 11, Archimedes Nardozza Jr. 12, Antonio Carlos Lima Pompeo 13, Francisco Bre-tas 14, Marcos Lima de Oliveira Leal 15, Marcus Vinicius Sadi 12, Jose Ricardo Tuma da Ponte 16, Gustavo Carvalhal 17
1 Grupo SONHE, Oncologia, Campinas, SP, Brasil; 2 Departamento de Urologia, Universi-dade de São Paulo- USP, Campus de Ribeirão Preto, Ribeirão Preto, SP, Brasil; 3 Divisão de Urologia e Departamento de Cirurgia Hospital das Clínicas, Universidade Federal de MG – UFMG, Belo Horizonte, MG, Brasil; 4 Hospital Beneficência Portuguesa de São Pau-lo, SP, Brasil; 5 Rede D’Or São Luiz, Rio de Janeiro, Brasil; 6 Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, Brasil; 7 Oncocentro, Belo Horizonte, MG, Brasil; 8 Departamento de Oncologia, Instituto do Câncer do Estado de São Paulo – ICESP, SP, Brasil; 9 Sociedade Brasileira de Oncologia Clinica – SBOC, Belo Horizonte, MG, Bra-sil; 10 Clinica AMO, Salvador, Bahia, Brasil; 11 Hospital Sírio-Libanês, São Paulo, SP, Brasil; 12 Departamento de Urologia e Cirurgia, Universidade Federal de São Paulo – UNIFESP, São Paulo, SP, Brasil; 13 Faculdade de Medicina do ABC, Urologia, Santo André, Brasil; 14 Hospital Mater Dei, Belo Horizonte, MG, Brasil; 15 Departamento de Urologia, Universidade Federal da Bahia – UFBA, Salvador, Bahia, Brasil; 16 Departamento de Urologia, Universi-dade do Estado do Pará – UEPA, Belém, PA, Brasil; 17 Divisão de Urologia e Departamento de Cirurgia, Pontifícia Universidade Católica do Rio Grande do Sul – PUC RS, Porto Ale-gre, RS, Brasil

 

ABSTRACT

Prostate cancer is the second most common cancer and the fifth leading cause of cancer deaths. In Brazil, it is likewise the second most common cancer among men, second only to non-melanoma skin cancers.
The aim of this consensus is to align different opinions and interpretations of the medical literature in a practical and patient-oriented approach. The first Brazilian Con-sensus on the Treatment of Advanced Prostate Cancer was published in 2017, with the goal of reducing the heterogeneity of therapeutic conduct in Brazilian patients with metastatic prostate cancer. We acknowledge that in Brazil the incorporation of different technologies is a big challenge, especially in the Sistema Único de Saúde (SUS), which allows for the disparity in the options available to patients treated in different institutions. In order to update the recommendations and to make them objective and easily accessible, once more a panel of specialists was formed in order to discuss and elaborate a new Brazilian Consensus on Advanced Prostate Cancer.
This Consensus was written through a joint initiative of the Brazilian Society of Clinical Oncology (SBOC) and the Brazilian Society of Urology (SBU) to support the clinical decisions of physicians and other health professionals involved in the care of patients with prostate cancer.

Keywords: Prostatic Neoplasms; Therapeutics; Consensus

[Full Text]


Penile skin flap: a versatile substitute for anterior urethral stricture

Vol. 45 (x): 2019 April 4.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0652


SURGICAL TECHNIQUE

Wissem Hmida 1, Mouna Ben Othmen 1, Amidou Bako 1, Mehdi Jaidane 1, Faouzi Mosbah 1
1 Department of Urology, Sahloul Hospital Sousse, Sousse, Tunísia

ABSTRACT

Purpose: Penile skin fl ap uretroplasty is a useful technique for a long urethral stricture due to the ample length and surgical handling characteristics. We investigated the surgical technique and initial results of uretroplasty for anterior urethral strictures using a dorsal penile skin flap.
Patients and methods: From January 2003 to January 2018, a total of 77 patients underwent substitution urethroplasty using dorsal penile skin fl ap for bulbar urethral strictures in our institution. All patients were assessed preoperatively, and followed postoperatively by physical examination, urinalysis, retrograde and voiding urethrography, urofl owme-try and post-void residual urine measurement. Success was defi ned as no requirement of additional urethral instru-mentation.
Results: The mean age was 45 years (10-87). The mean stricture length was 5cm (3-10cm). The mean fl ap length was 6cm. Urinary fi stula was the most common postoperative complication. The mean follow-up was 60 months (6-120). The overall success rate was 88%. Recurrent strictures were found in 4 patients (5%) at 1 year. At 3 year follow-up, 5 (7%) more patients had recurrences. All recurrences were managed by internal urethrotomy.
Conclusions: Substitution urethroplasty using penile skin fl ap appear to be a safe and effi cient technique for the treatment of a long and complex anterior urethral stricture. It provides encouraging cosmetic and functional results.

Keywords: Penis; Urethral Stricture; Bulbourethral Glands

[Full Text]


Spontaneous gas in a retroperitoneal mass: check the testis!

Vol. 45 (x): 2019 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0606


RADIOLOGY PAGE

Jérémy Dana 1, Florian Maxwell 1, 2, David. Eiss 3, Laurence Rocher 1, 2, 4
1 Department of Diagnostic & Interventional Radiology, Hôpitaux Universitaires Paris Sud, Site Bicêtre, Le Kremlin-Bicêtre, France; 2 Faculté Paris Sud, Le Kremlin-Bicêtre, France; 3 IR4M, CNRS, imagerie par résonance magnétique médicale et multi-modalités, CNRS Université Paris Sud, Orsay Cedex, France; 4 Department of Diagnostic & Interventional Radiology, Hôpital Necker, Paris, France

ABSTRACT

Testicular germ cell tumor is the most common cancer in 20-to 35-years-old men. There are known risk factors such as undescended testicle(s) and history of testicular cancer. Most lesions are germ cell tumors with two main subtypes: seminomas and non-seminomatous germ cell tumors.

[Full Text]


Intraoperative serious complications of laparoscopic urological surgeries: a single institute experience of 4,380 procedures

Vol. 45 (x): 2019 April 4.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0601


ORIGINAL ARTICLE

Ju Guo 1, Zhigang Zeng 1, Runfu Cao 1, Jieping Hu 1
1 Department of Urology, The First Affi liated Hospital of Nanchang University, Nanchang, Jiangxi, China

ABSTRACT

This study aimed to share a single institute experience of 4,380 procedures about in-traoperative serious complications of laparoscopic urological surgeries. From January 2005 to December 2013, 4,380 cases of laparoscopic urological surgeries were recruited in our department. The distribution, incidence, and characteristics of intraoperative serious complications were retrospectively sorted out and analyzed. The surgeries were divided into three groups: very diffi cult (VD), diffi cult (D), and easy (E). The com¬plication at Satava class II was defi ned to be serious. One hundred thirty one cases with intraoperative serious complications were found (3.0%). The incidence of these complications was signifi cantly increased along with the diffi culty of the surgeries (P<0.05). The highest morbidity of serious complication belonged to total cystectomy with a ratio of about 17% as compared with other surgeries (P<0.05). The types of these complications included small vascular injury demanding blood transfusion (101 cases, 77.1%), large vascular (venous and artery) injury (16 cases), hypercapnia & acidosis (8 cases), and organ injury (6 cases). The cases of conversion to open surgery were 37 (≤1%). There was no signifi cant difference in the rates of conversion to open surgery among the three groups (P>0.05). The overall tendency of the intraoperative serious complications was decreasing with the time from 2005 to 2013. In conclusion, through standardized training including improving the surgical technique, being familiar with the anatomic relationship, and constantly summarizing the experience and lessons, laparoscopic surgery could be safe and effective with not only minimal invasion but also few complications.

Keywords: Urology; Laparoscopy; Intraoperative Complications

[Full Text]


Non-functional paraganglioma of urinary bladder managed by transurethral resection

Vol. 45 (x): 2019 April 4.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0604


ORIGINAL ARTICLE

Baochao Zhang 1, Zhenrui Fu 1, Liwei Liu 1, Baomin Qiao1, Chunyu Liu 1
1 Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China

ABSTRACT

Purpose: As a rare bladder tumor, paraganglioma of the urinary bladder (PUB) is frequently misdiagnosed as bladder cancer, particularly for the non-functional type. To date, transurethral resection remains a controversial treatment for non-functional PUB.

This study aimed to identify the clinical features, pathological characteristics, prognosis, and safe/effective treatment of non-functional PUB using transurethral resection of the bladder tumor (TURBT).

Materials and Methods: The clinical records, radiological data, pathological characteristics and follow-up times were retrospectively reviewed in 10 patients with clinically and pathologically proven non-functional PUB in our hospital from January 2008 to November 2016. All patients underwent TURBT treatment.

Results: The incidence of non-functional PUB in patients with bladder cancer was 0.17%. The mean age at diagnosis was 44.5 ± 13.6 years (range, 29-70 years), and the patient population had a female: male ratio of 3: 2. No patients had excess catecholamine (CA) whilst four patients had painless hematuria. All neoplasms were completely resected via TURBT. The majority of samples were positive for immunohistochemical markers including chromogranin A (CgA) and Synaptophysin (Syn), but were negative for cytokeratins (CKs). Only a single recurrence was observed from the mean follow-up

period of 36.4 ± 24.8 months.

Conclusion: Complete TURBT is a safe and effi cient treatment that serves both diagnostic and therapeutic purposes. Histopathological and immunohistochemistry examinations are mandatory for diagnostic confi rmation. Long-term follow-up is recommended for patients with non-functional PUB.

Keywords: Paraganglioma; Urinary Bladder; Transurethral Resection of Prostate

[Full Text]


Predictors of complication after adrenalectomy

Vol. 45 (x): 2019 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0482


ORIGINAL ARTICLE

Victor Srougi 1, Joao A. B. Barbosa 1, Isaac Massaud 1, Isadora P. Cavalcante 2, Fabio Y. Tanno 1, Madson Q. Almeida 2, Miguel Srougi 1, Maria C. Fragoso 2, José L. Chambo 1
1 Divisão de Urologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil; 2 Divisão de Endocrinologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil

ABSTRACT

Purpose: To investigate risk factors for complications in patients undergoing adrenalectomy.

Materials and Methods: A retrospective search of our institutional database was performed of patients who underwent adrenalectomy, between 2014 and 2018. Clinical parameters and adrenal disorder characteristics were assessed and correlated to intra and post-operative course. Complications were analyzed within 30-days after surgery.

A logistic regression was performed in order to identify independent predictors of morbidity in patients after adrenalectomy.

Results: The fi les of 154 patients were reviewed. Median age and Body Mass Index (BMI) were 52-years and 27.8kg/m2, respectively. Mean tumor size was 4.9±4cm. Median surgery duration and estimated blood loss were 140min and 50mL, respectively.

There were six conversions to open surgery. Minor and major post-operative complications occurred in 17.5% and 8.4% of the patients. Intra-operative complications occurred in 26.6% of the patients. Four patients died. Mean hospitalization duration was 4-days (Interquartile Range: 3-8). Patients age (p=0.004), comorbidities (p=0.003) and pathological diagnosis (p=0.003) were independent predictors of post-operative complications. Tumor size (p<0.001) and BMI (p=0.009) were independent predictors of intra-operative complications. Pathological diagnosis (p<0.001) and Charlson score (p=0.013) were independent predictors of death.

Conclusion: Diligent care is needed with older patients, with multiple comorbidities and harboring unfavorable adrenal disorders (adrenocortical carcinoma and pheocromocytoma), who have greater risk of post-operative complications. Patients with elevated BMI and larger tumors have higher risk of intra, but not of post-operative complications.

Keywords: Adrenalectomy; Morbidity; Pathology

[Full Text]


Predicting urine output after kidney transplantation: development and internal validation of a nomogram for clinical use

Vol. 45 (x): 2019 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0701


ORIGINAL ARTICLE

Aderivaldo Cabral Dias Filho 1,2, João Ricardo Alves 1, Pedro Rincon Cintra da Cruz 1,3, Viviane Brandão Bandeira de Mello Santana 4, Cassio Luis Zanettini Riccetto 2
1 Unidade de Urologia e Transplante Renal, Instituto Hospital de Base do Distrito Federal (IHB), Brasília, DF, Brasil; 2 Divisão de Urologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brasil; 3 Divisão de Urologia, Hospital Universitário de Brasília (HUB), Brasília, DF, Brasil; 4 Unidade de Nefrologia e Transplante Renal, Instituto Hospital de Base do Distrito Federal (IHB), Brasília, DF, Brasil

ABSTRACT

Purpose: To analyze pre-transplantation and early postoperative factors affecting post-transplantation urine output and develop a predictive nomogram.

Patients and Methods: Retrospective analysis of non-preemptive first transplanted adult patients between 2001-2016. The outcomes were hourly diuresis in mL/Kg in the 1st (UO1) and 8th (UO8) postoperative days (POD). Predictors for both UO1 and UO8 were cold ischemia time (CIT), patient and donor age and sex, HLA I and II compatibility, pre-transplantation duration of renal replacement therapy (RRT), cause of ESRD (ESRD) and immunosuppressive regimen. UO8 predictors also included UO1, 1st/0th POD plasma creatinine concentration ratio (Cr1/0), and occurrence of acute cellular rejection (AR). Multivariable linear regression was employed to produce nomograms for UO1 and UO8.

Results: Four hundred and seventy-three patients were included, mostly deceased donor kidneys’ recipients (361, 70.4%). CIT inversely correlated with UO1 and UO8 (Spearman’s p=-0.43 and -0.37). CR1/0 inversely correlated with UO8 (p=-0.47). On multivariable analysis UO1 was mainly influenced by CIT, with additional influences of donor age and sex, HLA II matching and ESRD. UO1 was the strongest predictor of UO8, with significant influences of AR and ESRD.

Conclusions: The predominant influence of CIT on UO1 rapidly wanes and is replaced by indicators of functional recovery (mainly UO1) and allograft’s immunologic acceptance (AR absence). Mean absolute errors for nomograms were 0.08 mL/Kg h (UO1) and 0.05 mL/Kg h (UO8).

Keywords: Kidney Transplantation; Nomograms; Delayed Graft Function

[Full Text]


Synchronous presentation of muscle-invasive urothelial carcinoma of bladder and peritoneal malign mesothelioma

Vol. 45 (x): 2019 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0815


CHALLENGING CLINICAL CASES

Cem Basatac 1, Fatma Aktepe 2, Sezer Sağlam 3, Haluk Akpınar 1
1 Department of Urology, Istanbul Bilim University, Istanbul, Turkey; 2 Department of Pathology, Group Florence Nightingale Hospitals, Istanbul, Turkey; 3 Department of Medical Oncology, Istanbul Bilim University, Istanbul, Turkey

ABSTRACT

Introduction: Cancer is one of the most important leading cause of death in man and woman in the world. The occurrence of new cancer has become more frequent in recent years due to strict screening protocols and occupational and environmental exposure to carcinogens. The incidence of secondary malignancies has also increased due to close medical follow-up and advanced age. Herein, we report a case and its management diagnosed as synchronous peritoneal malignant mesothelioma and muscleinvasive urothelial carcinoma.
Case Description: A 71-year-old male presented with macroscopic hematuria and abdominal distension increasing gradually. A contrast enhanced computerized tomography demonstrated bladder mass and diffuse ascites with nodular peritoneal thickening and umbilical mass. He was treated with the multidisciplinary team working including urologist, medical oncologist and general surgeon.
Conclusions: To our knowledge, this is the fi rst case of peritoneal malign mesothelioma with synchronous muscle-invasive urothelial carcinoma. Because of the rarity of this condition, there is still no consensus on the defi nitive treatment protocols, yet. Individualized treatment with multidisciplinary close follow-up might improve the survival outcomes.

Keywords: Mesothelioma; Peritoneum; Neoplasms

[Full Text]


Testicular mixed germ cell tumor presenting with seizure as the initial symptom: a case report and literature review

Vol. 45 (x): 2019 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0523


CHALLENGING CLINICAL CASES

Syuan-Hao Syu 1, Chia-Lun Chang 2, Hung-Jen Shih 1, 3
1 Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan;  2 Department of Hematology, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan; 3 Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan

ABSTRACT

Most patients with testicular germ cell tumor present with a painless scrotal mass. We report a 19-year-old patient who presented with neurological complains. Rapid clinical progression to coma was noted during the staging work up. A diagnosis of testicular mixed germ cell tumor with multiorgan metastasis (lymph node, lung, liver and brain) was made. Patients with brain metastasis should receive chemotherapy alone or combined with surgery or radiotherapy. Because the clinical symptoms deteriorated quickly, surgery was used upfront followed by chemotherapy and radiotherapy for the brain tumor. After the first stage of treatment, the clinical symptoms, tumor markers and imaging findings were improved. The residual brain tumor was eliminated by chemotherapy, and only sparse degenerated tumor cells were noted in the brain tissue.
Longer follow up is required to assess the impact of our treatment strategy.

Keywords: Testis; Testicular Germ Cell Tumor 1 [Supplementary Concept]; Neoplasm Metastasis

[Full Text]


Re: Comparison of Gleason upgrading rates in transrectal ultrasound systematic random biopsies versus US-MRI fusion biopsies for prostate cancer

Vol. 45 (x): 2019 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2019.0048


LETTER TO THE EDITOR

Ibrahim Halil Bozkurt 1, Ertugrul Sefik 1, Ismail Basmaci 1, Serdar Celik 1
1 HSU Izmir Bozyaka Training and Research Hospital Urology Clinic, Izmir, Turkey

ABSTRACT

Not available

[Full Text]


Re: Prognosis of prostate cancer and prostate – specific antigen levels

Vol. 45 (x): 2019 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0867


LETTER TO THE EDITOR

Beuy Joob 1, Viroj Wiwanitkit 2
1 Sanitation 1 Medical Academic Center, Bangkok Thailand; 2 Honorary professor, Dr. DY Patil University, Pune, India

ABSTRACT

Not available

[Full Text]


Surgical treatment for renal masses in the elderly: analysis of oncological, surgical and functional outcomes

Vol. 45 (x): 2019 March 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0310


ORIGINAL ARTICLE

Slawomir Poletajew 1, Piotr Zapała 1, Bartlomiej Kopczyński 1, Lukasz Białek 1, Sylwia Bender 1, Tomasz Mutrynowski 1, Mateusz Nowak 1, Julia Mróz 1, Grzegorz Pędzisz 1, Bartosz Dybowski 1, Piotr Radziszewski 1
1 Department of Urology, Medical University of Warsaw, Warsaw, Poland

ABSTRACT

Purpose: Radical treatment in elderly patients with renal tumor remains debatable due to uncertainties regarding the risk of surgical complications, risk of end-stage renal disease (ESRD) and survival benefit. The aim of the study was to assess outcomes of radical treatment for renal cancer in elderly patients.
Materials and Methods: This retrospective analysis enrolled 507 consecutive patients treated with partial or radical nephrectomy due to renal mass. Patients with upfront metastatic disease (n=46) and patients lost to follow-up (n=110) were excluded from the analysis. Surgical, functional (screen for ESRD development) and survival outcomes were analyzed in patients aged >75 years in comparison to younger individuals.
Results: The analyzed group included 55 elderly patients and 296 younger controls. Within the cohort a total of 148 and 203 patients underwent radical and partial nephrectomies respectively. The rate of surgical complications, including grade >3 Clavien- Dindo complications, did not differ between groups (3.6% vs. 4.4%, p=0.63). Median length of hospital stay was equal in both groups (7 days). During a follow-up (median 51.9 months, no difference between groups), ESRD occurred in 3.4% of controls and was not reported in elderly group (p=0.37). Younger patients demonstrated a statistically significant advantage in both overall survival and cancer-specific survival over elderly patients (OS 94.6% vs. 87% p=0.036, CSS 97.3% vs. 89.1% p=0.0008).
Conclusions: Surgical treatment in elderly patients with renal tumor is as safe as in younger individuals and does not increase the risk of ESRD. However, cancer specific survival among these patients remains shorter than in younger patients.

Keywords: Kidney Neoplasms; Survival; Delayed Graft Function

[Full Text]


Laparoscopic radical cystectomy with intracorporeal ileal conduit: one center experience and clinical outcomes

Vol. 45 (x): 2019 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0262


ORIGINAL ARTICLE

Jianye Li 1, Feiya Yang 1, Qingbao He 1, Mingshuai Wang 1, Nianzeng Xing 1
1 Department of Urology, “Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China

ABSTRACT

Purpose: To introduce our experience with intracorporeal ileal conduit and evaluate the safety and feasibility of this endoscopic urinary diversion.
Materials and Methods: Between March 2014 and July 2017, thirty-six consecutive patients underwent laparoscopic radical cystectomy with intracorporeal ileal conduit.
Patients’ demographic data, perioperative data, 90-days postoperative outcomes and complications were collected. This cohort were divided into two groups of 18 patients each by chronological order of the operations to facilitate comparison of clinical data.
Data were evaluated using the students’ T test, Mann-Whitney test and Fisher’s Exact test.
Results: All surgeries were completed successfully with no conversion. Median total operating time and median intracorporeal urinary diversion time were 304 and 105 minutes, respectively. Median estimated blood loss was 200 mL, and median lymph node yield was 21. Twenty-six Clavien grade < 3 complications occurred within 30-days and 9 occurred within 30-90 days. Five Clavien grade 3-5 complications occurred within 30 days. No statistically signifi cant differences were found between the two groups except for intracorporeal urinary diversion time. At median follow-up of 17.5 (range 3-42) months, 6 patients experienced tumor recurrence/metastasis and 4 of these patients died.
Conclusions: Intracorporeal ileal conduit following laparoscopic radical cystectomy is safe, feasible and reproducible. With the accumulation of experience, the operation time can be controlled at a satisfactory level.

Keywords: Laparoscopy; Urinary Diversion; Cystectomy

[Full Text]


Mating with seminal vesicle-excised male can affect the uterus phospholipid fatty-acids composition during implantation in an experimental mouse model

Vol. 45 (x): 2019 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0485


ORIGINAL ARTICLE

Amir Fattahi 1, 2, Zeinab Latifi 3, Masoud Darabi 3, Ali Salmassi 2, Laya Farzadi 1, Maghsood Shaaker 3, Amir Mehdizadeh 4, Tohid Ghasemnejad 1, Leila Roshangar 5, Mohammad Nouri 1, 2
1 Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; 2 Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; 3 Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; 4 Liver and Gastrointestinal Diseases Research Centers, Tabriz University of Medical Sciences, Tabriz, Iran; 5 Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

ABSTRACT

Purpose: No comprehensive information is available about uterus fatty acid (FA) change during implantation period and possible effects of the seminal vesicle secretion on it.
Materials and Methods: In this study, we evaluated FA composition of uterus phospholipids during the implantation period in intact and seminal vesicle-excised (SVX) mated female mice. Forty NMRI female mice were divided into control (mated with intact male) and seminal vesicle excised (SVX)-mated (mated with SVX-male) groups.
The phospholipid fatty acids composition was monitored during the fi rst fi ve days of pregnancy using gas chromatography and also implantation rate was evaluated on fi fth day of pregnancy.
Results: We found that levels of linoleic acid (LNA) and arachidonic acid (ARA) showed a decreasing trend from the fi rst to the third day of pregnancy and then started to increase on the fourth day and peaked on the fi fth day. In contrast, the level of saturated FA (SFA) increased on the second and third day of pregnancy compared to the fi rst (p<0.05) and then decreased on the fourth and fi fth. We also found that the seminal vesicle secretion could affect the levels of LNA, ARA, SFA, and PUFA in uterine phospholipids especially on second and third day. Moreover, there was a positive correlation between ARA level and implantation rate in control but not SVX-mated groups.
Conclusions: It can be concluded that several uterus FA that have important roles in early pregnancy could be affected by seminal vesicle secretion.

Keywords: Uterus; Seminal Vesicles; Male

[Full Text]


Vasitis: a clinical confusion diagnosis with inguinal hernia

Vol. 45 (x): 2019 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0457


RADIOLOGY PAGE

Chunhsuan Lin 1, Tsung-yi Huang 1
1 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

ABSTRACT

Vasitis or inflammation of the vas deferens is a rarely described condition categorized as ei¬ther generally asymptomatic vasitis nodosa or the acutely painful infectious vasitis. Vasitis nodosa, the commonly described inflammation of the vas deferens, is benign and usually associated with a history of vasectomy. Clinically, patients present with a nodular mass and are often asymptomatic and require no specific treatment.

 

[Full Text]


Open anterograde anatomic radical retropubic prostatectomy technique: description of the first fifty-five procedures

Vol. 45 (x): 2019 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0421


VIDEO SECTION

Fabrício Borges Carrerette 1, 2, Emanuel Carvalho 3, Henrique Machado 3, Felipe Casa Freire 3, Ronaldo Damião 4
1 Faculdade de Ciencias Médicas, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil; 2 Uromedic – Urologia, Petropolis, RJ, Brasil; 3 Departamento de Cirurgia, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil; 4 Departamento de Urologia, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil

ABSTRACT

Introduction: Robotic-assisted radical prostatectomy is the leading surgical technique and was discussed in Pasadena Consensus Panel (1). The goal of this study is to present the results of the first fifty-five patients submitted to Anterograde Anatomic Radical Retropubic Prostatectomy technique (R2PA2), without adding complexity or cost.
Materials and Methods: Fifty-five eligible men with localized prostate cancer underwent R2PA2 from January, 2016 to December, 2017. The technique was previously described (2): the main surgical steps were anterograde dissection, ligation of the dorsal vascular complex without dividing, preservation of the bladder neck, nerve sparing, preservation of Denon¬villiers’ fascia and confection of the running suture anastomosis. All patients were operated on by second-year residents.
Results: All procedures were completed as planned, but one converted to retrograde prostatectomy (mean duration, 163.40 minutes; hospital stay, 4 days with 4.20 days of drainage; indwelling vesical catheterization of 9.80 days). Positive surgical margin was found in six T2 staging patient (10.90%) and five T3 (9.10%). Biochemical PSA recurrence occurred in three patients (5.50%).
Twenty-four (43.60%) were continent immediately after indwelling catheter removal, seventeen (30.90%) did not wear a pad at one postoperative month while eighteen (30%) used only one safety pad. Five minor complications occurred.
Conclusion: We were able to perform R2PA2 allowing men who do not have access to this new technology to be oper¬ated on with the same technique used in robotic surgery. This method was reproducible by low-volume prostate cancer surgeons; help inexperienced surgeons to develop skills valuable to future training with robotic techniques.

ACKNOWLEDGEMENTS

This work was supported by the FAPERJ – Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Ja¬neiro. Secretaria de Estado de Ciência, Tecnologia e Inovação do Governo do Estado do Rio de Janeiro, Brazil, and Pedro Ernesto University Hospital of the State University of Rio de Janeiro, Brazil.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180421_Carrerette_et_al

[Full Text]


 

Robotic partial nephrectomy after pazopanib treatment in a solitary kidney with segmental vein thrombosis

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0240


VIDEO SECTION

Juan D. Garisto 1, Julien Dagenais 1, Daniel Sagalovich 1, Riccardo Bertolo 1, Brian Rini 1, Jihad Kaouk 1
1 Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland OH, USA

ABSTRACT

Objective: To demonstrate our surgical technique of robotic partial nephrectomy (RPN) in a patient with a solitary kidney who received neoadjuvant Pazopanib, highlighting the multidisciplinary approach.
Materials and Methods: In our video, we present the case of 77-year-old male, Caucasian with 6.6cm left renal neoplasm in a solitary kidney. An initial percutaneous biopsy from the mass revealed clear cell RCC ISUP 2. After multidisciplinary tumor board meeting, Pazopanib (800mg once daily) was administered for 8 weeks with repeat imaging at completion of therapy. Post-TKI image study was compared with the pre-TKI CT using the Morphology, Attenuation, Size, and Structure criteria showing a favorable response to the treatment. Thereafter, a RPN was planned3. Perioperative surgical outcomes are presented.
Results: Operative time was 224 minutes with a cold ischemia time of 53 minutes. Estimated blood loss was 800ml and the length of hospital stay was 4 days. Pathology demonstrated a specimen of 7.6cm with a tumor size of 6.5cm consistent with clear cell renal carcinoma ISUP 3 with a TNM staging pT1b Nx. Postoperative GFR was maintained at 24 ml / min compared to the preoperative value of 33ml / min.
Conclusions: A multidisciplinary approach is effective for patients in whom nephron preservation is critical, providing na opportunity to select those that may benefi t from TKI therapy. Pazopanib may allow for PN in a highly selective subgroup of patients who would otherwise require radical nephrectomy. Prospective data will be necessary before this strategy can be disseminated into clinical practice.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180240_Garisto_et_al

[Full Text]


Enhancing PSMA-uptake with androgen deprivation therapy – a new way to detect prostate cancer metastases?

Vol. 45 (x): 2019 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0305


ORIGINAL ARTICLE

Conrad Leitsmann 1, Paul Thelen 1, Marianne Schmid 1, Johannes Meller 2, Carsten-Oliver Sahlmann 2, Birgit Meller 2, Lutz Trojan 1 , Arne Strauss 1
1 Department of Urology, University Medical Center Goettingen, Goettingen, Germany; 2 Department of Nuclear Medicine, University Medical Center Goettingen, Goettingen, Germany

ABSTRACT

Purpose: 68Ga-PSMA PET/CT imaging is a promising modality for the staging of recurrent prostate cancer (PCa). Current evidence suggests limited diagnostic value of the 68Ga-PSMA PET/CT in PSA-levels ≤0.3ng/mL. Experimental data have demonstrated na increase in PSMA-expression in PCa metastases by androgen deprivation in vitro. The aim of the current study was to investigate a possible enhancing effect of PSMA with low-dose androgen deprivation in patients with BCR and low PSA-levels.
Materials and Methods: Five patients with PCa and BCR, following radical prostatectomy, underwent 68Ga-PSMA PET/CT. A consecutive 68Ga-PSMA PET/CT was performed 6 to 11 days after injection of 80mg of Degarelix (Firmagon®). We recorded PSA and testosterone serum-levels and changes of PSMA-uptake in 68Ga-PSMA PET/CT images.
Results: Median PSA prior 68Ga-PSMA PET/CT was 0.27ng/mL. All patients had a decrease in testosterone serum levels from median 2.95μg/l to 0.16μg/l following Degarelix injection. We observed an increase in the standardized uptake value (SUV) in PSMA-positive lymphogenous and osseous lesions in two patients following androgen deprivation. In another two patients, no PSMA positive signals were detected in either the fi rst or the second scan.
Conclusion: Our preliminary results of this feasibility assessment indicate a possible enhancing effect of PSMA-imaging induced by low-dose ADT. Despite several limitations and the small number of patients, this could be a new approach to improve staging by 68Ga-PSMA PET/CT in PCa patients with BCR after primary therapy. Further prospective studies with larger number of patients are needed to validate our fi ndings.

Keywords: Prostatic Neoplasms; Radiotherapy; Magnetic Resonance Imaging

[Full Text]


Decrease in skeletal muscle index 1 year after radical cystectomy as a prognostic indicator in patients with urothelial bladder cancer

Vol. 45 (x): 2019 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0530


ORIGINAL ARTICLE

Yun-Sok Ha 1, Sang Won Kim 1, Tae Gyun Kwon 1, Sung Kwang Chung 1, Eun Sang Yoo 1
1 Department of Urology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea

ABSTRACT

Purpose: The present study aimed to determine whether sarcopenia after radical cystectomy (RC) could predict overall survival (OS) in patients with urothelial bladder cancer (UBC).
Materials and Methods: The lumbar skeletal muscle index (SMI) of 80 patients was measured before and 1 year after RC. The prognostic signifi cance of sarcopenia and SMI decrease after RC were evaluated using Kaplan–Meier analysis and a multivariable Cox regression model.
Results: Of 80 patients, 26 (32.5%) experienced sarcopenia before RC, whereas 40 (50.0%) experienced sarcopenia after RC. The median SMI change was -2.2 cm2/m2.
Patients with sarcopenia after RC had a higher pathological T stage and tumor grade than patients without sarcopenia. Furthermore, the overall mortality rate was signifi – cantly higher in patients with sarcopenia than in those without sarcopenia 1 year after RC. The median follow-up time was 46.2 months, during which 22 patients died. Kaplan-Meier estimates showed a signifi cant difference in OS rates based on sarcopenia (P=0.012) and SMI decrease (P=0.025). Multivariable Cox regression analysis showed that SMI decrease (≥2.2 cm2/m2) was an independent predictor of OS (hazard ratio: 2.68, confi dence interval: 1.007-7.719, P = 0.048).
Conclusions: The decrease in SMI after surgery might be a negative prognostic factor for OS in patients who underwent RC to treat UBC.

Keywords: Urinary Bladder Neoplasms; Sarcopenia; Survival

[Full Text]


A comparison of perioperative outcome between robot-assisted and laparoscopic radical prostatectomy: experience of a single institution

Vol. 45 (x): 2019 February 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0367


ORIGINAL ARTICLE

Feng Qi 1, Shangqian Wang 1, Haoxiang Xu 1, Yiren Gao 1, Gong Cheng 1, Lixin Hua 1
1 Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

ABSTRACT

Purpose: To compare perioperative and pathological results in different approaches of robotic or laparoscopic radical prostatectomy.
Materials and Methods: We retrospectively reviewed 206 patients diagnosed with pros¬tate cancer (PC) from June 2016 to October 2017 in the First Affiliated Hospital of Nan¬jing Medical University. A total of 132 cases underwent robot-assisted laparoscopic radical prostatectomy (RLRP) including 54 patients on transperitoneal robot-assisted laparoscopic radical prostatectomy (Tp-RLRP) and 78 on extraperitoneal robot-assisted laparoscopic radical prostatectomy (Ep-RLRP). Meanwhile, 74 patients performed with extraperitoneal laparoscopic radical prostatectomy (Ep-LPR) were also included. Peri¬operative and pathological data were compared among these groups.
Results: All operations were completed without conversion. There was no signifi¬cant difference in basic and pathological characteristics of patients between each two groups.
In Tp-RLRP vs. Ep-RLRP: Significant differences were found in the comparison in to¬tal operation time [235.98 ± 59.16 vs. 180.45 ± 50.27 min, P = 0.00], estimated blood loss (EBL) [399.07 ± 519.57 vs. 254.49 ± 308.05 mL, P = 0.0473], postoperative pelvic drainage time [5.37 ± 2.33 vs. 4.24 ± 3.08 d, P = 0.0237] and postoperative length of stay [8.15 ± 3.30 vs. 6.49 ± 3.49 d, P = 0.0068] while no significant differences were detected in other variables.
In Ep-RLRP vs. Ep-LPR: Longer total operation time was observed in Ep-RLRP when compared to Ep-LPR [180.45 ± 50.27 vs. 143.80 ± 33.13 min, P = 0.000]. No significant differences were observed in other variables.
Conclusion: In RLRP, Ep-RLRP was proved a safe and effective approach based on the perioperative results compared to Tp-RLRP. Ep-RLRP and Ep-LPR provides equivalent perioperative and pathological outcomes.

Keywords: Robotics; Laparoscopy; Prostatic Neoplasms

[Full Text]


Tumor-like appearance of Spermatic Granuloma

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0676


RADIOLOGY PAGE

Pablo Garrido-Abad 1, Ariel Díaz-Menéndez 2, Luis García-Martín 1, Isabel Senra-Bravo 2, Manuel Fernández-Arjona 1
1 Department of Urology, Hospital Universitario del Henares, Coslada, Universidad Francisco de Vitoria, Madrid, Spain; 2 Department of Pathology, Hospital Universitario del Henares, Coslada, Madrid, Spain

ABSTRACT

Not available

[Full Text]


Retrograde vs. antegrade fl exible nephroscopy for detection of residual fragments following PNL: A prospective study with computerized tomography control

Vol. 45 (x): 2019 February 2.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0695


ORIGINAL ARTICLE

Mehmet İlker Gökce 1, Omer Gülpinar 1, Arif Ibiş 1, Muratcan Karaburun 1, Eralp Kubilay 1, Evren Süer 1
1 Department of Urology, Ankara University School of Medicine, Adnan Saygun Caddesi, Altindağ, Ankara, Turkey

ABSTRACT

Introduction: The main aim of stone surgery is to establish stone free status. Performing fl exible nephroscopy is an effective tool in this manner. The aim of this study was to evaluate the role of retrograde fl exible nephroscopy for detection of residual fragments following percutaneous nephrolithotomy (PNL) in comparison with antegrade approach.
Materials and Methods: Data of 137 patients underwent ECIRS was collected prospectively. In all cases following stone clearance, collecting system was checked for residual fragments. First antegrade than retrograde fl exible nephroscopy was performed and success rates to reach all calices and detection of residual fragments were noted.
All patients underwent CT and success rate of antegrade and retrograde approaches were compared. PPV and NPV of retrograde approach to detect residual fragments were calculated.
Results: Antegrade and retrograde nephroscopy successfully accessed all of the calices in 101 (73.7%) and 130 (94.9%) patients respectively (p<0.0001). Residual fragments were observed in 18 (13.1%) patients following antegrade fl exible nephroscopy. Retrograde approach identifi ed residual stones in 17 more cases. These cases were treated with fl exible nephroscopy or secondary percutaneous tract. Postoperative CT revealed residual stones in 10 (7.3%) patients. PPV and NPV of retrograde fl exible nephroscopy were 83.3% and 96.2%.
Conclusions: Flexible nephroscopy effectively detects residual fragments following PNL. Retrograde approach was more successful than antegrade approach to reach all calices. We recommend performing retrograde fl exible nephroscopy following PNL especially in complex cases as it has the potential to increase SFR, decrease the need for second look surgery and unnecessary postoperative imaging.

Keywords: Nephrolithotomy, Percutaneous; Surgical Procedures, Operative; Ureter

[Full Text]


Treatment Options and Outcomes of Penile Constriction Devices

Vol. 45 (x): 2019 February 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0667


ORIGINAL ARTICLE

Leandro Koifman 1, Daniel Hampl 1, Maria Isabel Silva 1, Paulo Gabriel Antunes Pessoa 1, Antonio Augusto Ornellas 2, Rodrigo Barros 1
1 Hospital Municipal Souza Aguiar, Rio de Janeiro, RJ, Brasil; 2 Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brasil

ABSTRACT

Purpose: To study the effect of penile constriction devices used on a large series of patients who presented at our emergency facility. We explored treatment options to prevent a wide range of vascular and mechanical injuries occurring due to penile entrapment.
Materials and Methods: Between January 2001 and March 2016, 26 patients with pe¬nile entrapment were admitted to our facility and prospectively evaluated.
Results: The time that elapsed from penile constrictor application to hospital admis¬sion varied from 10 hours to 6 weeks (mean: 22.8 hours). Non-metallic devices were used by 18 patients (66.6%) while the other nine (33.4%) had used metallic objects. Acute urinary retention was present in six (23%) patients, of whom four (66.6%) un¬derwent percutaneous surgical cystotomy and two (33.4%) underwent simple bladder catheterization. The main reason for penile constrictor placement was erectile dysfunc¬tion, accounting for 15 (55.5%) cases. Autoerotic intention, psychiatric disorders, and sexual violence were responsible in five (18.5%), five (18.5%), and two (7.4%) cases, respectively. The mean hospital stay was 18 hours (range, 6 hours to 3 weeks).
Conclusion: Penile strangulation treatment must be immediate through the extraction of the foreign body, avoiding vascular impairments that can lead to serious complica¬tions. Most patients present with low-grade injuries and use penile constrictors due to erectile dysfunction. Removal of constrictor device can be challenging. The use of specific tools for achieving penile release from constrictors is a fast, safe and effective method. Patients with urinary retention may require urinary diversion.

Keywords: Penis; Constriction; Therapeutics

[Full Text]


Hematologic parameters and neutrophil / lymphocyte ratio in the prediction of urethroplasty success

Vol. 45 (x): 2019 February 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0682


ORIGINAL ARTICLE

Ramazan Topaktaş 1, Ahmet Ürkmez 1, Emre Tokuç 1, Mehmet Akyüz 1, Musab A. Kutluhan 1
1 Department of Urology, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey

ABSTRACT

Objective: The pathophysiology of urethral stricture and its recurrence remains vague and one of the important causes is progressive infl ammation. It has been shown in recent years that the neutrophil / lymphocyte ratio is a marker of systemic infl ammation and is associated with prognosis in many cardiovascular diseases, malignancies and chronic infl ammatory diseases. We assessed simple systemic infl ammation markers preoperatively and surgical techniques for urethral stricture recurrence after urethroplasty.
Patients and Methods: After exclusion criteria applied, a total of 117 male cases operated with urethroplasty in our clinic between January 2012 and June 2017 were included in the study and analyzed retrospectively. Localization and length of the strictures of the patients, neutrophil counts and percentages, lymphocyte counts and percentages, and neutrophil / lymphocyte ratios in preoperative peripheral blood samples were statistically analyzed. Recurrent stricture during fi rst 12 months follow-up after the surgery has been assessed as recurrence.
Results: The mean age of the patients was 54.12 ± 16.35 and the mean urethral stricture length was 3.44 ± 1.83 cm. Recurrence was observed in 30.1% of cases who received buccal graft, 30% in penile skin applied cases and 26.1% of cases treated with end-to-end anastomosis and there was no statistically signifi cant difference between neutrophil, lymphocyte, neutrophil / lymphocyte ratio and average stricture segment length between recurrent and non-recurrent cases (p > 0.005).
Conclusions: We consider that neutrophil, lymphocyte counts and their ratio prior to urethroplasty and the technique performed are not parameters that can be used to predict stricture recurrence. Prospective and randomized new trials with larger patient populations are needed to make more accurate judgments about the role of these inflammatory parameters.

Keywords: Inflammation; Neutrophils; Urethral Stricture

[Full Text]


Iatrogenic Ureteral Obstruction During Transvaginal Oocyte Retrieval

Vol. 45 (x): 2019 February 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0692


CHALLENGING CLINICAL CASES

Ali Sami Gurbuz 1, 2, Ali Cenker 3
1 Deparment of Obstetrics and Gynaecology KTO Karatay University Medical Faculty Konya, Turkey; 2 Novafertil IVF Center Konya, Turkey; 3 Department of Urology, Akademi Meram Hospital Konya, Turkey

ABSTRACT

Transvaginal oocyte retrieval is a crucial step in assisted reproductive technology.
Various complications may arise during this procedure. Ureteral injury is a rare, but a serious complication in gynecological practice. During oocyte retrieval, ureteral injuries, detachment and obstruction can be seen, though rare. In this study, we will present ureteral obstruction that develops secondary to small hematoma, which mimics ovarian cyst torsion or ruptured ovarian cyst.

Keywords: Oocyte Retrieval; Ureter; Hematoma

[Full Text]


Smartphone-based stent tracking application for prevention of forgotten ureteral double-J stents: a prospective study

Vol. 45 (x): 2019 February 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0707


ORIGINAL ARTICLE

Volkan Ulker 1, Hasan Anil Atalay 2, Ozgur Cakmak 1, Cem Yucel 1, Orcun Celik 1, Zafer Kozacioglu 1
1 Department of Urology, Health Sciences University, Tepecik Training and Research Hospital, Izmir, Turkey; 2 Department of Urology, Health Sciences University, Okmeydani Training and Research Hospital, Istanbul, Turkey

ABSTRACT

Purpose: Retained or forgotten ureteral stents (FUS) have a potential to cause signifi¬cant morbidity as well as medico-legal issues and increased cost. We aimed to evaluate the efficacy and usefulness of smartphone-based Ureteral Stent Tracker (UST) appli¬cation and compare the results with basic appointment card system to prevent FUS, prospectively.
Materials and Methods: A total of 90 patients who underwent ureteroscopic stone treat¬ment procedure with indwelling DJ stents were equally distributed into two groups. In group-1, patients were followed using UST application. In group-2, only appointment cards were given to the patients. Two groups were compared in terms of stent overdue times and complete lost to follow up rates.
Results: Forty-four patients in group-1 and 43 patients in group-2 completed the study. Among patients, 22.7% in group-1 and 27.9% in group-2 did not return for the stent removal on the scheduled day. In group-1, these patients were identified using the UST and called for the stent removal on the same day. After 6 weeks of maximal wait¬ing period, mean overdue times in group-1 and group-2 were 3.5 days and 20 days, respectively (p = 0.001) . In group-2, 3 patients (6.9%) were lost to follow up, while in group-1, it was none (p = 0.001).
Conclusions: We found that the patients who were followed by the smartphone-based UST application has less overdue times and lost to follow up cases compared to the basic appointment card system. The UST application easily follows patients with in¬dwelling ureteral stents and can identify patients when overdue.

Keywords: Ureteroscopy; Patient Safety; Urolithiasis

[Full Text]


Robot-assisted Simple Prostatectomy with Tunnel-Shaped Trigonization (RASP-TST) – A Novel Technique

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0611


VIDEO SECTION

Marcos Tobias-Machado 1, Cristiano Linck Pazeto 1, Eliney Ferreira Faria 2, Breno Dauster 3, William Enrique Pertuz Genes 1, Ricardo Hissashi Nishimoto 4
1 Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil, 2 Departmento de Urologia Hospital do Câncer de Barretos, Barretos, SP, Brasil, 3 Serviço de Urologia, Hospital São Rafael, Salvador, BA, Brasil; 4 Departamento de Urologia Hospital Alberto Cavalcanti, Belo Horizonte, MG, Brasil

ABSTRACT

To describe a technical modifi cation for robotic-assisted simple prostatectomy (RASP) using three-steps reconstructive technique to achieve a 360‑ trigonization of the bladder mucosa. Through fi ve-trocars transperitoneal access, we perform a longitudinal incision of the bladder wall and prostate capsule. Our technique of RASP is very similar to the standard operative technique described during laparoscopic and robotic removal of adenoma, however, for reconstruction, we propose the Tunnel-Shaped Trigonization (TST). The fi rst step is the advancement of a bladder mucosa fl ap until the posterior part of the prostatic urethra. The second step, a running suture between the advanced mucosa and the prostatic capsule is done bilaterally. At this point, the prostate capsule should be totally isolated from the rest of the urinary tract. Finally, the third step is closing both sides of the capsule and bladder mucosa anteriorly identical to a tunnel conformation. Hiding the prostatic capsule optimizes the patient recovery since hematuria is the most related factor for hospital stay length.

This pilot-case has shown satisfactory results without the need for continuous bladder irrigation. The prostate volume in the TRUS was 130 cm3 and the preoperative International Prostate Symptom score was 24. He was discharged at second postoperative day and no late complications were detected. In conclusion, the TST-RASP seems to be a safe and feasible modifi cation of the RASP. We hope that the application of the TST can lead us to lower rates of blood loss, transfusion and postoperative complications in comparison to the standard technique.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180611_Tobias-Machado_et_al

[Full Text]


Limited significance of repeated long-term radiological and hormonal examination in nonfunctioning adrenal incidentalomas

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0235


ORIGINAL ARTICLE

Masayuki Tasaki 1, Takashi Kasahara 1, Itsuhiro Takizawa 1, Kazuhide Saito 1, Tsutomu Nishiyama 1, Yoshihiko Tomita 1
1 Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan

ABSTRACT

Purpose: The purposes of the present study were to evaluate growth rate of nonfunc¬tioning adrenal incidentalomas (AIs) and their development to hormonal hypersecre¬tion on follow-up.
Materials and methods: A retrospective study was conducted from the electronic medi¬cal records. A total of 314 patients were diagnosed with adrenal tumors between 2000 and 2016. After excluding patients who had overt adrenal endocrine disorders or whose adrenal tumors were clinically diagnosed as metastatic malignancies, we investigated 108 patients with nonfunctioning AIs including characteristics, the treatment, the way of follow-up and pathology.
Results: Fifteen patients received immediate adrenalectomy because of the initial tu¬mor size or patient’s preference. Pathological examination revealed malignancy in 2 patients. In the remaining 93 patients, radiological examinations were performed periodically. Tumor enlargement of ≥ 1.0cm was observed in 8.6% of the patients who were followed up as nonfunctioning AIs with a median follow-up period of 61.5 months (range: 4-192). Eleven patients underwent adrenalectomy. On the pathologi¬cal examinations, all of the tumors, which showed a size increase, were diagnosed as benign tumors. Regarding the followed up patients without adrenalectomy, only 2.4% of the patients had tumor enlargement during the prolonged follow-up. Furthermore, none of the patients developed hormonal hypersecretion or clinical signs such as obe¬sity, glucose intolerance or poorly controlled hypertension.
Conclusions: Tumor enlargement of AIs did not correlate with malignancy. The value of repeat radiological and hormonal examinations may be limited in the long-term follow-up of patients whose AIs are not enlarged.

Keywords: Adrenal incidentaloma [Supplementary Concept]; Adrenalectomy; Radiology

[Full Text]


A higher circulating concentration of 25-hydroxyvitamin-D decreases the risk of renal cell carcinoma: a case-control study

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0186


ORIGINAL ARTICLE

Fei Li 1, HongFan Zhao 1, Lina Hou 2, Fengsheng Ling 3 , Yue Zhang, 1, WanLong Tan 1
1 Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China; 2 Department of Healthy Management, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China; 3 Department of Urology, Foshan Women and Children Hospital Foshan Guangdong, P.R. China

ABSTRACT

Objective: To investigate the relationship between vitamin D status, using circulating 25-hydroxyvitamin D [25 (OH) D], and renal cell carcinoma (RCC) risk in a case-control study, because the association between the two is unclear in China.
Materials and Methods: A total of 135 incident RCC cases were matched with 135 controls by age and sex. The blood samples were collected on the fi rst day of hospitalization before surgery to measure plasma 25 (OH) D. Logistic regression analyses were used to calculate odds ratios (ORs) and 95% confi dence intervals (95% CIs) with adjustment for several confounders (e.g. age, gender, smoking and season of blood draw). Furthermore, the association of RCC with 25 (OH) D in units of 10 ng / mL as a continuous variable were also examined.
Results: The average plasma 25 (OH) D concentrations in RCC were signifi cantly lower compared with those of the controls (21.5 ± 7.4 ng / mL vs. 24.1 ± 6.6 ng / mL, respectively; P = 0.003). In the adjusted model, inverse associations were observed between circulating 25 (OH) D levels and RCC risk for 25 (OH) D insuffi ciency (20-30 ng / mL) with OR of 0.50 (95% CI: 0.29-0.88; P = 0.015) and a normal 25 (OH) D level (≥30 ng / mL) with OR of 0.30 (95% CI: 0.13-0.72; P = 0.007), compared with 25 (OH) D deficiency (< 20 ng / mL). Furthermore, results with 25 (OH) D as a linear variable indicated that each 10 ng / mL increment of plasma 25 (OH) D corresponded to a 12% decrease in RCC risk.
Conclusions: This case-control study on a Chinese Han population supports the protective effect of a higher circulating concentration of 25 (OH) against RCC, whether the confounding factors are adjusted or not.

Keywords: Carcinoma, Renal Cell; Vitamin D; 25-Hydroxyvitamin D 2

[Full Text]


Antibiotic prophylaxis prior to urodynamic study in patients with traumatic spinal cord injury. Is there an indication?

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0574


ORIGINAL ARTICLE

Marcello Torres da Silva 1, André Luis Barboza 2, Maria Malen Pijoán 3, Paulo Sergio Siebra Beraldo 4
1 Serviço de Urologia, Rede Sarah de Hospitais de Reabilitação, São Luís, MA, Brasil; 2 Serviço de Urologia, Rede Sarah de Hospitais de Reabilitação, Brasília, DF, Brasil 3 Instituto Universitario Italiano de Rosario – Ciências Biomédicas, Rosario, Santa Fe, Argentina; 4 Serviço de Lesão Medular, Rede Sarah de Hospitais de Reabilitação, Brasília, DF, Brasil

ABSTRACT

Study design: Retrospective cohort of patients with traumatic spinal cord injury (SCI) that have been hospitalized for physical-functional rehabilitation purposes.
Objectives: To compare the incidence of urinary tract infection (UTI) after urodynamic study (UDS) in three hospitals that adopted different protocols with regard to the preparation of patients.
Setting: Sarah Network of Rehabilitation Hospitals, Brazil.
Materials and Methods: Between 2014 and 2015, 661 patients from three units of the same hospital network, one of which does not use antimicrobial prophylaxis independently of urine culture results, were evaluated after having undergone UDS. The results were compared in both univariate and multivariate analyses (logistic regression).
Results: The global rate of UTI after UDS was that of 3.18% (IC 95% 2.1-4.8), with no differences between the units. In the univariate analysis the only variable that was associated with UTI after UDS was that of T6 injuries or above (P = 0.029). The logistic regression has confi rmed this result, with an adjusted odds ratio of 3.06 (IC 95% 1.01 to 9.26; P = 0.0476). The use of antimicrobial prophylaxis did not alter that risk.
Conclusions: This study has demonstrated that the use of antimicrobials does not prevent UTI after UDS. Patients with T6 traumatic SCI or above have got three times more chance of developing UTI after UDS if compared to those with a T7 injury or below, independently of the use of antimicrobials. Even in these patients the use of antimicrobials would not be justifi ed.

Keywords: Urinary Tract Infections; prevention and control [Subheading]; Spinal Cord Injuries

[Full Text]


Can Neutrophil-to-Lymphocyte ratio predict the response to BCG in high-risk non muscle invasive bladder cancer?

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0249


ORIGINAL ARTICLE

Marco Racioppi 1, Luca Di Gianfrancesco 1, Mauro Ragonese 1, Giuseppe Palermo 1, Emilio Sacco 1, Pier Francesco Bassi 1
1 Department of Urology, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS – Università Cattolica del Sacro Cuore di Roma

ABSTRACT

Objectives: To evaluate the neutrophil-to-lymphocyte ratio (NLR) as a prognostic factor for response of high risk non muscle invasive bladder cancer (HRNMIBC) treated with BCG therapy.
Materials and Methods: Between March 2010 and February 2014 in a tertiary center 100 consecutive patients with newly diagnosed HRNMIBC were retrospectively analyzed.
Patients were divided according to NLR value: 46 patients with NLR value less than 3 (NLR < 3 group), and 54 patients with NLR value more than 3 (NLR ≥ 3 group).
At the end of follow-up 52 patients were high grade disease free (BCG-responder group) and 48 patients underwent radical cystectomy for high grade recurrence or progression to muscle invasive disease (BCG non-responder group). The average follow-up was 60 months. Intervention: analysis and correlation of preoperative NLR value with response to BCG in terms of recurrence and progression.
Results: The optimal cut-off for NLR was ≥3 according to the receiver operating characteristics analysis (AUC 0.760, 95% CI, 0.669-0.850). Mean NLR value was 3.65 ± 1.16 in BCG non-responder group and 2.61 ± 0.77 in BCG responder group (p = 0.01). NLR correlated with recurrence (r = 0.55, p = 0.01) and progression risk scores (r = 0.49, p = 0.01). In multivariate analysis, NLR (p = 0.02) and EORTC recurrence risk groups (p = 0.01) were associated to the primary endpoint. The log-rank test showed statistically significant difference between NLR < 3 and NLR ≥3 curves (p < 0.05).
Conclusions: NLR value preoperatively evaluated could be a useful tool to predict BCG response of HRNMIBC. These results could lead to the development of prospective studies to assess the real prognostic value of NLR in HRNMIBC.

Keywords: Urinary Bladder Neoplasms; Neutrophils; Lymphocytes

[Full Text]


Can quadrivalent human papillomavirus prophylactic vaccine be an effective alternative for the therapeutic management of genital warts? an exploratory study

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0355


ORIGINAL ARTICLE

Hoon Choi 1
1 Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea

ABSTRACT

Objective: To evaluate the treatment effect of genital warts, we investigated the quad¬rivalent HPV vaccine injection compared with surgical excision.
Materials and Methods: This prospective study included 26 patients (M:F = 24:2) who received HPV vaccine or surgical excision. After explanation of surgical excision or HPV vaccine, 16 patients underwent surgical excision and the others received HPV vaccine injections. Based on gross findings of genital warts, treatment outcomes were classified as complete response (no wart), partial response, and failed treatment.
Results: Among enrolled patients, 42% (11 / 26) patients had recurrent genital warts. In vaccination group, complete response rates of genital wart were 60% following 3 times HPV vaccine. Partial response patients wanted to excise the genital lesions before the 3 times injection, because they worried about sexual transmission of disease to their sexual partners. One patient underwent surgical excision after 3 times injection. Excision sites included suprapubic lesions, but other sites including mid-urethra and glans showed complete response after injection. At a mean follow-up period of 8.42 ± 3.27 months, 10 patients (100%) who received HPV vaccine did not show recurrence.
Conclusion: The response rates after HPV vaccine injection were 90% (complete and partial). Our results suggested that HPV vaccines could be effective in management of genital warts.

Keywords: Human papillomavirus 31; Vaccines; Therapeutics

[Full Text]


REPLY TO THE AUTHORS: Re: The effect of urethroplasty surgery on erectile and orgasmic functions: a prospective study

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0793.1


LETTER TO THE EDITOR

Ahmet Urkmez 1, Ozgur H. Yuksel 2, Emrah Ozsoy 1, Ramazan Topaktas 1, Aytac Sahin 2, Orhan Koca 1, Metin I. Ozturk 1
1 Department of Urology, University of Health Sciences, Haydarpasa Numune Research & Training Hospital, Istanbul, Turkey; 2 Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Research & Training Hospital, Istanbul, Turkey

ABSTRACT

Not available

[Full Text]


Re: The effect of urethroplasty surgery on erectile and orgasmic functions: a prospective study

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0793


LETTER TO THE EDITOR

Michael S. Floyd Jr. 1, Ahmad M. Omar 1 , Andrew D. Baird 2 , Paul C. B. Anderson 3
1 Department of Reconstructive Urology, St Helens & Knowsley Hospital NHS Trust, Whiston Hospital, Warrington Road, Liverpool, United Kingdom; 2 Department of Reconstructive Urology, Aintree University Hospital Lower Lane, Aintree, Liverpool, , United Kingdom; 3 Department of Genitourethral Reconstruction, Russell’s Hall Hospital Pensnett Road, Dudley, West Midlands, United Kingdom

ABSTRACT

Not available

[Full Text]


Sacrospinous hysteropexy with a low weight transvaginal polypropylene mesh for treatment of complete uterovaginal eversion

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0555


VIDEO SECTION

Arnold P. P. Achermann 1, Éder S. Brazão Junior 1, Cássio L. Z. Riccetto 1, Paulo C. R. Palma 1
1 Divisão de Urologia Feminina, Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade de Campinas, UNICAMP, Brasil

ABSTRACT

Introduction: Pelvic Organ Prolapse (POP) is a common condition in elderly resulting from the weakening of the organ suspension elements of multifactorial origin. It compromises significantly the quality of life and can affect more than 50% of multiparous women. Stage IV prolapse or complete uterovaginal eversion corresponds to 10% of the cases and the only form of curative treatment is the surgical correction. The aim of this video is to demonstrate our technique of sacrospinous hysteropexy with a low weight transvaginal polypropylene mesh for treatment of this challenge condition, focusing on technical details in order to prevent mesh related complications. Major, but rare complications, include: infection, prolapse recurrence, abscess formation, bladder perforation and urinary fistula. These situations are related mostly to low volume centers.
Materials and Methods: A 70 years old female with a stage IV POP had obstructive lower urinary tract symptoms. Only after reducing prolapse, it was possible to urinate, but without stress urinary incontinence. No topic estrogen was pre¬scribed before the surgery and she also didn´t take any kind of hormone replacement therapy. Transvaginal ultrasound and the Pap smear screening were done with normal results. Cystoscopy wasn´t employed at anytime of this procedure. Hydrodissection of vaginal wall was followed by longitudinal incision from the level of bladder neck to the cervix. Notice that the ideal dissection should maintain the vaginal thickness, and address the plane of the connective tissue between the bladder and the vagina. Bladder base is then released from the anterior aspect of the cervix in order to create a site to pericervical ring repair and to fix the apex of the Calistar Soft® with polypropylene 3.0 stitches. A blunt dissection extended downwards through the lateral aspect of the levator ani fascia till the identification of the ischial spine and sacrospinous ligaments bilaterally. Two polypropilene 2.0 threads mounted on a specially designed tissue anchor system (TAS) are then fixed into each sacrospinous ligament 1.5 to 2 cm away from the ischial spine and repaired for further prosthesis anchoring. Then, a longitudinal incision is done at the posterior vaginal wall and the recto-vaginal fascia detachment from the posterior aspect of the pericervical ring is identified and corrected with interrupted polypropylene 2.0 stitches to the cervix and to the pericervical aspect of elongated uterosacrus ligaments bilaterally. The Calistar Soft A (anterior) and P (posterior)® prosthesis were fixed at the anterior and posterior aspects of the cervix, respectively, with interrupted polypropylene 3.0 stitches and meshes’ arms are fixed to the sacrospinous ligament using the previously implanted TAS. Then, the distal Calistar Soft A® arms were bilaterally fixed into the internal obturator muscles using its fish spine–like multipoint fix device in order to prevent mesh folding. Finally, perineal body repair was done and vaginal wall was closed with individual absorbable interrupted polyglactin 2.0 sutures and a 16 Fr Foley catheter as well as a vaginal pack embedded on neomicin-bacitracin cream were kept overnight.
Results: A high satisfaction rate has been computed with synthetic mesh to POP surgery correction. Approximately 10% of cases of mesh exposure may occur, most of them oligosymptomatic and easy handed by excision or with topic estrogen preparations. After 1 year follow-up, our patient is still satisfied without any complain and no relapse.
Conclusion: We described a successful treatment of stage IV POP in an old female patient. This technique can be used for advanced end stage POP patients, especially those with some contraindication to sacropromontopexy, but who want to keep vaginal length and uterus. Anatomical knowledge, obedience to technical care, and intensive training are the keys for minimizing the risk of complications. Although we had success with this technique, more studies with proper random¬ization are necessary to compare success and complications of sacrospinous hysteropexy with a low weight transvaginal polypropylene mesh to sacropromontopexy.

Available at: https://www.intbrazjurol.com.br/video-section/20180555_Achermann_et_al

[Full Text]


Single-Port Trans-Perineal Approach to Cystoprostatectomy with Intracorporeal Ileal Conduit Urinary Diversion and Lymph-Nodes Dissection using a Purpose-Built Robotic System: Surgical Steps in a Preclinical Model

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0524


VIDEO SECTION

Juan Garisto 1, Riccardo Bertolo 1, Eddie Chan 2, Jihad Kaouk 1
1 Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland OH, USA; 2 Chinese University of Hong Kong and Division of Urology at Prince of Wales Hospital, Shatin, Hong Kong

ABSTRACT

Aim: To report the technique for single-port trans-perineal cystoprostatectomy with intracorporeal ileal conduit urinary diversion and lymph nodes dissection using a purpose-built robotic platform (da Vinci SP1098, Intuitive Surgical, Sunny¬vale, CA, USA).
Materials and Methods: In a male cadaver the SP1098 robotic system was used to perform cystoprostatectomy with intracorporeal ileal conduit urinary diversion and lymph nodes dissection by single-port trans-perineal approach. The surgery was completed through a 2.5-cm perineal incision through which a GelPOINT Mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) and a dedicated 25-mm multichannel port accommodating a 12 x 10-mm oval articulating robotic camera, three 6-mm double-jointed articulating robotic instruments and a 6-mm acces¬sory laparoscopic instrument were positioned. At the planned level of the stoma for the ileal conduit, a 12-mm port was placed through which the EndoGIA® stapler was used to mature the urinary diversion
Results: The total operative time was 185 min. The procedure was successfully completed without the need for additional ports placement. The benefits of the trans-perineal approach, particularly in longer procedures as radical cystectomy with intracorporeal urinary diversion, might include the avoided need of Trendelenburg position, with undoubtful advantages for the patient and the anesthesiologist in terms of respiratory mechanics and hemodynamics.
Conclusions: The feasibility of single-port trans-perineal cystoprostatectomy with intracorporeal ileal conduit urinary diversion and lymph nodes dissection using the SP1098 purpose-built robotic platform is demonstrated. The duplication of the described surgical steps in the clinical model is awaited when the platform will be available on the market.

Available at: https://www.intbrazjurol.com.br/video-section/20180524_Garisto_et_al

[Full Text]


Iatrogenic foreign body in urinary bladder: Holmium laser vs. Ceramic, and the winner is…

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0229


VIDEO SECTION

Daniele Castellani 1, Luca Gasparri 1, Redi Claudini 1, Maria Pia Pavia 1, Alessandro Branchi 1, Marco Dellabella 1
1 Department of Urology, IRCCS-INRCA, Ancona, Italy

ABSTRACT

Introduction: Urological surgery is estimated to be the third most common cause of iatrogenic-retained foreign bodies (1).
Presentation: A 76-year old man was undergoing a transurethral resection of bladder tumor with a 26-Ch continuous flow resectoscope (Karl Storz, Germany). Before starting resection, a detachment of resectoscope sheath tip was noted.
The ceramic tip was free-floating in the bladder lumen, and it would not fit within the sheath, making direct extraction using the loop impossible. An attempt was made to break it with a stone punch, but it was unsuccessful due to impossibility of closing it in the branches. Therefore, we decided to fragment the tip with holmium laser (RevoLix®, LISA Laser products, Germany), using an 800-micron, front-firing fiber. Laser device was settled at with 2.5 J energy and 5 Hz frequency.
Ceramic appeared very hard, but it was difficult to carry on breaking with this setting because of tip retropulsion.
Then, laser setting was switched to lower energy and higher frequency (1 J and 13 Hz). This setting guaranteed the same power of 13 W, but with minimal retropulsion.
Results: Tip was fragmented against the posterior bladder wall in seven pieces, which were retrieved trough the outer sheath. A total 5.62 kJ were used to fragment it. At the end, superficial lesions of the posterior bladder wall were highlighted.
Surgical time was 55 minutes. Patient was discharged home next day without problems.
Conclusions: Holmium laser fragmentation is a safe and effective approach to remove foreign bodies from the bladder.

ARTICLE INFO
Available at: https://www.intbrazjurol.com.br/video-section/20180229_Castellani_et_al

[Full Text]


Primary renal angiosarcoma with extensive hemorrhage: CT and MRI findings

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0375


RADIOLOGY PAGE

Suk Hee Heo 1, Sang Soo Shin 1, Taek Won Kang 2, Ga Eon Kim 3
1 Department of Radiology, Chonnam National University Medical School, Gwangju, South Korea; 2 Department of Urology, Chonnam National University Medical School, Gwangju, South Korea; 3 Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea

ABSTRACT

Primary angiosarcomas of the kidney are very rare, but highly aggressive tumors showing poor prognosis. Patients frequently complain of flank pain, hematuria, or a palpable mass. We present a case of primary renal angiosarcoma occurring in a 61-year-old man. CT images depicted a huge exophytic mass (16 cm in diameter) in the right kidney, exhibiting extensive hemorrhage. The mass showed centripetal peripheral nodular enhancement on dynamic contrast-enhanced images. Furthermore, MR imaging revealed a tangled mesh of tumor vessels in the periphery of the mass. We suggest its inclusion in the differential diagnosis of cases of hemorrhagic renal tumors with prominent vasculature.

Keywords: Magnetic Resonance Imaging; Tomography, X-Ray Computed

[Full Text]


Proposal of a new way to evaluate the external sphincter function prior male sling surgey

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0146


ORIGINAL ARTICLE

Daniel Carlos Moser 1, Carlos Arturo Levi D’ancona 1, Brunno Raphael Iamashita Voris 1, Daniel Lahan 1, Kavina Jani 2, Gerard D. Henry 1
1 Departamento de Cirurgia Urológica, Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil; 2 Department of Urology, Ark-La-Tex Urology, Shreveport, Louisiana, USA

ABSTRACT

Objective: To propose a new way to objectively evaluate the external sphincter function prior to male sling surgery.
Materials and Methods: We evaluated the pre-operative sphincter function throughout sphincter pressure at rest (SPAR) and sphincter pressure under contraction (SPUC) obtained throughout urethral profilometry profile (UPP) of 10 consecutive patients (age range, 54-79 years) treated with the retrourethral transobturator sling (RTS) for stress urinary incontinence (SUI) because of prostate surgery. The primary endpoint for surgery success rate was post-operative pad weight test. This was correlated to preoperative pad test, RT, SPAR and SPUC. Post-operatively patients were classified as continent (no pad use) and those who still were incontinent.
Results: Mean SPUC in the continent and incontinent group was respectively 188 + 8.8 (median 185.1, range 181 to 201) and 96.9 + 49.4 (median 109.9, range 35.6 to 163.6) (P = 0.008). Mean 24-hour pad test was 151 + 84.2gm (median 140, range 80 to 245) and 973 + 337.1gm (median 1940, range 550 to 1200) in post-operative continent and incontinent groups respectively (P = 0.008). The repositioning test (RT) was positive in all continent patients except one. The RT was also positive in three incontinence patients (false positive). In all post-operative continent patients SPUC was higher than 180cmH2O and pre-operative pad test was less than 245gm.
Conclusions: SPUC seems to be a way for optimizing the sphincter evaluation as well to become a useful tool for patient selection prior to RTS surgery.

Keywords: Urinary Incontinence; Prostatectomy; Transurethral Resection of Prostate

[Full Text]


Prostate brachytherapy with iodine-125 seeds: analysis of a single institutional cohort

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0142


ORIGINAL ARTICLE

Elton Trigo Teixeira Leite 1, 2, João Luis Fernandes da Silva 1, Eduardo Capelletti 1, Cecilia Maria Kalil Haddad 1, Gustavo Nader Marta 1, 2
1 Departamento de Radioterapia, Hospital Sirio-Libanês, São Paulo, SP, Brasil; 2 Serviço de Radioterapia – Departamento de Oncologia da Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brasil

ABSTRACT

Objectives: Brachytherapy (BT) with iodine-125 seeds placement is a consolidated treatment for prostate cancer. The objective of this study was to assess the clinical outcomes in patients with prostate cancer who underwent low-dose-rate (LDR) –BT alone in a single Brazilian institution.
Materials and Methods: Patients treated with iodine-125 BT were retrospectively assessed after at least 5 years of follow-up.
Patients who received combination therapy (External beam radiation therapy-EBRT and BT) and salvage BT were not included.
Results: 406 men were included in the study (65.5% low-risk, 30% intermediate-risk, and 4.5% high-risk patients). After a median follow-up of 87.5 months, 61 (15.0%) patients developed biochemical recurrence. The actuarial biochemical failure-free survival (BFFS) at 5 and 10 years were 90.6% and 82.2%, respectively. A PSA nadir ≥ 1 ng / mL was associated with a higher risk of biochemical failure (HR = 5.81; 95% CI: 3.39 to 9.94; p ≤ 0.001). The actuarial metastasis-free survival (MFS) at 5 and 10 years were 98.3% and 94%, respectively. The actuarial overall survival (OS) at 5 and 10 years were 96.2% and 85.1%, respectively. Acute and late grade 2 and 3 gastrointestinal toxicities were observed in 5.6%, 0.5%, 4.6% and 0.5% of cases, respectively. For genitourinary the observed acute and late grade 2 and 3 toxicities rates were 57.3%, 3.6%, 28% and 3.1%, respectively. No grade 4 and 5 were observed.
Conclusions: BT was effective as a defi nitive treatment modality for prostate cancer, and its endpoints and toxicities were comparable to those of the main series in the literature.

Keywords: Brachytherapy; Iodine-125 [Supplementary Concept]; Prostate; Radiotherapy

[Full Text]


Laparoscopic sacrocolpopexy for neovaginal prolapse in a patient after male-to-female sex reassignment surgery

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0086


VIDEO SECTION

Marek Roslan 1, Marcin Markuszewski 2, Wojciech Piaskowski 2, Wojciech Połom 2, Sławomir Letkiewicz 3
1 Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland; 2 Department of Urology, Medical University of Gdańsk, Gdańsk, Poland; 3 Institute of Immunology and experimental therapy, Polish Academy of Science, Wrocław, Poland

ABSTRACT

Introduction: Male / female sex reassignment surgery is performed on transsexuals, and includes removal of the male external genitalia, and creation of the neovagina from the skin of the penis, usually allowing sexual intercourse (1, 2). The incidence of the prolapse of the neovagina is not known; however, such complication is observed relatively rarely (3, 4). the long-term outcomes of prolapse treatment in transsexual patients are not available in the literature. The purpose of this study was to demonstrate laparoscopic sacrocolpopexy to repair a neovagina prolapse in a patient after male-to-female sex reassignment surgery.
Materials and Methods: In september 2013, a laparoscopic repair was performed on a 44-year-old woman who presented a neovaginal prolapse of pelvic organ prolapse quantification (pop-q) stage iii, twenty one years after sex reassignment surgery. This condition caused painful or even indisposed intercourse. in may 2013, the patient underwent unsuccessful vaginal treatment with the suturing device. Before the initial surgery, the patient was examined with cystoscopy, urody¬namics and microbiology; no pathologies were found. laparoscopic repair of the neovaginal prolapse followed the prin¬ciples described previously in the natural female (5). In the supine lithotomy position, a standard multiport laparoscopic sacrocolpopexy was performed with the use of the polypropylene mesh (Artisyn® y-shaped mesh, ethicon, inc somerville, nj.) and coated polyglactin sutures.
The following steps were applied: exposure of the anterior and posterior neovaginal walls; suturing the bifurcated end of the mesh to the neovagina; longitudinal incision of the parietal peritoneum and creation of a tunnel for the mesh; fixa¬tion of the proximal end of the mesh to the promontorium; and closure of the parietal peritoneum over the mesh that was placed retroperitoneally. The draining tube was left for 24 hours.
Results: The operation was completed successfully, with no blood loss or complications. The operative time was 115 minutes. The patient was discharged on the 2nd postoperative day. In a four-year follow-up, the patient presented sig¬nificant improvement of symptoms, a small prolapse of approximate pop-q stage i, and declared performing satisfying intercourse.
Conclusions: Laparoscopic sacrocolpopexy with the use of a polypropylene mesh to repair a neovaginal prolapse in transsexuals seems to be a valuable alternative to other procedures. Further observations and evaluation of a greater number of patients will be necessary to assess the actual value of the method.

ARTICLE INFO
Available at: https://www.intbrazjurol.com.br/pdf/aop/video/20180086_Roslan

[Full Text]


 

Robot assisted radical nephrectomy + hysterectomy and specimen retrieval per vaginum (NOSE)

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0351


VIDEO SECTION

Jagdeesh N. Kulkarni 1, Nitesh Maurya 2, Sushrut Bhukte 3, Vrunda Karanjgaokar 4
1 Department of Urology, Bombay Hospital and Medical Research Centre, Mumbai, India; 2 Depart­ment of Surgical Oncology, Asian Cancer Institute, Mumbai, India; 3 Department of Uro-Oncology, Asian Cancer Institute, Mumbai, India; 4 Department of Gynae-Oncology, Asian Cancer Institute, Mumbai, India

ABSTRACT

We demonstrate robot assisted radical nephrectomy with hysterectomy in the same sitting position followed by specimen retrieval per vagina (NOSE- Natural Orifice Specimen Extraction)

A 36 year old female P2L2, presented with long standing dysmenorrhoea. Abdominal sonography detected incidental large left renal mass with a large fundal fibroid.

CT scan revealed 8cmx8cm mass arising from mid and lower zone of the left kidney without vascular invasion and lymphadenopathy with a large fundal fibroid. Rest of the adnexes were normal.

She underwent robot assisted left radical nephrectomy first in lateral docking position. After bagging the nephrectomy specimen, robot was dedocked. Later, the patient was put in lithotomy position and with central docking, and hyster­ectomy was completed. Both the specimens were retrieved through the vagina without compromising the oncological principles.

Patient had a smooth post-operatory recovery and discharged on postoperative day 2. Histopathology revealed RCC Furh­man grade 4 while hysterectomy specimen showed fibroadenoma with adenomyosis. No adjuvant therapy was instituted and at 3 months patient is doing well.

We conclude that two organ excision and extraction of specimen through vagina (NOSE) using two arms is possible in selected cases with excellent outcome in terms of early return to work with minimal morbidity. Also. limited use of instru­ments augments reduction in treatment cost.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180351_Kulkarni_et_al

[Full Text]


Robotic simple prostatectomy plus panniculectomy and Giant umbilical hernia repair

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0565


VIDEO SECTION

Angelica Beatriz Hernandez 1, Luis G. Medina 1, Pierre A. Hueber 1, Felipe Placco Araujo Glina 1, Hannah Landsberger 1, Daniel Oberlin 1, Giovanni Cacciamani 1, Byron Lopez 1, Ketan Patel 2, Rene J. Sotelo 1
1 Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; 2 Department of Surgery, Division of Plastic and Reconstructive Surgery, Keck School of Medici­ne, University of Southern California, Los Angeles, CA, USA

ABSTRACT

Introduction: Simple prostatectomy is the gold standard for prostates >80 grams, robotic system has proven to help into speed the recovery of the patient and in morbid obesity the advantages of the robotic system can help to perform a suc­cessful surgery.

Case: 80 years old male with morbid obesity (BMI 45) and several other comorbidities, with history of an umbilical hernia and obstructive lower urinary tract symptoms in acute urinary retention. PSA was 7 ng/dl, DRE demonstrates a >100gr prostate gland. A robotic simple prostatectomy, urethropexy, umbilical hernia repair and panniculectomy in Fleur-de-Lis was performed.

Results: Operative time (OT) and estimated blood loss (EBL) were 438 min and 160 ml respectively. A JP drain was placed in the pelvis and 2 additional were left in the abdominal cavity with several Penrose drains. No immediate or intraopera­tive complications were observed. The length of stay (LOS) was 6 days without complications. Pathology report showed prostate of 304gr and benign prostatic tissue.

Discussion: In patients with multiple comorbidities robot-assisted surgery provides advantages of shorter LOS, EBL, less transfusion and lower rate of complications. In patients with morbid obesity where the increased girth makes difficult the open approach, robotic surgery is an ideal way to provide definitive treatment; concomitant, Fleur-de-Lis panniculec­tomy can correct the abdominal contour in both vertical and horizontal orientation at the same time that provides a better plane for trocar insertion, an accurate location of the needle tip and a proper position of the remote center decreasing the possible complication of port placement.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180565_Hernandez_et_al

[Full Text]


Crossover transseptal vasovasostomy: alternative for very selected cases of iatrogenic injury to vas deferens

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0445


CHALLENGING CLINICAL CASES

Fernando Korkes 1, Oseas Castro Neves Neto 2
1 Divisão de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil; 2 Hospital Israelita Albert Einstein, São Paulo, SP, Brasil

ABSTRACT

Inguinal herniorraphy is a possible cause of iatrogenic seminal tract obstruction. Diagnosing and correcting these vasal injuries can be challenging. Successful re-anastomosis is technically challenging, with relatively low success rates. An uncommon alternative for selected cases is the crossover transseptal vasovasostomy. We herein report a case of a 36-year-old male patient with vas deferens injury after herniorraphy and a contralateral hypotrophic testis. He was successfully treated through microsurgical crossover transseptal vasovasostomy, with spontaneous pregnancy achieved, and the technique is presented in details.

Keywords: Azoospermia; Herniorrhaphy; Infertility; Vasovasostomy

[Full Text]


Effect of vitamin D supplementation on 24-hour urine calcium in patients with calcium Urolithiasis and vitamin D deficiency

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0522


ORIGINAL ARTICLE

Maryam Taheri 1, Sanaz Tavasoli 1, Fatemeh Shokrzadeh 1, Fahimeh Bagheri Amiri 1, Abbas Basiri 1
1 Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

ABSTRACT

Purpose: Hypercalciuria is one of the risk factors for calcium kidney stone formation (the most common type of urinary stones). Although vitamin D deficiency is prevalent among urolithiasis patients, the effect of vitamin D supplementation on urine calcium in these patients is still unclear.

Materials and Methods: In this retrospective study, medical and laboratory tests records of 26 patients with recurrent calcium kidney stones and vitamin D deficiency treated with 50000IU vitamin D per week for 8-12 weeks were analyzed. The changes in 24-hour urine calcium (24-h Ca), serum 25-hydroxyvitamin D (25 (OH) D), serum parathormone (PTH), other 24-hour urine metabolites and calculated relative supersaturations of calcium oxalate (CaOxSS), calcium phosphate (CaPSS) and uric acid (UASS) were assessed. Moreover, correlations between changes in 24-h Ca and other aforementioned variables were assessed.

Results: Serum 25 (OH) D and 24-h Ca increased after vitamin D supplementation, while serum PTH decreased (p < 0.001, for all analyses). The levels of 24-hour urine sodium and urea increased significantly (p = 0.005 and p = 0.031, respectively). The levels of CaOxSS and CaPSS increased, but the changes were not significant (p = 0.177, and p = 0.218, respectively). There were no correlations between the changes in 24-h Ca and serum 25 (OH) D or PTH.

Conclusions: The result of current study suggests that although urine Ca increased in vitamin D supplemented patients, this increase was not associated with the increase in serum vitamin D and may be due to other factors such as dietary factors. Further randomized clinical trials considering other factors associated with urine Ca are warranted.

Keywords: Parathyroid Hormone; Urolithiasis; Vitamin D

[Full Text]


Balloon dilation for failed pyeloplasty in children?

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0407


ORIGINAL ARTICLE

Haifeng Duan 1, 2, Wei Zhu 1, 2, Wen Zhong 1, 2, Xiaohang Li 1, 2, Guohua Zeng 1, 2
1 Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China; 2 Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China

ABSTRACT

Objective: Pyeloplasty is considered the gold standard treatment for ureteropelvic junction obstruction (UPJO). However, the failure rate of pyeloplasty is as high as 10% and repeat pyeloplasty is more difficult. This study aimed to evaluate the efficacy of balloon dilatation for failed pyeloplasty in children.

Materials and Methods: Between 2011 and 2017, 15 patients, aged 6 months to 14 years, were treated with balloon dilation for restenosis of UPJO after a failed pyeloplasty.

Ultrasound and intravenous urography were used to evaluate the primary outcome. Success was defined as the relief of symptoms and improvement of hydronephrosis, which was identified by ultrasound at the last follow-up.

Results: All patients successfully completed the operation, 13 patients by retrograde approach and 2 patients by antegrade approach. Thirteen patients were followed for a median of 15 (4 to 57) months and 2 patients were lost to follow-up. Resolution of the hydronephrosis was observed in 5 cases. The anteroposterior diameter (APD) of the pelvis decreased by an average of 12.4 ± 14.4mm. Eight patients needed another surgery.

The average postoperative hospital stay was 1.78 ± 1.4 days. Two patients experienced fever after balloon dilation. No other complications were found.

Conclusions: Balloon dilatation surgery is safe for children, but it is not recommended for failed pyeloplasty in that group of patients, owing to the low success rate.

Keywords: Cakut [Supplementary Concept]; Angioplasty, Balloon; Child

[Full Text]


Role of native Thiol, total Thiol and dynamic Disulphide in diagnosis of patient with prostate cancer and prostatitis

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0469


ORIGINAL ARTICLE

Mehmet Solakhan 1, Hulya Cicek 2, Nuri Orhan 2, Mustafa Yildirim 3, 4
1 Department of Urology, Medicalpark Gaziantep Hospital, Bahçeşehir University School of Medicine, Gaziantep, Turkey; 2 Department of Medical Biochemistry, Medicalpark Gaziantep Hospital, Gaziantep, Turkey; 3 Department of Internal Medicine, Medicalpark Gaziantep Hospital, Bahçeşehir University School of Medicine, Gaziantep, Turkey; 4 Department Medical Oncology, Medicalpark Gaziantep Hospital, Bahçeşehir University School of Medicine, Gaziantep, Turkey

ABSTRACT

Background: Our study investigates whether Native Thiol, Total Thiol and disulphide levels measured in serum of patients with prostate cancer and prostatitis and of healthy subjects, have any role in differential diagnosis.

Materials and Methods: Patients followed up for histopathologically verified diagnosis of prostate cancer and prostatitis in 2016-2017 at the Medicalpark Gaziantep Hospital Urology Clinic were included in the study. Native Thiol (NT), Total Thiol (TT), Dynamic Disulphide (DD) levels in serum were measured by a novel automated method.

Results: NT, TT, DD, NT / TT ratios, DD / TT ratio and DD / NT ratio were measured as 118.4 ± 36.8μmoL / L, 150.3 ± 45.3μmoL / L, 15.9 ± 7μmoL / L, 78.8 ± 7μmoL / L, 10.5 ± 3.5μmoL / L, 13.8 ± 5.8μmoL / L respectively in patients with prostate cancer; as 116.4 ± 40.5μmoL / L, 147.5 ± 50.1μmoL / L, 15.5 ± 8.7μmoL / L, 79.7 ± 9μmoL / L, 10.1 ± 4.5μmoL / L, 13.5 ± 7.2μmoL / L in patients with prostatitis and as 144.1 ± 21.2μmoL / L, 191 ± 32.3μmoL / L, 23.4 ± 10.1μmoL / L, 76.1 ± 98.3μmoL / L, 11.9 ± 4.1μmoL / L, 16.4 ± 6.9μmoL / L in healthy subjects. Significant difference was detected between groups of NT, TT and DD levels (p = 0.008, p = 0.001, p = 0.002). No significant difference was detected in terms of the NT / TT, DD / TT and DD / NT rates (p = 0.222, p = 0.222, p = 0.222).

Conclusions: Serum NT, TT, DD levels in patients with prostatitis and prostate cancer were found significantly lower compared to the control group. This indicates that just as inflammation, prostate cancer also increases oxidative stress on tissues.

Keywords: Prostatic Neoplasms; Oxidative Stress

[Full Text]


Trends in renal calculus composition and 24-hour urine analyses in patients with neurologically derived musculoskeletal deficiencies

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0531


ORIGINAL ARTICLE

Lee A. Hugar 1, Ilan Kafka 2, Thomas W. Fuller 1, Hassan Taan 1, Timothy D. Averch 1, Michelle J. Semins 1
1 Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 2 Shaare Zedek Medical Center, Jerusalem, Israel

ABSTRACT

Purpose: To better characterize metabolic stone risk in patients with neurologically derived musculoskeletal deficiencies (NDMD) by determining how patient characteristics relate to renal calculus composition and 24-hour urine parameters.

Materials and Methods: We performed a retrospective cohort study of adult patients with neurologically derived musculoskeletal deficiencies presenting to our multidisciplinary Kidney Stone Clinic. Patients with a diagnosis of NDMD, at least one 24-hour urine collection, and one chemical stone analysis were included in the analysis. Calculi were classified as primarily metabolic or elevated pH. We assessed in clinical factors, demographics, and urine metabolites for differences between patients who formed primarily metabolic or elevated pH stones.

Results: Over a 16-year period, 100 patients with NDMD and nephrolithiasis were identified and 41 met inclusion criteria. Thirty percent (12 / 41) of patients had purely metabolic calculi. Patients with metabolic calculi were significantly more likely to be obese (median body mass index 30.3kg / m2 versus 25.9kg / m2), void spontaneously (75% vs. 6.9%), and have low urine volumes (100% vs. 69%). Patients who formed elevated pH stones were more likely to have positive preoperative urine cultures with urease splitting organisms (58.6% vs. 16.7%) and be hyperoxaluric and hypocitraturic on 24-hour urine analysis (37mg / day and 265mg / day versus 29mg / day and 523mg / day).

Conclusions: Among patients with NDMD, metabolic factors may play a more significant role in renal calculus formation than previously believed. There is still a high incidence of carbonate apatite calculi, which could be attributed to bacteriuria. However, obesity, low urine volumes, hypocitraturia, and hyperoxaluria suggest an underrecognized metabolic contribution to stone formation in this population.

Keywords: Nephrolithiasis; Urinary Bladder, Neurogenic; Kidney Calculi

[Full Text]


Impact of time from biopsy to surgery on complications, functional and oncologic outcomes following radical prostatectomy

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0196


ORIGINAL ARTICLE

Mary E. Westerman 1, Vidit Sharma 1, George C. Bailey 1, Stephen A. Boorjian 1, Igor Frank 1, Matthew T. Gettman 1, R. Houston Thompson 1, Matthew K. Tollefson 1, Robert Jeffrey Karnes 1
1 Department of Urology, Mayo Clinic, Rochester, Minnesota, USA

ABSTRACT

Introduction: To determine the impact of time from biopsy to surgery on outcomes following radical prostatectomy (RP) as the optimal interval between prostate biopsy and RP is unknown.

Material and methods: We identified 7, 350 men who underwent RP at our institution between 1994 and 2012 and had a prostate biopsy within one year of surgery. Patients were grouped into five time intervals for analysis: ≤ 3 weeks, 4-6 weeks, 7-12 weeks, 12-26 weeks, and > 26 weeks. Oncologic outcomes were stratified by NCCN disease risk for comparison. The associations of time interval with clinicopathologic features and survival were evaluated using multivariate logistic and Cox regression analyses.

Results: Median time from biopsy to surgery was 61 days (IQR 37, 84). Median follow-up after RP was 7.1 years (IQR 4.2, 11.7) while the overall perioperative complication rate was 19.7% (1,448/7,350). Adjusting for pre-operative variables, men waiting 12-26 weeks until RP had the highest likelihood of nerve sparing (OR: 1.45, p = 0.02) while those in the 4-6 week group had higher overall complications (OR: 1.33, p = 0.01). High risk men waiting more than 6 months had higher rates of biochemical recurrence (HR: 3.38, p = 0.05). Limitations include the retrospective design.

Conclusions: Surgery in the 4-6 week time period after biopsy is associated with higher complications. There appears to be increased biochemical recurrence rates in delaying RP after biopsy, for men with both low and high risk disease.

Keywords: Surgical Procedures, Operative; Prostatectomy; Therapeutics

[Full Text]


 

Initial experience of video endoscopic inguinal Lymphadenectomy in a center located at northeast brazilian region

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0521


ORIGINAL ARTICLE

Aurus Dourado Meneses ¹, Pablo Aloisio Lima Mattos ¹, Walberto Monteiro Neiva Eulálio Filho 2 , Taíla Sousa de Moura Fé 3, Rodolfo Myronn de Melo Rodrigues 2, Marcos Tobias-Machado 4
1 Divisão de Urologia, Hospital São Marcos, Teresina, PI, Brasil; 2 Universidade Federal do Piaui, Teresina, PI, Brasil; 3 Centro Universitário Uninovafapi, Teresina, PI, Brasil; 4 Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil

ABSTRACT

Introduction: Video endoscopic inguinal lymphadenectomy – VEIL – has emerged as an alternative to reduce post-surgical complications (PSC) in patients with penile cancer submitted to inguinal lymphadenectomy (IL). In some series, these PSC are observed in more than 50% of patients. The objectives of the present study are to describe the initial experience of VEIL in a Hospital in Teresina, PI, Brazil, and to analyze PSC incidence.

Material and Methods: Retrospective descriptive study of patients submitted to VEIL from March 2014 to November 2015. Data were collected regarding surgical time, bleeding, complications, lymph node number, conversion, global complications, drainage time, cellulitis, lymphocele, cutaneous necrosis, miocutaneous necrosis and hospitalization time.

Results: 20 lower limbs of 11 patients were operated. Mean age was 51.4 (24-72) years. Mean surgical time was 85 (60-120) minutes. No patient showed intrasurgical complications, bleeding > 50 mL or conversion. Three surgeries evolved with lower limb edema, 2 with lymphoceles and one patient had cutaneous necrosis and another bulging of surgical wound. Mean time of hospitalization was 4 (2-11) days. A mean of 5.8 (1-12) lymph nodes were dissected in each surgery.

Conclusion: VEIL is a safe and easy technique with lower incidence of PSC that can be reproduced in small centers.

Keywords: Penile Neoplasms; Lymph Node Excision; Minimally Invasive Surgical Procedures

[Full Text]


Clinicopathological characteristics of surgically treated localized renal masses in patients previously exposed to chemotherapy

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0126


ORIGINAL ARTICLE

Efrat Tsivian 1, Matvey Tsivian 1, Christina Sze 1, Ariel Schulman 1, Thomas J. Polascik 1
1 Division of Urology, Department of Surgery, Duke University Medical Center, Durham, USA

ABSTRACT

Purpose: To explore the potential association between renal mass characteristics and a history of chemotherapy.

Materials and methods: A retrospective review of records of patients surgically treated for a localized renal mass between 2000 and 2012 was undertaken following an institutional review board approval. Patients age and sex, renal mass clinical characteristics (radiological size and mode of presentation) and pathological characteristics (diagnosis, renal cell carcinoma subtype, Fuhrman grade and stage) were compared between patients with and without a history of chemotherapy, using Fisher’s exact test, Student’s t-test and Wilcoxon rank sum test. A multivariate logistic analysis was performed to evaluate the independent association of chemotherapy and tumor pathology.

Results: Of the 1,038 eligible patients, 33 (3%) had a history of chemotherapy. The distribution of clinical stage, renal mass diagnosis, renal cell carcinoma subtype, Fuhrman grade, pathological stage, sex and median age were similar between the general population and the chemotherapy group. However, the latter had a higher rate of incidental presentation (P = 0.003) and a significantly smaller median radiological tumor size (P = 0.01). In a subset analysis of T1a renal cell carcinoma, the chemotherapy group presented an increased rate of high Fuhrman grade (P = 0.03). On multivariate analysis adjusted for radiological tumor size, sex and age the chemotherapy cohort had a 3.92 higher odds for high Fuhrman grade.

Conclusion: Patients with a history of chemotherapy typically present with smaller renal masses that, if malignant, have higher odds of harboring a high Fuhrman grade and thus may not be suitable for active surveillance.

Keywords: Carcinoma, Renal Cell; Chemotherapy, Cancer, Regional Perfusion; Kidney Neoplasms

[Full Text]


Is moderate hypofractionation accepted as a new standard of care in north america for prostate cancer patients treated with external beam radiotherapy? Survey of genitourinary expert radiation oncologists

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0275


ORIGINAL ARTICLE

Shearwood McClelland III 1, 2, Kiri A. Sandler 3, Catherine Degnin 4, Yiyi Chen 4, Arthur Y. Hung 2, Timur Mitin 2
1 Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, U.S.A; 2 Department of Radiation Medicine, Oregon Health and Science University, Portland, OR, U.S.A; 3 Department of Radiation Oncology, University of California at Los Angeles, Los Angeles, CA, U.S.A; 4 Biostatistics Shared Resource, Oregon Health and Science University, Portland, OR, U.S.A

 

ABSTRACT

 

Introduction: Several recent randomized clinical trials have evaluated hypofractionated regimens against conventionally fractionated EBRT and shown similar effectiveness with conflicting toxicity results. The current view regarding hypofractionation compared to conventional EBRT among North American genitourinary experts for management of prostate cancer has not been investigated.

Materials and Methods: A survey was distributed to 88 practicing North American GU physicians serving on decision – making committees of cooperative group research organizations. Questions pertained to opinions regarding the default EBRT dose and fractionation for a hypothetical example of a favorable intermediate – risk prostate cancer (Gleason 3 + 4). Treatment recommendations were correlated with practice patterns using Fisher’s exact test.

Results: Forty – two respondents (48%) completed the survey. We excluded from analysis two respondents who selected radical hypofractionation with 5 – 12 fractions as a preferred treatment modality. Among the 40 analyzed respondents, 23 (57.5%) recommend conventional fractionation and 17 (42.5%) recommended moderate hypofractionation.

No demographic factors were found to be associated with preference for a fractionation regimen. Support for brachytherapy as a first choice treatment modality for low – risk prostate cancer was borderline significantly associated with support for moderate hypofractionated EBRT treatment modality (p = 0.089).

Conclusions: There is an almost equal split among North American GU expert radiation oncologists regarding the appropriateness to consider moderately hypofractionated EBRT as a new standard of care in management of patients with prostate cancer.

Physicians who embrace brachytherapy may be more inclined to support moderate hypofractionated regimen for EBRT. It is unclear whether reports with longer followups will impact this balance, or whether national care and reimbursement policies will drive the clinical decisions. In the day and age of patient – centered care delivery, patients should receive an objective recommendation based on available clinical evidence.

The stark division among GU experts may influence the design of future clinical trials utilizing EBRT for patients with prostate cancer.

Keywords: Prostatic Neoplasms; Dose Hypofractionation; Neoplasm Grading

[Full Text]


Robot assisted radical prostatectomy in kidney transplant recipients: surgical, oncological and functional outcomes of two different robotic approaches

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0308


ORIGINAL ARTICLE

Francesco Alessandro Mistretta 1, Antonio Galfano 2, Ettore Di Trapani 1, Dario Di Trapani 2, Andrea Russo 1, Silvia Secco 2, Matteo Ferro 1, Gennaro Musi 1, Aldo Massimo Bocciardi 2, Ottavio de Cobelli 1
1 Department of Urology, European Institute of Oncology, Milan, Italy; 2 Department of Urology, Niguarda Hospital, Milan, Italy

ABSTRACT

Background: To date, few series on robot-assisted radical prostatectomy (RARP) in kidney transplant recipients (KTRs) have been published.

Purpose: To report the experience of two referral centers adopting two different RARP approaches in KTRs. Surgical, oncological and functional results were primary outcomes evaluated in the study.

Material and methods: We retrospectively analyzed data from 9 KTRs who underwent transperitoneal RARP or Retzius-sparing RARP for PCa from October 2012 to April 2016.

Data were reported as median and interquartile range (IQR). Pre- and postoperative outcomes were compared by non-parametric Wilcoxon signed-rank test. Significant differences were accepted when p ≤ 0.05. Overall survival was assessed using Kaplan-Meier method. Results: Four KTRs underwent a T-RARP and 5 a RS-RARP. Patient median age was 60 (56-63) years. Charlson comorbidity index was 6 (5-6). Preoperative median PSA was 5.6 (5-15) ng / mL. Preoperative Gleason score (GS) was 6 in 5 patients, 7 (3 + 4) in 3, and 8 (4 + 4) in one. Pre- and postoperative creatinine were 1.17 (1.1; 1.4) and 1.3 (1.07; 1.57) mg / dL (p = 0.237), while eGFR was 66 (60-82) and 62 (54-81) mL / min / 1.73m2 (p = 0.553), respectively.

One (11.1%) Clavien-Dindo grade II complication occurred. Two extended template lymphadenectomies were performed, both with nodal invasion. These two patients experienced a biochemical recurrence and were subjected to RT. Two patients (22.2%) had PSMs. Median follow-up was 42 months. Seven patients (77.8%) were continent, 5 (55.6%) were potent. Two (22.2%) patients died during follow-up for oncologic unrelated causes. Conclusions: Our series suggests that both RARP approaches are safe and feasible techniques in KTRs for PCa.

Keywords: Kidney Transplantation; Prostatic Neoplasms; Prostatectomy; Robotics

[Full Text]


Salvage radiotherapy for biochemical recurrence after radical prostatectomy: does the outcome depend on the prostate cancer characteristics?

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0039


ORIGINAL ARTICLE

Gustavo Arruda Viani 1, Ana Carolina Hamamura 1, Alexandre Ciuffi Correa 1, Felipe Teles de Arruda 1
1 Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brasil

ABSTRACT

Objective: To build a model to evaluate the impact of salvage radiotherapy (SRT) in men with PSA rise or persistent PSA after undergoing radical prostatectomy (RP).

Materials and Methods: The study included 107 node-negative patients treated with SRT after RP at a single institution. Patients received SRT for either prostate-specific antigen (PSA) rising, or PSA persistence after RP. All patients received local radiation to the prostate / seminal vesicle bed. The primary measured outcome was the biochemical recurrence (BCR) free survival. Multivariable Cox regression analysis was used to develop a risk-stratification group to identify predictive factors associated with the probability of BCR at 5yr.

Results: At a median follow-up of 52 months, the BCR free survival rate and overall survival in 5 years was 73% and 94%, respectively. At multivariable analysis, pre-SRT PSA level > 0.35ng / mL (p = 0.023), negative margins (p = 0.038), and seminal vesicles invasion (p = 0.001) were significantly associated with BCR free survival. Three risk groups using regression analysis for SRT administration was built. Low-, intermediateand the high-risk groups had a BCR free survival in 5-years of 96%, 84%, and 44% (p = 0.0001), respectively.

Conclusions: We developed a risk group stratification to show the impact of SRT based on prostate cancer characteristics. SRT showed to be extremely beneficial for patients with low- and intermediate-risk tumors. Moreover, the risk-group built could identify patients classified as high-risk who might benefit from more aggressive treatment for SRT.

Keywords: Radiotherapy; Prostatectomy; Prostatic Neoplasms

[Full Text]


Role of Adiponectin in prostate cancer

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0261


REVIEW ARTICLE

Xiaobo Hu 1,2, Cong Hu 2, Caiping Zhang 2, Min Zhang 2, Shiyin Long 2, Zhaohui Cao 1,2
1 Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study, University of South China, Hengyang, China; 2 Department of Biotechnology, School of Pharmacy and Biosciences, University of South China, Hengyang, China

ABSTRACT

Obesity is defined as a chronic and excessive growth of adipose tissue. It has been associated with a high risk for development and progression of obesity-associated malignancies, while adipokines may mediate this association. Adiponectin is an adipose tissue-derived adipokines, with significant anti-diabetic, anti-inflammatory, anti-atherosclerotic and anti-proliferative properties. Plasma adiponectin levels are decreased in obese individuals, and this feature is closely correlated with development of several metabolic, immunological and neoplastic diseases. Recent studies have shown that prostate cancer patients have lower serum adiponectin levels and decreased expression of adiponectin receptors in tumor tissues, which suggests plasma adiponectin level is a risk factor for prostate cancer. Furthermore, exogenous adiponectin has exhibited therapeutic potential in animal models. In this review, we focus on the potential role of adiponectin and the underlying mechanism of adiponectin in the development and progression of prostate cancer. Exploring the signaling pathways linking adiponectin with tumorigenesis might provide a potential target for therapy.

Keywords: Prostatic Neoplasms; Obesity; Stress, Physiological

[Full Text]


The TNM 8th edition: Validation of the proposal for organ – confined (pT2) prostate cancer

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0338


ORIGINAL ARTICLE

Athanase Billis 1, Leandro L. L. Freitas 1, Larissa B. E. Costa 1, Icleia S. Barreto 1, Luis A. Magna 2, Wagner E. Matheus 3, Ubirajara Ferreira 3
1 Departamento de Anatomia Patológica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil; 2 Departamento de Genética Médica / Bioestatística da Faculdade de Ciências Médicas (Unicamp), Campinas, SP, Brasil; 3 Departmento de Urologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil

ABSTRACT

Purpose: The 8th edition of the TNM has been updated and improved in order to ensure a high degree of clinical relevance. A major change in prostate includes pathologically organ – confined disease to be considered pT2 and no longer subclassified by extent of involvement or laterality. The aim of this study was to validate this major change.

Materials and Methods: Prostates were step – sectioned from 196 patients submitted to radical prostatectomy with organ confined disease (pT2) and negative surgical margins. Tumor extent was evaluated by a semiquantitative point count method. The dominant nodule extent was recorded as the maximal number of positive points of the largest single focus of cancer from the quadrants. Laterality was considered as either total tumor extent (Group 1) or index tumor extent (Group 2). Time to biochemical recurrence was analyzed with the Kaplan – Meier product limit analysis and prediction of shorter time to biochemical recurrence with Cox proportional hazards model.

Results: In Group 1, 43 / 196 (21.9%) tumors were unilateral and 153 / 196 (78.1%) bilateral and in Group 2, 156 / 196 (79.6%) tumors were unilateral and 40 / 196 (20.4%) bilateral. In both groups, comparing unilateral vs bilateral tumors, there was no significant clinicopathological difference, and no significant association with time as well as prediction of shorter time to biochemical recurrence following surgery.

Conclusions: Pathologic sub – staging of organ confined disease does not convey prognostic information either considering laterality as total tumor extent or index tumor extent. Furthermore, no correlation exists between digital rectal examination and pathologic stage.

Keywords: Prostate; Prostatic Neoplasms; Pathology, Surgical

[Full Text]


Can expressed prostatic secretions effect prostate biopsy decision of urologist?

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0292


ORIGINAL ARTICLE

Osman Ergün 1, Erdem Çapar 2, Yunus Emre Göğer 3, Ayşe Gül Ergün 4
1 Department of Urology, Medical Faculty, Süleyman Demirel University, Isparta, Turkey; 2 Department of Urology, Gediz State Hospital, Gediz,Turkey; 3 Department of Urology, Medical Faculty, Necmettin Erbakan University, Konya, Turkey; 4 Department of Microbiology, Isparta City Hospital, Isparta, Turkey

ABSTRACT

Objectives: To evaluate the frequency of NIH category IV prostatitis, and the use of expressed prostatic secretions tests in an effort to improve the reliability of prostate specific antigen as an indicator, to avoid unnecessary prostate biopsy.

Materials and Methods: 178 expressed prostatic secretion positive patients with serum prostate specific antigen levels of ≥ 2.5 ng / mL were included in present prospective study. The diagnostic evaluation included detailed history and physical examination, digital rectal examination, urine analysis, urine culture, and expressed prostatic secretions tests. Transrectal ultrasonography was used both to measure prostate volume and conduct 12 core prostate biopsy.

Results: The prevalence of NIH category IV prostatitis was 36.9% (178 / 482) in our population of men. In our study patients (n: 178) prostate biopsy results were classified as; 66 prostatitis, 81 BPH, and 31 Pca. In asymptomatic prostatitis group, expressed prostatic secretion mean leucocyte ratio was higher compared to other two groups (p < 0.0001). The relation between number of expressed prostatic secretion leucocytes and prostatitis, benign prostate hyperplasia, and prostate cancer is analyzed. If 16 is taken as the cut of number for leucocyte presence, its sensitivity is 0.92 (AUC = 0.78 p = 0.01).

Conclusions: The number of leucocytes in expressed prostatic secretion is higher in the chronic prostatitis group. If the leukocyte presence of 16 and above is taken as the cut off point, the sensitivity becomes 0.92 (AUC = 0.78). We firmly believe that our new cut off value may be used as to aid prostate specific antigen and derivates while giving biopsy decision.

Keywords: Prostatitis; Prostate; Inflammation

[Full Text]


Percutaneous resection of metastatic renal cell carcinoma

Vol. 45 (x): 2019 January 1.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0490


VIDEO SECTION

Amir Toussi 1, Deepak Agarwal 1, Bradley Leibovich 1, Aaron Potretzke 1
1 Department of Urology, Mayo Clinic, Rochester, MN, United States

ABSTRACT

Introduction: Metastasis-directed therapy of small solitary foci of metastatic renal cell carcinoma has been associated with improved survival. Percutaneous resection of tumors in the upper tract urinary system has been widely used for treatment of localized urothelial carcinoma, however, its role in renal cell carcinoma has not been described.

Herein, we present the first case of patient undergoing percutaneous resection of renal cell carcinoma in the contralateral renal pelvis.

Materials and Methods: This is a case report describing the diagnosis, management and surgical approach to renal cell carcinoma recurrence in the contralateral renal pelvis.

Results: Our patient was a 75-year-old male with a history of renal cell carcinoma status post radical nephrectomy who developed a solitary 2 cm recurrence in the contralateral renal pelvis, which was found after he presented with gross hematuria. He underwent successful percutaneous resection of this recurrence with final pathology showing clear cell renal cell carcinoma.

Conclusion: We present the first case of renal cell carcinoma recurrence in the contralateral renal pelvis treated with percutaneous resection.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180490_Toussi_et_al

[Full Text]


Small cell bladder cancer: should we consider prophylactic cranial irradiation?

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0242


ORIGINAL ARTICLE

Tara Nikonow Morgan 1, Robert M. Turner II 1, Julian Baptiste 2, Timothy D. Lyon 1, Jodi K. Maranchie 1, Ronald L. Hrebinko 1, Benjamin J. Davies 1, Jeffrey R. Gingrich 1, Bruce L. Jacobs 1
1 Department of Urology, University of Pittsburgh, Pennsylvania, U.S.A; 2 School of Medicine, University of Pittsburgh, Pennsylvania, U.S.A

ABSTRACT

Purpose: To describe the clinical characteristics, treatment patterns, and outcomes in patients with small cell bladder cancer at our institution, including those who received prophylactic cranial irradiation (PCI) for the prevention of intracranial recurrence.

Materials and Methods: Patients with small cell bladder cancer treated at a single institution between January 1990 and August 2015 were identified and analyzed retrospectively for demographics, tumor stage, treatment, and overall survival.

Results: Of 44 patients diagnosed with small cell bladder cancer, 11 (25%) had metastatic disease at the time of presentation. Treatment included systemic chemotherapy (70%), radical surgery (59%), and local radiation (39%). Six patients (14%) received PCI. Median overall survival was 10 months (IQR 4 – 41). Patients with extensive disease had worse overall survival than those with organ confined disease (8 months vs. 36 months, respectively, p = 0.04). Among those who received PCI, 33% achieved 5 – year survival.

Conclusion: Outcomes for patients with small cell bladder cancer remain poor. Further research is indicated to determine if PCI increases overall survival in small call bladder cancer patients, especially those with extensive disease who respond to chemotherapy.

 Keywords: Prophylactic Surgical Procedures; Urinary Bladder Neoplasms; Carcinoma, Small Cell

[Full Text]


A rare case of prostato – symphyseal fistula after GreenLight photovaporization of the prostate

Vol. 44 (x): 2018 September 9.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0209


RADIOLOGY PAGE

Pablo Garrido-Abad 1, Manuel Ramírez-Sánchez 1, Luis García-Martín 1, Manuel Fernández-Arjona 1
 1 Department of Urology. Hospital Universitario del Henares, Coslada, Madrid, Spain

ABSTRACT

Not available

[Full Text]


 

Micro-ureteroscopy for treatment of pelvic ureteral stone in pediatric patient

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0223


VIDEO SECTION

Diogo Nunes-Carneiro 1, João Ferreira Cabral 1, Avelino Fraga 1, Vítor Cavadas 1
1 Departamento de Urologia de Centro Hospitalar do Porto, Instituto de Ciências Biomédicas de Abel Salazar, Porto, Portugal

ABSTRACT

Introduction: During the last years there has been an effort in miniaturizing the endoscopic devices.

The video presents an alternative for the management of distal ureteral stone, using a ureteral access of 4.85 Fr and 27 cm of length, previously described as micro-ureteroscopy.

Material and Methods: This procedure was performed through a 3-part all-seeing needle, consisting of micro-optics 0.9 mm in diameter with a 120-degree angle of view, an irrigation channel and an integrated light.

Clinical Case: Seven year-old boy, with history of preterm birth (29 weeks) was referred to our consultation complaining of left back pain and an elevation of serum creatinine.

The renal ultrasound revealed a left ureterohydronephrosis, caused by a 10 mm stone located 13 mm from the uretero­vesical junction.

The patient underwent a micro-ureteroscopy with laser lithotripsy. The stone was fragmented with an average energy of 0.5 J with 12 Hz of frequency. The total energy spent was 12514 J. At the end of the procedure, a double J stent was placed.

The procedure lasted 45 minutes and was uneventful. The patient was discharged 24h after the procedure without com­plaints and remained stone free.

Conclusion: Micro-ureteroscopy is a safe and effective technique in distal ureteral lithiasis treatment in children. The small dimensions of the equipment increase the safety of the procedure making this a good option for the treatment of ureteral stones in children.

 ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180223_Nunes-Carneiro_et_al

[Full Text]


Robotic surgery in the management of complex pelvic endometriosis

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0718


VIDEO SECTION

Guillermo Velilla 1, Roberto Ballestero 1, Marcos Gómez 2, Sergio Zubillaga 1, Ernesto Herrero 1, Elena Yllera 3, José Luis Gutiérrez 1
1 Department of Urology, Hospital Universitario Marqués de Valdecilla, Santander, Spain; 2 Department of General Surgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain; 3 Department of Radiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain

 

ABSTRACT

Introduction: Endometriosis consists in the proliferation of endometrial tissue outside of the uterine cavity, predominantly in the ovaries but also in the urinary bladder or bowel. About 10% of fertile women are affected and the main symptoms are pain, menstrual disorders and infertility. Surgery is the treatment option for those symptomatic patients in which medical treatment had no success.

Material and Methods: We report on a case of a 43 – years – old patient without urologic personal history submitted to our office because of a grade – III right – hydronephrosis. The patient, with an endometriosis diagnosis since years, presents chronic pelvic pain with the daily necessity of strong opioids intake. CT scan revealed several endometriosis implants in the uterine wall and rectum that caused right ureteral entrapment. Renography revealed a 24% function in the right kidney. After right nephrostomy a multidisciplinary committee decided surgical intervention. With robotic approach, we performed an hysterectomy with right salpingo – oophorectomy; release, resection and right ureteral reimplantation; anterior resection of the rectum and protective ileostomy. Vaginal extraction of the specimen. In this video we show the key steps of the procedure.

Results: Total operative time: 330 minutes. Total bleeding: 250 cc. Nephrostomy removal: 4 th day. Urethral catheter removal: 5 th day. Patient was discharged in the 7 th day. Ureteral JJ – stent removal: 30 th day. CT urography reveals a permeable ureteral tract with no urine leakage. Renography shows a progressive improvement of the kidney function.

Conclusions: Robotic surgery allows a correct handling of endometriosis, mainly in complex cases. It is a safe and reproducible technique with correct outcomes in selected patients. A multidisciplinary team is required.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20170718_Velilla_et_al

[Full Text]


Laparoscopic approach for intravesical surgery using pneumovesicum in the management of anterior colporrhaphy mesh erosion and stones around the bladder neck

Vol. 44 (x): 2018 September 9.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0046


VIDEO SECTION

Young Dae Bae 1, Hoon Choi 1, Jae Hyun Bae 1, Bum Sik Tae 1
1 Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Korea

ABSTRACT

Introduction and objective: Perforation of the bladder or urethra and erosion of the mesh after cystocele repair surgery are not uncommon and have potentially serious complications. Traditionally, surgical management of such complications has involved excision of the mesh using either a transurethral approach or open surgery. In this video, we present our experience of laparoscopic transvesical surgery for exposed mesh and stone.

Materials and methods: Patient was placed in the lithotomy position under general anesthesia and a 30° operating cystoscope was inserted under direct vision. After filling the bladder with 300 mL normal saline, a 5 – mm VersaStepTM bladeless trocar was placed 2 cm above the pubic symphysis. Two more 5 mm trocars were placed bilaterally at 3 cm intervals from the initial trocar site. The pneumovesicum state was maintained at 8 – 12 mmHg and a 5 mm telescope was introduced. Using a curved dissector and curved Mayo scissors, the exposed mesh was mobilized and removed. Interrupted 4 – 0 Vicryl sutures were used to close the defect. To localize the ureteral orifice, intravenous Indigo Carmine was used. The bladder stones were removed through the urethra using a stone basket, guided using a ureteral stent pusher.

Results: Total operation time was 55 min and the Foley catheter was removed at post – operative day 5 after postoperative cystography.

Conclusions: Excellent visualization of mesh exposure and ureteral orifice was possible under laparoscopic transvesical surgery, and reconstruction including the mucosa and muscle layer was able to be achieved. This method is useful and feasible, with minimal invasiveness and an early post – operative recovery.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180046_Bae_et_al

Int Braz J Urol. 2018; 44 (Video #X): XXX-X

[Full Text]


 

Safety and effectiveness evaluation of open reanastomosis for obliterative or recalcitrant anastomotic stricture after radical retropubic prostatectomy

 Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0681


ORIGINAL ARTICLE

Carlos Roberto Giúdice 1, Patricio Esteban Lodi 1, Ana Milena Olivares 1, Ignacio Pablo Tobia 1, Gabriel Andrés Favre 1
1 Department of Urology, Reconstructive Surgery Area, Hospital Italiano de Buenos Aires, Argentina

ABSTRACT

Purpose: To evaluate safety, efficacy and functional outcomes after open vesicourethral re – anastomosis using different approaches based on previous urinary continence.

Materials and Methods: Retrospective study of patients treated from 2002 to 2017 due to vesicourethral anastomosis stricture (VUAS) post radical prostatectomy (RP) who failed endoscopic treatment with at least 3 months of follow-up. Continent and incontinent patients post RP were assigned to abdominal (AA) or perineal approach (PA), respectively. Demographic and perioperative variables were registered. Follow-up was completed with clinical interview, uroflowmetry and cystoscopy every 4 months. Success was defined as asymptomatic patients with urethral lumen that allows a 14 French flexible cystoscope.

Results: Twenty patients underwent open re-anastomosis for VUAS after RP between 2002 and 2017. Mean age was 63.7 years (standard deviation 1.4) and median follow-up was 10 months (range 3 – 112). The approach distribution was PA 10 patients (50%) and AA 10 patients (50%). The mean surgery time and median hospital time were 246.2 ± 35.8 minutes and 4 days (range 2 – 10), respectively with no differences between approaches. No significant complication rate was found. Three patients in the AA group had gait disorder with favorable evolution and no sequels.

Estimated 2 years primary success rate was 80%. After primary procedures 89.9% remained stenosis – free. All PA patients remained incontinent, and 90% AA remained continent during follow-up.

Conclusion: Open vesicourethral re – anastomosis treatment is a reasonable treatment option for recurrent VUAS after RP. All patients with perineal approach remained incontinent while incontinence rate in abdominal approach was rather low.

 

Keywords: Erectile Dysfunction; Prostatectomy; Urinary Incontinence

[Full Text]


 

Moderate or severe LUTS is associated with increased recurrence of non – muscle – invasive urothelial carcinoma of the bladder

Vol. 44 (x): 2018 October 10.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0068


ORIGINAL ARTICLE

Austin Lunney 1, Allan Haynes 1, Pranav Sharma 1
1 Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX, USA

ABSTRACT

Purpose: Non – muscle – invasive bladder cancer (NMIBC) can recur despite transurethral resection (TURBT) and adjuvant intravesical therapy. Tobacco products excreted in the urine are hypothesized to cause tumor – promoting effects on urothelial cells through direct contact. We determined if moderate or severe lower urinary tract symptoms (LUTS) (defined as International Prostate Symptom Score [IPSS] ≥ 8) was associated with increased tumor recurrence.

Materials and Methods: We retrospectively identified 70 consecutive men initially diagnosed with NMIBC at our institution from 2010 – 2016. Means were compared with independent T – test and proportions with chi – square analysis. Multivariate logistic regression was performed to determine independent predictors of recurrence.

Results: The majority of patients had Ta disease (58.6%) followed by T1 (28.6%) and Tis (12.9%). Forty – one (58.6%) patients had moderate or severe LUTS upon presentation within 30 days of initial TURBT with mean IPSS of 13.2 vs. 5.2 in the control group (p < 0.01). Biopsy – proven tumor recurrence occurred in 24 (34.3%) patients at mean follow-up of 31.7 months. Mean time to recurrence was 14.6 months. Moderate or severe LUTS was an independent predictor of tumor recurrence (odds ratio [OR]: 19.1, 95% confidence interval [CI]: 2.86 – 127; p = 0.002). Voiding or storage symptoms based on the IPSS did not independently correlate with tumor recurrence (p = 0.08 and p = 0.31, respectively) although total mean IPSS score did (OR: 1.26, 95% CI: 1.07 – 1.47, p = 0.005).

Conclusions: The presence of moderate or severe LUTS may be an important prognostic factor in NMIBC. Patients with significant urinary symptoms could be monitored more aggressively due to higher recurrence risk.

Keywords: Urinary Bladder Neoplasms; Lower Urinary Tract Symptoms; Carcinoma, Transitional Cell

[Full Text]


 

Removal of intramural trapped intrauterine device by cystoscopic incision of bladder wall

Vol. 44 (x): 2018 September 9.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0056


VIDEO SECTION

Abbas Basiri 1, Behnam Shakiba 1, Niloufar Rostaminejad 1
1 Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

ABSTRACT

_______________________________________________________________________________________

A healthy 37 – year – old woman referred to our clinic with one – year history of recurrent urinary tract infection, dy­suria and frequency. Her past medical history informed us that an IUD (Copper TCu380A) had been inserted 11 years ago. Eleven months after the IUD insertion she had become pregnant, unexpectedly. At that time, she had undergone gynecological examination and abdominal ultrasound study. However, the IUD had not been found, and the gynecologist had made the diagnosis of spontaneous fall out of the IUD. She had experienced normal pregnancy and caesarian section with no complications.

On physical examination, pelvic examination was normal and no other abnormalities were noted. Urinalysis revealed microhematuria and pyuria. Urine culture was positive for Escherichia coli. Ultrasound study revealed a calculus of about 10 mm in the bladder with a hyperdense lesion. A plain abdominal radiograph was requested which showed a metallic foreign body in the pelvis. We failed to remove the IUD by cystoscopic forceps because it had strongly invaded into the uterine and bladder wall. Despite previous papers suggesting open or laparoscopic surgeries in this situation (1, 2), we performed a modified cystoscopic extraction technique. We made a superficial cut in the bladder mucosa and muscle with J – hook monopolar electrocautery and extracted it completely with gentle traction.

This technique can decrease the indication of open or laparoscopic surgery for extraction of intravesical IUDs. In the other side of the coin, this technique may increase the risk of uterovesical fistula. Therefore, the depth of incision is important and the surgeon should cut the bladder wall superficially with caution. Although present study is a case report which is normally classified as with low level of evidence, it seems that our modified cystoscopic extraction technique is a safe and useful method for extraction of partially intravesical IUDs.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180056_Basiri_et_al
Int Braz J Urol. 2018; 44 (Video #X): XXX-X

[Full Text]


 

Anterograde irrigation – assisted ureteroscopic lithotripsy in patients with percutaneous nephrostomy

Vol. 44 (x): 2018 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0238


VIDEO SECTION

Jemo Yoo 1, Seung-Ju Lee 1, Hyun-Sop Choe 1, Hee Youn Kim 1, Joon Ho Lee 1, Dong Sup Lee 1
1 St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea

ABSTRACT

In complicated urinary tract infection with ureteral calculi, urinary diversion is inevitable. So, stenting or percutaneous drainage can be an option. In hemodynamically unstable patients, percutaneous drainage is superior to ureteral stenting (1). Once acute infection is controlled, definite treatment of the stone is necessary. According to a guideline, semirigid ureteroscopy is recommended for lower and mid – ureter stone and flexible ureteroscopy for upper ureter stone (2). Semi – rigid ureteroscopy can migrate stone to kidney, especially in upper ureter stone, lowering stone free rate (3). Not only flexible ureteroscopy creates additional costs but also is barely available in developing countries (4, 5). So, the authors would like to introduce anterograde irrigation – assisted ureteroscopic lithotripsy in patients with percutaneous nephrostomy.

Retrograde irrigation was connected and flowed minimally enough to secure visual field. Once stone is noted, another saline irrigation, which is placed above 40 cm over the patient is connected to nephrostomy. Retrograde irrigation is disconnected from ureteroscope and the previous connected channel on ureteroscope is opened. Actual pressure detected by barometer from the opened channel of ureteroscope is usually about 30 cmH2O while anterograde irrigation is administered in maximal flow, which means fully opened anterograde irrigation is not hazardous to kidney. There was no complication in 17 patients submitted to this method.

Video shows advantages of our practice: clear visual field; reduced risk of stone migration into kidney; induced spontaneous passage of fragments without using instrumentation; and decreased operation time. In short, most of surgeons, even unexperienced, can perform an excellent procedure with less time consuming using our method.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180238_Yoo_et_al

Int Braz J Urol. 2018; 44 (Video #X): XXX-X

[Full Text]


 

Early term effect of ureterorenoscopy (URS) on the Kidney: research measuring NGAL, KIM-1, FABP and CYS C levels in urine

Vol. 43 (x): 2017 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2016.0638


ORIGINAL ARTICLE

Erdal Benli 1, Sema Nur Ayyildiz 2, Selma Cirrik 3, Tevfik Noyan 2, Ali Ayyildiz 4, Abdullah Cirakoglu 1
1 Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey; 2 Department of Biochemistry, Faculty of Medicine, Ordu University, Ordu, Turkey; 3 Department of Physiology, Faculty of Medicine, Ordu University, Ordu, Turkey; 4 Department of Urology, Research and Training Hospital, Ankara, Turkey

ABSTRACT

Aim: URS is a very commonly used procedure for treatment of ureter stones. Increased hydrostatic pressure in the collecting system linked to fluids used during the procedure may cause harmful effects on the kidney. The aim of this study is to determine whether the URS procedure has a negative effect on the kidney by investigating NGAL, KIM-1, FABP and Cys C levels in urine.

Material and Methods: This study included 30 patients undergoing ureterorenoscopy (URS) for ureter stones. Urine samples were collected 5 times; before the URS procedure (control) and at 1, 3, 5 and 12 hours following the procedure. NGAL, KIM-1, FBAP and Cys C levels were measured in urine and compared with the control values.

Results: The NGAL levels in urine before the procedure and at 1, 3, 5 and 12 hours after the procedure were 34.59±35.34; 62.72±142.32; 47.15±104.48; 45.23±163.16 and 44.99±60.79ng/mL, respectively (p=0.001). Similarly, the urinary KIM-1, FABP and Cys C levels were found to increase compared to control values; however this increase did not reach statistical significance (p >0.05).

Conclusions: After the URS procedure, there were important changes in NGAL, FABP, KIM-1 and Cys C levels. These changes reached statistical significance for NGAL, but did not reach significance for the other parameters. In conclusion, the URS procedure significantly affects the kidney; however, this effect disappears over time.

Keywords: Acute Kidney Injury; Kidney; Lithotripsy

[Full Text]


 

WITHDRAWN: Comparison of vacuum-assisted closure therapy and debridement with primer surgical closure for fournier’s gangrene treatment: 10 years’ experience of a single centre

Vol. 43 (x): 2017 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0052


ORIGINAL ARTICLE

Mustafa Ozan Horsanali 1, Utku Eser 2, Burcu O. Horsanali 3, Omer Altaş 3, Huseyin Eren 4
1 Department of Urology, Izmir Katip Celebi University Ataturk Training and Research Hos-pital, Izmir, Turkey; 2 Department of Family Medicine, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey; 3 Department of Anesthesiology and Reanimation, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey; 4 Department of Urology, Recep Tayyip Erdogan University, Rize, Turkey.

ABSTRACT

The International Brazilian Journal of Urology will retract this article because the authors were not authorized to publish the data according to the Department of Urology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey, where the paper was done.