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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

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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

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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

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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

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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

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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

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Related Post

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

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Related Post

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

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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

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Related Post

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

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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

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Related Post

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

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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

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Related Post

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

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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

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Related Post

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]


Related Post

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]


Related Post

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]


Related Post

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]


Related Post

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]


Related Post

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]


 

Related Post

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]


Related Post

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]


Related Post

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]


Related Post

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]


Related Post

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]


Related Post

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]


Related Post

A very easy technique of stenting for laparoscopic pyeloplasty: penbegul intravenous cannula (PICA) technique

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

doi: 10.1590/S1677-5538.IBJU.2018.0303


SURGICAL TECHNIQUE

Necmettin Penbegul 1, Murat Atar 2, Cem Alan 2, Yasar Bozkurt 2, Namik Kemal Hatipoglu 2
1 Department of Urology, VM Medical Park Bursa Hospital, Bursa, Turkey; 2 Department of Urology, Dicle University School of Medicine, Diyarbakir, Turkey

ABSTRACT

Introduction: Double-J stent insertion during laparoscopic pyeloplasty is a difficult and time-consuming process and several techniques were defined to perform a double-J stent with an antegrade approach. In this study we present the technique (PICA) of antegrade double-J placement during laparoscopic pyeloplasty by using 14 gauge intravenous cannula.

Surgıcal technıque: After we complete the suturing of the posterior wall of the anastomosis during laparoscopic pyeloplasty, we first puncture the abdominal wall with a 14-gauge “intravenous cannula” from a location that provides most suitable angle for inserting the double-J stent into the ureter. We remove the metal needle of the cannula, and the sheath which has an inner diameter of 5.2F remains over the abdominal wall.

The double J stent is then advanced from inside the cannula sheath to the intraperitoneal area; under laparoscopic imaging the stent is gently grasped at its distal end using an atraumatic laparoscopic forceps to insert it into the ureter. The stent is then pulled down to its proximal end, and after the guidewire is removed, the proximal end of the double-J stent is placed inside the renal pelvis with an atraumatic forceps. With this technique we can apply the double-J stent in just one step. Additionaly we can use a 14-gauge IV cannula sheath as a trocar when needed during laparoscopic pyeloplasty to retract an organ or reveal an anastomosis line.

Comments: Our new technique of antegrade double-J placement during laparoscopic pyeloplasty by 14 gauge intravenous cannula sheath, is very easy and quick to perform.

Keywords: Stents; Laparoscopy; Surgical Procedures, Operative

[Full Text]


Related Post

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]


Related Post

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]


Related Post

Inpatient interventions that may preclude outpatient open pyeloplasty in infants

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

doi: 10.1590/S1677-5538.IBJU.2018.0252


ORIGINAL ARTICLE

İrfan Dönmez 1, Alonso Carrasco Jr. 2, Amanda F. Saltzman 2, Duncan T. Wilcox 2
1 Department of Urology, Denver Anschutz Medical Campus, University of Colorado, CO, United of States; 2 Department of Pediatric Urology, Children’s Hospital Colorado, Denver, CO, United of States

ABSTRACT

Objective: In the majority of published series, children undergoing open pyeloplasty are admitted for at least one night. We hypothesized that it would be possible in the majority of infants to perform open pyeloplasty as an outpatient procedure.

Materials and Methods: All patients who underwent open pyeloplasty by a single surgeon between 2008 and 2016 were retrospectively reviewed. Demographic data (age at surgery, gender, pre- and postoperative imaging studies, laterality, type of local anesthesia), operative time, duration of hospital stay, need for narcotic analgesics, complications, readmission within 1-month after surgery and need for additional procedures were abstracted.

Results: A total of 18 infants underwent open pyeloplasty by single surgeon. Mean age at time of surgery was 19 months (range 3-23 months). There were 8 girls and 10 boys. In addition to general anesthesia, all of the patients received regional anesthesia (caudal block 8, epidural block 8, subcutaneous nerve block 2). Median operative time was 135 minutes (range 81-166). Median hospital stay was 1 day (range 1 to 2). Two patients required iv narcotics for pain management. None of the patients required parenteral administration of other medications during the short hospitalization. No patients required any additional procedures or hospital readmissions within 1 month from surgery.

Conclusions: In appropriately selected patients, outpatient pyeloplasty appears to be feasible with an oral postoperative analgesia plan to be administered at home.

Keywords: Ureteral Obstruction; Child; Anesthesia

[Full Text]


Related Post

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]


Related Post

Prospective comparison of the novel visual prostate symptom score (VPSS) versus the international prostate symptom score (IPSS), and assessment of patient pain perception with regard to transrectal ultrasound guided prostate biopsy

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

doi: 10.1590/S1677-5538.IBJU.2018.0496


ORIGINAL ARTICLE

M. Els 1, C. Heyns 1, A. van der Merwe 1, A. Zarrabi 1
1 Department of Urology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa

ABSTRACT

Objective: To compare the International Prostate Symptom Score (IPSS) and novel Visual Prostate Symptom Score (VPSS) in patients with lower urinary tract symptoms (LUTS), to correlate scores with uroflowmetry and prostate volume and assess patient perceptions regarding pain prior to, and after prostate biopsy.
Materials and Methods: Patients with LUTS who had an indication for transrectal ultrasound (TRUS) biopsy were included. Patients completed the IPSS-, VPSS- and prostate biopsy pain assessment questionnaires. Assessment included uroflowmetry, post- void residual volume and prostate volume (measured with TRUS).
Results: One hundred men were included. There were statistically significant correlations between the VPSS score and IPSS score (correlation coefficient (r) = 0.802); VPSS and Qmax (r = -0.311); VPSS and. Qave (r = -0.344); prostate volume with VPSS (r = 0.194) and Qmax (r = -0.260). The VPSS was quicker to complete than the IPSS (mean 100 vs. 165 seconds). The mean anticipated pain score before biopsy was 2.8 (range 0-6), and after biopsy (experienced pain) it was 1.8 (range 0-5). The pain during biopsy was less than expected in 67% of patients.
Conclusion: In men with LUTS scheduled to undergo prostate biopsy, the VPSS score correlated positively with the IPSS score. Men with limited education take less time to complete the VPSS. Patient’s perception of expected pain or discomfort during TRUSguided prostate biopsy was significantly higher than the pain actually experienced during biopsy. Men with lower education level had significantly higher expectation of pain prior to biopsy, but similar pain during biopsy.

Keywords: Pain Perception; Lower Urinary Tract Symptoms; Literacy

[Full Text]


 

Related Post

Comparison of retrograde flexible ureteroscopy and percutaneous nephrolithotomy in treating intermediatesize renal stones (2-3cm): a meta-analysis and systematic review

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

doi: 10.1590/S1677-5538.IBJU.2018.0510


ORIGINAL ARTICLE

Zhu Zewu 1, Yu Cui 1, Zeng Feng 1, Li Yang 1, Hequn Chen 1
1 Department of Urology, Xiangya Hospital, Central South University, Changsha, China

 

ABSTRACT

Purpose: To systematically assess the effectiveness and safety of retrograde flexible ureteroscopy (FURS) versus percutaneous nephrolithotomy (PCNL) in treating intermediate-size renal stones (2-3cm).

Materials and Methods: PubMed, Ovid MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE were researched to identify relevant studies up to May 2018. Article selection was performed through the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The Newcastle-Ottawa Scale was applied to assess the methodological quality of case-control studies.

Results: Six retrospective case-controlled trials were included for meta-analysis. The pooled results showed that PCNL was associated with a higher initial stone-free rate (SFR). After more complementary treatments, FURS provided a final SFR (OR: 1.69; 95% CI, 0.93-3.05; P = 0.08) comparable to that achieved by PCNL. PCNL was associated with a higher rate of overall intraoperative complications (OR: 1.48; 95% CI, 1.01-2.17; P = 0.04) and longer hospital stay (MD: 2.21 days; 95% CI, 1.11 to 3.30; P < 0.001). Subgroup analysis by Clavien-graded complication showed PCNL had significantly higher rates of minor complications (OR: 1.58; 95% CI, 1.04-2.41; P = 0.03). No significant difference was noted in major complications (OR: 1.14; 95% CI, 0.53-2.45; P = 0.73) or operative times (MD: -9.71 min; 95% CI, -22.02 to 2.60; P = 0.12).

Conclusions: Multisession FURS is an effective and safe alternative to PCNL for the management of intermediate-size renal stones (2-3cm). It is advisable to balance the benefits and risks according to the individual characteristics of patients and to decide with patients by discussing the advantages and disadvantages of each procedure.

 Keywords: Ureteroscopy; Nephrolithotomy, Percutaneous; Kidney Calculi

[Full Text]


Related Post

Study of the renal Parenchymal volume during the human fetal period

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

doi: 10.1590/S1677-5538.IBJU.2018.0538


ORIGINAL ARTICLE

Andre L. Lima Diniz 1, Nadia C. Pinheiro Rodrigues 1, Francisco J. B. Sampaio 1, Luciano A. Favorito 1
1 Unidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro, UERJ, Rio de Janeiro, RJ, Brasil

ABSTRACT

Objective: To evaluate the renal parenchymal area in human fetuses, providing a descriptive analysis on the renal area development by demographic factors during the second gestational trimester.

Material and Methods: We analyzed 84 fetuses (44 males and 40 females), for a total of 168 renal units evaluated in terms of longitudinal length, superior pole width, inferior pole width and thickness. Renal volume was calculated by ellipsoid formula. After renal pelvis dissection, length and width were evaluated; as pelvis is free of urine, we considered thickness as 1mm. Renal pelvis volume was also calculated by ellipsoid formula.

Renal parenchymal area was assessed by excluding the volume of the renal pelvis from the total renal volume. We performed the statistical analysis by simple linear regression assessing the association between the variables analyzed with the fetal age.

Results: Gestational age ranged from 12 to 23 weeks post conception. Mean renal parenchymal area of the right kidney was 666.22mm3 (45.86 to 2375.35mm3) and for the left kidney was 606.76mm3 (68.63 to 2402.57mm3). No statistical difference was observed between the sides (p-value = 0.3456) or genders (p-value = 0.07429). Linear regression between renal parenchymal volume and gestational age was positive for right kidney (y = 133.74x-1479.94 / r² = 0.4009) and left kidney (y = 149.53x-1761.59 / r² = 0.4591).

Conclusions: The linear regression analysis indicated that renal parenchymal area correlated significantly and positively with fetal age, weight and crown-rump length with no statistical differences between gender or laterality. These growth curves provide a reference for functional volume of the kidney during fetal period.

Keywords: Hydronephrosis; Fetus; Kidney; Parenchymal Tissue

[Full Text]


Related Post

Re: HPV vaccination for penile cancer eradication: cost effectiveness view

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

doi: 10.1590/S1677-5538.IBJU.2018.0659


LETTER TO THE EDITOR

Beuy Joob 1, Viroj Wiwanitkti 2
1 Sanitation Medical Academic Center, Bangkok Thailand; 2 DY Patil University, Pune, India

 ABSTRACT

Not available

[Full Text]


 

Related Post

CT-guided minimally-invasive penile fracture repair

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

doi: 10.1590/S1677-5538.IBJU.2018.0525


CHALLENGING CLINICAL CASES

Cui Yan 1, Bing-xue Liang 1, Hai-bin Huang 1, Bi-rong Liang 1, Zheng Zhou 1, Ling-jun Wang 1, Zhong-qi Yang 1, Shao-xiang Xian 1
1 Department of Traditional Chinese Medicine, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China

 ABSTRACT

 We present the case of a 28 year old patient with an incomplete tear of the tunica albuginea occurred after having sexual intercourse in the female superior position. The diagnostic assessment was performed first clinically, then with CT, owing to its high resolution, allowed to exactly detect the tear location leading to precise preoperative planning. After adequate diagnosis through imaging and proper planning, the patient was performed a selective minimally invasive surgical approach to repair the lesion.

The patient had good erection with no angular deformity or plaque formation after a 3-month follow-up.

 

Keywords: Penis; Urology; Sutureless Surgical Procedures; Tomography, X-Ray Computed

[Full Text]


Related Post

Effect of a high-fat diet on the rat bladder wall and bioactive action of Brazil nut oil

Vol. 44 (x): 2018 December 12.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0547


ORIGINAL ARTICLE

Aline Costa de Souza 1, Carla Braga Mano Gallo 1, Magna Cottini da Fonseca Passos 2, Carolina Croccia 3, Glauciane Lacerda Miranda 3, Francisco José Barcellos Sampaio 1, Bianca Martins Gregório 1
1 Unidade de Pesquisa Urogenital, Centro Biomédico, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; 2 Departamento de Nutrição Aplicada, Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; 3 Instituto de Nutrição Josue de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil

ABSTRACT

High-fat diet-induced obesity is associated with metabolic disorders. The Brazil nut has bioactive substances and has been used to control the damage caused by obesity in several organs. The work intended to show the damage caused by high-fat diet in the bladder wall and if the Brazil nut oil added to the diet could ameliorate or reverse this effect. Sixty-day-old rats were divided into two groups: C (control, n = 30) and HF (high-fat, n = 30) diets. At 90 days, 10 animals of each group were sacrificed. The others were divided into 4 groups: C and HF (animals that maintained their previous diet, n = 10 for each group) and C / Bno and HF / Bno (animals whose control or high-fat diet was supplemented by Brazil nut oil, n = 10 for each group). Sacrifice occurred at 120 days, and the bladders were removed and analyzed. Epithelial height was increased in the HF compared to the C group. In contrast, the C / Bno had a lower epithelial height compared to the others. The percentage of collagen between the detrusor muscle fibers was significantly greater in C / Bno, HF and HF / Bno than in control group. The HF had a larger muscle fiber diameter than the C group, while the C / Bno presented lower values than the HF and HF / Bno groups. HF diets induced bladder wall damage. These changes in the rat’s bladder wall were partially reversed by the Bno.

Keywords: Bladder; Nuts; Diet, High-Fat; Rats

[Full Text]


 

Related Post

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]


Related Post

Immunohistochemical expressionof sodium-dependent glucose transporter – 2 (SGLT-2) in clear cell renal carcinoma: possible prognostic implications

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

doi: 10.1590/S1677-5538.IBJU.2018.0271


ORIGINAL ARTICLE

Minoru Kobayashi 1, Toshitaka Uematsu 2, Yuumi Tokura 2, Kohei Takei 2, Kazumasa Sakamoto 2, Takahiro Narimatsu 2, Akinori Nukui 3, Takao Kamai 2
1 Department of Urology, Utsunomiya Memorial Hospital, Tochigi, Japan; 2 Department of Urology, Dokkyo Medical University, Tochigi, Japan; 3 Department of Urology, Nasu Red Cross Hospital, Tochigi, Japan

ABSTRACT

Purpose: Glucose is a major energy resource for tumor cell survival and growth, and its influx into cells is mainly carried out by facilitative glucose transporters (GLUTs). Sodium – dependent glucose transporters (SGLTs) have been highlighted as playing important roles in diabetic treatment. However, their potential roles in cancer remain unclear. We examined expression patterns of SGLTs in tumor tissues together with conventional pathological variables to determine prognostic significance in patients with renal cell carcinoma (RCC).

Materials and Methods: Nephrectomy specimens were obtained from 68 patients. GLUT – 1, – 2 and SGLT – 1, – 2 expression in tumor and adjacent normal tissues were ana­lyzed by immunohistochemical staining, and intensity was quantified using an image analyzer.

Results: The four glucose transporters evaluated were broadly distributed in tumor tissues as well as throughout the normal parenchyma. There was no significant corre­lation between transporter expression and conventional pathological variables. How­ever, increased SGLT – 2 expression was significantly associated with shorter overall survival (p < 0.01), regardless of metastatic status.

Conclusions: We propose possible prognostic significance of SGLT – 2 expression in human RCC. Given that glucose is a major energy resource for tumor cells and that glucose transport is largely mediated by SGLT, SGLT – 2 may serve as a possible thera­peutic target in RCC.

Keywords: Immunohistochemistry; Glucose Transport Proteins, Facilitative; Carcinoma, Renal

[Full Text]


Related Post

Implant of ATOMS® system for the treatment of postoperative male stress urinary incontinence: results of a single centre

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

doi: 10.1590/S1677-5538.IBJU.2018.0171


ORIGINAL ARTICLE

Alessandro Giammò 1, Enrico Ammirati 2, Annarita Tullio 3,Gianni Bodo 1, Alberto Manassero 1, Paolo Gontero 2, Roberto Carone 1
1 Department of Neuro-Urology, CTO – Spinal Unit, Città della Salute e della Scienza di Torino, Turin, Italy; 2 Department of Urology, Molinette Hospital, Città della Salute e della Scienza di Torino, Turin, Italy; 3 Hygiene and Clinical Epidemiology Unit, S. Maria della Misericordia University Hospital of Udine, Udine, Italy

ABSTRACT

Purpose: The aim of our study is to evaluate the efficacy and safety of ATOMS® system for the treatment of postoperative male stress urinary incontinence (SUI).
Materials and methods: We retrospectively evaluated all patients treated at our institution for postoperative male SUI with ATOMS® implant. We excluded patients with low bladder compliance (< 20 mL / cmH2O), uncontrolled detrusor overactivity, detrusor underactivity (BCI < 100), urethral or bladder neck stricture and low cystometric capacity (< 200 mL).
Results: From October 2014 to July 2017 we treated 52 patients, mean age 73.6 years. Most of them (92.3%) had undergone radical prostatectomy, 3.85% simple open pros¬tatectomy, 3.85% TURP; 28.8% of patients had undergone urethral surgery, 11.5% ad¬juvant radiotherapy; 57.7% had already undergone surgical treatment for urinary in¬continence. The average24 hours pad test was 411.6 g (180 – 1100). The mean follow-up was 20.1 months (8.1 – 41.5) 30.8% of patients were dry, 59.6% improved ≥ 50%, 7.7% improved < 50% and 1.9% unchanged. In total 73.1% reached social continence. There was a significant reduction of the 24 hours pad test and ICIQ – UI SF scores (p < 0.01).
In the postoperative follow-up we detected complications in 8 patients (19%): 5 cases of displacement of the scrotal port, in 2 cases catheterization difficulties, one case of epididimitis and concomitant superficial wound infection; no prosthesis infection, nor explants.
Radiotherapy, previous urethral surgery,previous incontinence surgery were not statistically related to social continence rates (p 0.65;p 0.11;p 0.11).
Conclusions: The ATOMS® system is an effective and safe surgical treatment of mild and moderate male postoperative SUI with durable results in the short term.

Keywords: Suburethral Slings; Urinary Incontinence; Surgical Procedures, Operative

[Full Text]


Related Post

Predictors of surgical complications of nephrectomy for urolithiasis

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

doi: 10.1590/S1677-5538.IBJU.2018.0246


ORIGINAL ARTICLE

Alexandre Danilovic 1, Thiago Augusto Cunha Ferreira 1, Gilvan Vinícius de Azevedo Maia 1, Fabio Cesar Miranda Torricelli 1, Eduardo Mazzucchi 1, William Carlos Nahas 1, Miguel Srougi 1
1 Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil

ABSTRACT

Objectives: Nephrectomy due to stone disease may be a challenging procedure owing to the presence of significant inflammation and infection, involving high complication rate. The objective of our study was to identify predictors for complications of nephrectomy for urolithiasis.
Patients and Methods: A retrospective review of 149 consecutive patients > 18y submitted to simple nephrectomy for urolithiasis from January 2006 to July 2012 was performed. Clinical data, computed tomography findings and pathology report were analyzed. Postoperative complications were categorized based on Clavien – Dindo classification.
Logistic multivariate regression models assessed the predictors for surgical complications of nephrectomy for urolithiasis.
Results: Eighty-three (55.7%) patients were submitted to laparoscopic nephrectomy and 66 (44.2%) to open procedure. Conversion to open surgery was necessary in 19.2% (16 / 83). On univariable analysis, higher preoperative chronic kidney stage (p = 0.02), Charlson comorbidity index ≥ 2 (p = 0.04), higher ASA score (p = 0.001), urgency due to sepsis (p = 0.01), kidney size ≥ 12 cm (p = 0.006), renal and perirenal abscess (p = 0.004 and 0.002 respectively) and visceral adhesion (p = 0.04) were associated with Clavien – Dindo score > 1. On multivariate analysis, higher ASA score (p = 0.01), urgency due to sepsis (p = 0.03), kidney size ≥ 12 cm (p = 0.04) and preoperative abscess (p = 0.04) remained significantly associated with complications. End – stage renal disease with dialysis was needed post – operatively in 3.4% (5 / 144) of patients.
Conclusions: We identified that higher ASA score, urgency due to sepsis, kidney size ≥ 12 cm and preoperative abscess were associated with Clavien – Dindo score > 1.

Keywords: Nephrectomy; Urolithiasis; Postoperative Complications

[Full Text]


 

Related Post

Prognosis of patients with prostate cancer and middle range prostate – specific antigen levels of 20 – 100 ng / mL

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

doi: 10.1590/S1677-5538.IBJU.2018.0143


ORIGINAL ARTICLE

Hiroaki Iwamoto 1, Kouji Izumi 1, Yoshifumi Kadono 1, Atsushi Mizokami 1
1 Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan

ABSTRACT

Introduction: Prostate – specific antigen (PSA) is a useful biomarker for detection of prostate cancer (PCa) and for risk classification in addition to TNM classification and
Gleason score (GS). We reported the role of PSA in patients with low (< 20 ng / mL) and extremely high (≥ 100 ng / mL) PSA levels. However, it is unclear whether a correlation
exists between middle range PSA levels (20 – 100 ng / mL) at diagnosis and prognosis.
Materials and Methods: Between January 2000 and December 2014, 1873 patients underwent prostate biopsy at Kanazawa University Hospital. Of 802 patients who were diagnosed with PCa, 148 patients with middle range PSA levels (20 – 100 ng / mL) were retrospectively analyzed.
Results: The percentage of patients with T3 – 4 consistently increased as PSA levels increased from 20 to 100 ng / mL. Although the percentage of patients with GS ≥ 8 or metastases increased as PSA levels increased up to approximately 70 ng / mL, there was no significant increase between 70 and 100 ng / mL. PCa – specific and castration – resistant PCa – free survivals were adversely associated with PSA levels up to 70 ng / mL, but not between 70 and 100 ng / mL.
Conclusion: PSA is a useful biomarker for predicting prognosis at levels between 20 and 70 ng / mL. However, PSA cannot be used as a prognostic factor in patients with PCa and PSA levels ≥ 70 ng / mL. When the PSA level reaches approximately 70 ng / mL, prognosis might bottom and reach a plateau.

Keywords: Biomarkers; Prognosis; Prostatic Neoplasms

[Full Text]


 

Related Post

The importance of histopathologic review of biopsies in patients with prostate cancer referred to a tertiary uro-oncology center

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

doi: 10.1590/S1677-5538.IBJU.2018.0099


ORIGINAL ARTICLE

Wagner Eduardo Matheus 1, Ubirajara Ferreira 2, Elimilson A. Brandão 2, Aline A. Ferruccio 3, 4, Athanase Billis 5
1 Departamento de Cirurgia, Hospital das Clínicas da Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil; 2 Departamento de Urologia da Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil; 3 Departamento de Urooncologia da Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil; 4 Pontifícia Universidade Católica de Campinas – PUC, Campus II, Campinas, SP, Brasil; 5 Departamento de Anatomia Patológica da Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil

ABSTRACT

Introduction: In view of the detailed histologic evaluation of prostate cancer (PC), it is usually advisable to provide a “second opinion” to confirm diagnosis. This study aimed to compare the Gleason score (GS) of initial diagnosis versus that of histopathologic review of patients with PC. The secondary objective was to compare initial GS versus histopathologic review versus post – surgical histopathology.
Material and methods: Retrospective study based on chart review of patients with PC that attended the Uro – oncology Department of Hospital das Clínicas – UNICAMP – Campinas, Brazil, from April, 2002, to April, 2012. Data were divided in groups: patients with biopsies performed elsewhere, biopsies after pathological review and histopathological results following retropubic radical prostatectomy (RRP). These were evaluated in relation to GS difference using Fleis’s Kappa concordance coefficient.
Results: 402 PC patients, with a median age of 66 years, were evaluated. Reviewed GS showed worsening, with accuracy of 61.2%, and Kappa concordance value = 0.466. Among 143 patients submitted to surgery, GS varied widely, regarding initial evaluation, review and post – surgical RRP. Joint concordance of evaluations was weak (Kappa = 0.216), mainly due to almost no existence concordance between initial evaluation and following RRP (Kappa = 0.041).
Conclusion: There is a great histopathological variation of initial GS versus reviewed GS. There is also a better correlation of reviewed GS and post – surgical GS than with initial GS. The second opinion by an uropathologist improves diagnosis and should be advised for better therapeutic decision.

Keywords: Prostatic Neoplasms; Neoplasm Grading; Pathology

[Full Text]


 

Related Post

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]


 

Related Post

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]


Related Post

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]


Related Post

Comparative study of percutaneous nephrolithotomy performed in the traditional prone position and in three different supine positions

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

doi: 10.1590/S1677-5538.IBJU.2018.0191


ORIGINAL ARTICLE

Petronio Augusto de Souza Melo 1, Fabio Carvalho Vicentini 1, Rodrigo Perrella 1, Claudio Bovolenta Murta 1, Joaquim Francisco de Almeida Claro 1
1 Divisão de Urologia do Centro de Saúde Masculina do Hospital Brigadeiro, São Paulo, SP, Brasil

ABSTRACT

Purpose: To compare the outcomes of percutaneous nephrolithotomy (PCNL) performed in the prone position (PRON) and in three variations of the supine position.

Materials and Methods: We performed a retrospective analysis of patients that underwent PCNL at our institution from June 2011 to October 2016 in PRON and in three variations of the supine position: complete supine (COMPSUP), original Valdivia (VALD), and Galdakao – modified Valdivia (GALD). All patients had a complete pre – operative evaluation, including computed tomography (CT). Success was defined as the absence of residual fragments larger than 4 mm on the first post – operative day CT.

Results: We analyzed 393 PCNLs: 100 in COMPSUP, 94 in VALD, 100 in GALD, and 99 in PRON. The overall success rate was 50.9% and was similar among groups (p = 0.428). There were no differences between groups in the number of punctures, stone – free rate, frequency of blood transfusions, drop in hemoglobin level, length of hospital stay, and severe complications (Clavien ≥ 3). COMPSUP had a significantly lower oper­ative time than the other positions. COMPSUP had lower fluoroscopy time than VALD.

Conclusion: Patient positioning in PCNL does not seem to impact the rates of success or severe complications. However, COMPSUP is associated with a shorter surgical time than the other positions.

Keywords: Nephrolithotomy, Percutaneous; Prone Position; Kidney Calculi

[Full Text]


Related Post

Dramatic polarization in genitourinary expert opinions regarding the clinical utility of positron emission tomography (PET) imaging in prostate cancer

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

doi: 10.1590/S1677-5538.IBJU.2018.0208


ORIGINAL ARTICLE

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

ABSTRACT

Objectives: To ascertain the opinions of North American genitourinary (GU) experts regarding inclusion of technologies such as prostate – specific membrane antigen (PSMA) and C – 11 choline positron emission tomography (PET) into routine practice.

Materials and Methods: A survey was distributed to North American GU experts. Ques­tions pertained to the role of PSMA and C – 11 PET in PCa management. Participants were categorized as “supporters” or “opponents” of incorporation of novel imaging techniques. Opinions were correlated with practice patterns.

Results: Response rate was 54% and we analyzed 42 radiation oncologist respondents. 17 participants (40%) have been in practice for > 20 years and 38 (90%) practice at an academic center. 24 (57%) were supporters of PSMA and 29 (69%) were supporters of C – 11. Supporters were more likely to treat pelvic nodes (88% vs. 56%, p < 01) and trended to be more likely to treat patients with moderate or extreme hypofractionation (58% vs. 28%, p = 065). Supporters trended to be more likely to offer brachytherapy boost (55% vs. 23%, p = 09), favor initial observation and early salvage over adjuvant radiation (77% vs. 55%, p = 09), and to consider themselves expert brachytherapists (69% vs. 39%, p = 09).

Conclusions: There is a polarization among GU radiation oncology experts regarding novel imaging techniques. A correlation emerged between support of novel imaging and adoption of treatment approaches that are clinically superior or less expensive. Pre – existing biases among GU experts on national treatment – decision panels and leaders of cooperative group studies may affect the design of future studies and influence the adoption of these technologies in clinical practice.

Keywords: Prostatic Neoplasms; Positron- Emission Tomography; Radiotherapy

[Full Text]


Related Post

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

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

doi: 10.1590/S1677-5538.IBJU.2018.0276


ORIGINAL ARTICLE

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

Objectives: to examine the effects of urethroplasty surgery on sexual functions by tak­ing into account age, location of stenosis, length of stenosis and surgical technique parameters.

Materials and Methods: The prospective study was conducted between January 2015 and August 2017 with 60 cases. Patients were categorized according to age groups (19-65 / 65-75 years), surgery technique and stricture localization and length. Before the urethroplasty operation and postoperative 6th month follow-up, the international index of erectile function (IIEF) form (15 questions), was filled, the relevant domains of sexual function; erectile function (Q1,2,3,4,5,15), orgasmic function (Q9,10) and overall satisfaction (Q13,14) were assessed.

Results: The mean age of the cases is 54 ± 13. However, preoperative IIEF, sexual sat­isfaction and orgasmic function averages of patients with a stenosis segment length of 1-3 cm was found to be significantly higher than that of patients with a stenosis segment length of 4-7 cm. Between stenosis segment length groups, there was no statistical difference in terms of preoperative and postoperative sexual functions. And also, there was no statistically significant change in patients’ preoperative and post­operative sexual function scores in terms of localization of stricture and surgery tech­niques. However, there were statistically significant change in the postoperative IIEF and sexual satisfaction averages according to preoperative averages.

Conclusion: Our study suggests that urethroplasty surgery itself does not significantly affect erectile function, orgasmic function, and general sexual satisfaction regardless of the type of surgery, localization and length of stenosis. Besides, there was a signifi­cant decrease in erectile function in senior adults.

Keywords: Erectile Dysfunction; Prospective Studies; Orgasm

[Full Text]


Related Post

Re: Incidence and treatment of malignant tumors of the genitourinary tract in renal transplant recipients

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

doi: 10.1590/S1677-5538.IBJU.2018.0406


LETTER TO THE EDITOR

Michael S. Floyd Jr. 1, Altaf Q. Khattak 1

1 Department of Reconstructive Urology, St Helens & Knowsley Hospital NHS Trust Whiston Hospital, Liverpool, United Kingdom

Not available

[Full Text]


Related Post

Does the experience of the bedside assistant effect the results of robotic surgeons in the learning curve of robot assisted radical prostatectomy?

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

doi: 10.1590/S1677-5538.IBJU.2018.0184


ORIGINAL ARTICLE

Haci Ibrahim Cimen 1, Yavuz Tarik Atik 1, Serkan Altinova 2, Oztug Adsan 1, Mevlana Derya Balbay 3
1 Department of Urology, Sakarya University, School of Medicine, Sakarya, Turkey; 2 Ankara Ataturk Training and Research Hospital, Ankara, Turkey; 3 American Hospital, Istanbul, Turkey

ABSTRACT

Introduction: The success of the robot assisted radical prostatectomy (RARP) proce­dures depend on a successful team, however the literature focuses on the performance of a console surgeon. The aim of this study was to evaluate surgical outcomes of the surgeons during the learning curve in relation to the bedside assistant’s experience level during RARP.

Materials and Methods: We retrospectively reviewed two non – laparoscopic, beginner robotic surgeon’s cases, and we divided the patients into two groups. The first surgeon completed the operations on 20 patients with a beginner bedside assistant in February – May 2009 (Group-1). The second surgeon completed operations on 16 patients with an experienced (at least 150 cases) bedside assistant in February 2015 – December 2015 (Group-2). The collected data included age, prostate volume, prostate specific antigen (PSA), estimated blood loss, complications and percent of positive surgical margins. In addition, the elapsed time for trocar insertion, robot docking, console surgery, speci­men extraction and total anesthesia time were measured separately.

Results: There were no significant differences between the groups in terms of age, co­morbidity, prostate volume, PSA value, preoperative Gleason score, number of positive cores, postoperative Gleason score, pathological grade, protection rate of neurovascu­lar bundles, surgical margin positivity, postoperative complications, length of hospital stay, or estimated blood loss. The robot docking, trocar placement, console surgery, anesthesia and specimen extraction times were significantly shorter in group 2 than they were in group 1 (17.75 ± 3.53 min vs. 30.20 ± 7.54 min, p ≤ 0.001; 9.63 ± 2.71 min vs. 14.40 ± 4.52 min , p = 0.001; 189.06 ± 27.70 min vs. 244.95 ± 80.58 min, p = 0.01; 230.94 ± 30.83 min vs. 306.75 ± 87.96 min, p = 0.002; 10.19 ± 2.54 min vs. 17.55 ± 8.79 min, p = 0.002; respectively).

Conclusion: Although the bedside assistant’s experience in RARP does not appear to influence the robotic surgeon’s oncological outcomes during the learning curve, it may reduce the potential complications by shortening the total operation time.

Keywords: Prostatic Neoplasms; Robotics; Prostatectomy

[Full Text]


Related Post

The iranian model as a potential solution for the current kidney shortage crisis

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

doi: 10.1590/S1677-5538.IBJU.2018.0441


LETTER TO THE EDITOR

Bahar Bastani 1
1 Division of Nephrology, Saint Louis University Health Science Center, Saint Louis, MO, USA

Not available

[Full Text]


Related Post

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]


 

Related Post

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]


 

Related Post

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]


 

Related Post

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

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Related Post

The impact of single positive surgical margin features on biochemical recurrence after robotic radical prostatectomy

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

doi: 10.1590/S1677-5538.IBJU.2017.0702


ORIGINAL ARTICLE

Ismail Evren 1, Ahmet Hacıislamoğlu 1, Mithat Ekşi 1, Abdullah Hızır Yavuzsan 1, Fırat Baytekin 2, Yunus Çolakoğlu 1, Didem Canoğlu 2, Volkan Tugcu 1
1 Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey; 2 Department of Pathology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey

ABSTRACT

Objective: Parameters predictive of biochemical or clinical recurrence after Radical Prostatectomy (RP) were determined as pre-treatment PSA value, pathologic tumor stage, tumor grade and presence of Positive Surgical Margin (PSM), extracapsular ex­tension and seminal vesicle invasion and the status of pelvic lymph nodes. The aim of our study is to evaluate the effect of additional features in patients undergoing RP in our clinic.

Materials and Methods: We studied 556 RP operations performed between 2009 and 2016 for prostate cancer at this clinic. Preoperative and postoperative data of the pa­tients were retrospectively reviewed. RP specimens were examined by two pathologists specialized in this subject. Of these patients, 78 (14.02%) patients with PSM were in­cluded in the study. The pathology slides of these patients were reassessed. The length of PSM (mm), localization (apex, basis and posterolateral) and Gleason pattern at this margin was determined and statistical correlations with BCR were calculated.

Results: The mean follow-up after the RP of 41 patients included in the study was 37.4 ± 13.2 months. During the follow-up period of the patients, BCR was observed in 16 patients (39.02%). No statistically significant difference was observed in age and prostate volume between the groups with and without BCR development (p > 0.05). Preoperative PSA level was found to be statistically significantly higher in the group with BCR development compared to the group without recurrence (p = 0.004). In-group comparisons in each aforementioned Gleason score groups were performed in terms of BCR development and the preoperative Gleason score in the group with development of recurrence was found to be statistically significantly higher compared to the group without recurrence (p = 0.007). The length of the surgical margin was measured as 7.4 ± 4.4 mm in the BCR-developing group and 4.7 ± 3.8 mm in the no-BCR- developing group; it was statistically significantly higher in the group with development of recur­rence (p = 0.03).

Conclusion: Length and location of the PSM and the Gleason score detected in the PSM region could not predict biochemical recurrence according to the results of this present study. However high preoperative PSA value is an independent prognostic factor for biochemical recurrence.

Keywords: Margins of Excision; Prostatectomy; Pathology

[Full Text]


 

Related Post

First – line, non – cryopreserved autologous stem cell transplant for poor – risk germ – cell tumors: Experience in a developing country

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

doi: 10.1590/S1677-5538.IBJU.2017.0562


ORIGINAL ARTICLE

Eucario Leon-Rodriguez 1, Monica M. Rivera-Franco 1, Dennis Lacayo-Leñero 2, Andrea Campos-Castro 2, Monica I. Meneses-Medina 3
1 Stem Cell Transplantation Program, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; 2 Stem Cell Transplantation Program,Hematology Section, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico; 3 Stem Cell Transplantation Program, Oncology Section, Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran Mexico City, Mexico

ABSTRACT

Purpose: The current first – line treatment for non – seminomatous germ cell tumor (NSGCT) consists of four cycles of cisplatin, etoposide, and bleomycin (BEP), which results in 5 – year overall survival < 60% in patients with poor – risk features. Autolo­gous hematopoietic stem cell transplantation (auto – HSCT) as a method for overcom­ing high toxicity after high dose chemotherapy (HDC) has been explored in different solid tumors, but has remained standard practice only for NSGCT. Our objective was to describe outcomes of patients with poor – risk NSGCT who underwent first – line autologous HSCT in a tertiary center in Mexico.

Patients and Methods: Twenty nine consecutive patients with NSGCT who received first – line, non – cryopreserved autologous HSCT at the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City, Mexico, from November 1998 to June 2016, were retrospectively analyzed.

Results: The median age at transplantation was 23 (15 – 39) years. Most patients (n = 18, 62%) had testicular primary tumor, and 23 had metastases (79%). Complete re­sponse after auto – HSCT was observed in 45%. Non – relapse mortality was 0. Five – year relapse / progression free and overall survival were 67% and 69%, respectively.

Conclusions: This small single limited – resource institution study demonstrated that patients with poor – risk NSGCT are curable by first – line HDC plus autologous HSCT and that this procedure is feasible and affordable to perform using non – cryopreserved hematopoietic stem cells.

Keywords: Stem Cell Transplantation; Neoplasms; Cryopreservation

[Full Text]


 

Related Post

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]


 

Related Post

Vascular injuries during laparoscopic donor nephrectomy and proposed risk reduction strategies

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

doi: 10.1590/S1677-5538.IBJU.2018.0281


VIDEO SECTION

Parag Sonawane 1, Arvind Ganpule 1, Abhishek Singh 1, Ravindra Sabnis 1, Mahesh R. Desai 1
1 Department of Urology, Division of Laparoscopic and Robotic Surgery, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India

ABSTRACT

 Introduction: Laparoscopic donor nephrectomy (LDN) has become the standard of care and popular among most of the transplant centres across the globe.

Objective of this video is to report different vascular injuries, their management during LDNs and propose risk reduction strategies.

Patient and methods: This was a retrospective analysis of all the LDNs performed between January 2011 and March 2016. All donor nephrectomies were performed laparoscopically by transperitoneal route, under ideal operative conditions by expert laparoscopic surgeons and by novice surgeons.

Results: 858 LDNs (left, n = 797; right, n = 61) were performed during the study period with 5 cases of vascular injuries. Mean (SD) donor age was 45.5 (± 10.76) years and the operative time was 165 (± 44.4) min. Of these five cases, two had renal vein injury, while the three others had renal artery, inferior vena cava and aortic injury (one each). Four injuries occurred during left LDN and only one during a right LDN. Vascular injuries were managed using the Rescue stitch or metallic clips as indicated. Risk reduction strategy was developed to avoid vascular injuries during LDN, which include – meticulous attention to port placement, addition of fourth port, complete dissection of upper pole and pedicle before clipping, and judicious use of ultrasonic diathermy.

Conclusions: Careful evaluation of computed tomography angiography just before surgery will act like a global position­ing system (GPS) for the operating surgeon. Rescue stitch is a saviour. Not to panic and being well versed with the risk reduction strategies of laparoscopy and rescue measures is of paramount importance.

 ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180281_Sonawane_et_al

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Robot – assisted laparoscopic local recurrence resection after radical prostatectomy

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

doi: 10.1590/S1677-5538.IBJU.2017.0503


VIDEO SECTION

Fabio C. M. Torricelli 1, Paulo Afonso de Carvalho 1, 2, Giuliano B. Guglielmetti 1,2, William C. Nahas 1, 2, Rafael F. Coelho 1, 2, 3
1 Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil; 2 Instituto do Cancer do Estado de Sao Paulo (ICESP), São Paulo, SP, Brasil; 3 Hospital Israelita Albert Einstein, São Paulo, SP, Brasil

ABSTRACT

Introduction and objective: Local prostate cancer recurrence is usually treated with salvage radiation (sRDT) with or with­out adjuvant therapy. However, surgical resection could be an option. We aim to present the surgical technique for robot – assisted laparoscopic resection prostate cancer local recurrence after radical prostatectomy (RP) and sRDT in 2 cases.

Patients and method: First case depicts a 70 year – old man who underwent RP in 2001 and sRDT in 2004. Following ad­juvant therapy, patient had biochemical recurrence. MRI showed a solid mass in the prostatic fossa close to vesicourethral anastomosis, measuring 2.1 cm and PET / CT revealed hyper caption significant uptake in the prostatic fossa. Second case is a 59 year – old man who underwent RP in 2010 and sRDT in 2011. Again, patient presented with biochemical recur­rence. PET / CT showed hyper caption in the prostatic fossa. Biopsy conformed a prostate adenocarcinoma. Both patients underwent robot – assisted extended pelvic lymph nodes dissection and local recurrence resection. A standard 4 robotic arms port placement was utilized.

Results: Both procedures were uneventfully performed in less than 3 hours and there were no complications. Pathologi­cal examination showed a prostate adenocarcinoma Gleason 7 and 8 in the first and second case, respectively; surgical margins and lymph nodes were negative. After 6 months of follow-up, continence was not affected and both patients presented with PSA < 0.15 ng / mL.

Conclusion: Robot – assisted laparoscopic resection of prostate cancer local recurrence after RP and sRDT detected by PSMA PET / CT seems to be safe in experienced hands. It may postpone adjuvant therapy in selected cases.

Available at: https://www.intbrazjurol.com.br/video-section/20170503_Torricelli_et_al

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

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A severely encrusted forgotten double – J ureteral catheter with giant stone formation

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

doi: 10.1590/S1677-5538.IBJU.2018.0330


RADIOLOGY PAGE

Gaurav Garg 1, Deepanshu Sharma 1, Siddharth Pandey 1, Manoj Kumar 1
1 King George’s Medical University, Lucknow, India

Not available

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A novel “six stitches” procedures for pediatric and adult buried penis

Vol. 44 (x): 2018 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0688


VIDEO SECTION

Junhao Lei 1, Chunhua Luo 1, Xinghuan Wang 1,2, Xinjun Su 1
1 Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China; 2 Center for Evidence-based and Translational Medicine, Wuhan University, Wuhan, China

ABSTRACT

Introduction: The buried penis, if not treated before adolescence, will lead to psychological and physical disorders in adulthood. Therefore, early surgical intervention is necessary. At present, the common surgical methods include the penile corpus fixation, the Johnson’s operation, the Devine’s method, the modified Devine’s method, Shiraki’s method, etc. However, we found that these traditional surgeries showed various postoperative complications, such as long-term prepuce edema, avascular necrosis of skin flaps, stenotic prepuce, scarring, and poor appearance. This video shows the main technical steps of our innovative surgical procedure “Six Stitch” (SS) method for the buried penis.
Materials and Methods: The designation of the so-called SS method was based on the total knots made (six knots were made for the SS procedure).
After the crura penis was fully exposed via a longitudinal incision at the penoscrotal junction, at the 2 o’clock position (around the penis), the superficial layer of albuginea of the crura penis was sutured to the prepubic ligament with 2-0 non-absorbable sutures to prevent the retraction of the penis (the 1st knot). The same procedure was used for the 10 o’clock position (the 2nd knot); At the 2 o’clock position, the skin and subcutaneous tissue at the pubic mound were sutured to the prepubic ligament to reconstruct the appearance of dorsum penis (the 3rd knot). The same procedures were used for the 10 o’clock position (the 4th knot). At the 5 o’clock position, the ventral albuginea was sutured to the tunica dartos and subcutaneous tissue at the penoscrotal junction to reconstruct the penoscrotal angle (the 5th knot). The same procedures were used for the 4 o’clock position (the 6th knot). Finally, the gloved prepuce was reset and circumcision was conducted if the redundant prepuce existed.
Results: We have done a total of 64 cases of SS procedures for concealed penis; mean length improvement was 3.8 ± 0.5 cm, with a satisfying 95 percent (61 / 64), which was much longer than the outcome of the above-mentioned methods.
Mean operative time was 62.3 ± 12.1 minutes, and there was no serious intraoperative or postoperative complication (only 2 presented scar hyperplasia at the incision site).
Conclusions: In conclusion, after the SS procedure, patients with buried penis can acquire an almost 4 cm improvement of penile length and covert incision at the midline of the scrotum, with an acceptable and low incidence of adverse events.
This safe and effective procedure may be a viable option for the surgical management of pediatric and adult buried penis.

ARTICLE INFO
Available at: https://www.intbrazjurol.com.br/video-section/20170688_ Lei_et_al
Int Braz J Urol. 2018; 44 (Video #X): XXX-X

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Easy, reproducible extraperitoneal pelvic access for robot – assisted radical prostatectomy

Vol. 44 (x): 2018 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0175


VIDEO SECTION

Antonio Rebello Horta Gorgen 1, Christian P. Pavlovich 2
1 Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil; 2 Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

ABSTRACT

Robot – assisted radical prostatectomy is commonly performed transperitoneally (tRARP), although the extraperitoneal (eRARP) approach is a safe and effective alternative that may be preferred in certain situations. We developed a novel method of direct access into the space of Retzius with a visual obturator port (VisiportTM) for laparoscopic or robotic prostatectomy.

We present an instructional video of extraperitoneal pelvic access for eRARP with both internal and external camera views. The patient is first placed in lithotomy and 15° Trendelenburg position. The camera is inserted infraumbilically and angled caudally. The pre-peritoneal space is accessed through the anterior rectus fascia using a VisiportTM (Covidien, $ 60 www.esutures.com), and the working space is developed with a kidney – shaped balloon OMSPDBS2TM (Covidien, $ 49 www.esutures.com). After the space is insufflated, subsequent trocars are angled in extraperitoneally under direct vision. The average time from incision to final port placement after a learning curve of about 50 cases is 8 minutes (IQR 7-10).

We have performed over 1.000 cases using this technique and eRARP has become our procedure of choice. Our last 500 + cases were performed robotically. Approximately 10% of the time peritoneotomies were noted, but rarely did these require conversion to tRARP. There have been no bowel or other abdominal organ injuries, major vascular or other complications in any of these cases.

 

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180175_Gorgen_et_al

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

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Evaluation of incidence and histolopathological findings of soft tissue sarcomas in genitourinary tract: Uludag university experience

Vol. 44 (x): 2018 June 6.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0048


ORIGINAL ARTICLE

Berna Aytac Vuruskan 1, Mıne Ozsen 1, Burhan Coskun 2, Ulviye Yalcinkaya 1
1 Department of Surgical Pathology, Uludag University, Faculty of Medicine, Bursa, Turkey; 2 Department of Urology, Uludag University, Faculty of Medicine, Bursa, Turkey

ABSTRACT

Purpose: In this study we aimed to review urological soft tissue sarcomas of genito­urinary tract that were diagnosed in our institution and their prognostic factors for survival.

Materials and Methods: The clinical and pathological records of 31 patients who had diagnosis of soft tissue sarcomas primarily originating from the genitourinary tract between 2005-2011 were reviewed.

Results: The most common site was kidney (17 cases, 54.8%), and most common di­agnosis was leiomyosarcoma (11 cases, 35.4%). A total of 24 patients (77.4%) had surgical excision. The surgical margins were positive in 7 patients who presented with local recurrence after primary resection. Twelve patients developed metastatic disease. During follow-up (range 9-70 month), 26 of the 31 patients (88.9%) were alive. Sig­nificant survival differences were found according to histological type (p: 0.001), with lower survival rates for malignant fibrous histiocytoma. The tumor size, the presence of metastasis at the time of diagnosis and tumor localization were not statistically significant for overall survival.

Conclusions: In our series, prostate sarcomas, paratesticular rhabdomyosarcoma and malignant fibrous histiocytoma had poor prognosis, especially in patients presenting with metastatic disease.

Keywords: Genitourinary Tract Anomalies [Supplementary Concept]; Sarcoma; Survival

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Comparison of renal function after robot – assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy

 Vol. 44 (x): 2018 April 4.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0103


ORIGINAL ARTICLE

Giray Ergin 1, Omer Gokhan Doluoglu 2, Mustafa Kıraç 1, Muhammet Fatih Kilinc 2, Burak Köprü 1, Bugra Bilge Keseroglu 2, Mustafa Burak Hoscan 3
1 Department of Urology Clinic, Yuksek Ihtisas University, Medical Faculty, Koru Hospital, Ankara, Turkey; 2 Department of Urology Clinic, Ankara Training and Research Hospital, Ankara, Turkey; 3 Department of Urology Clinic, Medstar Topcular Hospital, Antalya, Turkey

ABSTRACT

Purpose: To investigate the effect of robot assisted laparoscopic radical prosta­tectomy (RALP) and open retropubic radical prostatectomy (RRP) on early renal function in this study.

Materials and Methods: Preoperative and postoperative urea, creatinine, Hb, eGFR values of patients who had undergone RALP and RRP with prostate cancer (PCa) diagnosis were recorded in our clinic. The percentages of change in these values are calculated. Preoperative and postoperative urea, creatinine, Hb and eGFR changes were compared with each other. Student-t test was used for intergroup comparison, and paired sample t test was used to compare changes between preoperative and postoperative values of the same group.

Results: There were 160 and 93 patients in the RALP and RRP group, respectively. In the RALP group, postoperative urea and creatinine increased significantly com­pared to preoperative baseline values while eGFR was decreased (p = 0.0001, p = 0.001, p = 0.0001, respectively). Except for Hb in the RRP group, the changes in these values were statistically insignificant (p = 0.50, p = 0.75, p = 0.30, respec­tively).

Conclusions: We should be more careful when we perform RALP in patients at risk of impaired renal function despite being a minimally invasive surgical method with superior visual characteristics.

Keywords: Prostatic Neoplasms; Prostatectomy; Video-Assisted Surgery

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Supposed pituitary-production of human chorionic Gonadotropin induced by androgen deprivation therapy

Vol. 44 (x): 2018 April 4.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0654


ORIGINAL ARTICLE

Koji Yoshimura 1, Yoshiharu Nakashima 1, Kyohei Sugiyama 1, Naoki Kohei 1, Akitoshi Takizawa 2
1 Department of Urology, Shizuoka General Hospital, Shizuoka, Japan; 2 Department of Urology, International Goodwill Hospital, Yokohama, Japan

 

ABSTRACT

 

Introduction: The main cause of slightly elevated human chorionic gonadotropin (HCG) after successful treatment of male germ cell tumors is considered to be pituitary-derived HCG. It is well known that pituitary-derived HCG is frequently detected in postmenopausal women. We evaluated the status of serum HCG in men with elevated gonadotropins, which were induced by androgen deprivation therapy, using commercially available assays.

Materials and Methods: We enrolled 44 patients with prostate cancer, who underwent luteinizing-hormone releasing hormone agonist treatment. We measured serum follicle-stimulating hormone (FSH), serum luteinizing hormone (LH), serum total HCG, serum free HCGβ subunit, and urine total HCG 3 times per patient, on the day of treatment initiation, the next day, and 3 months after.

Results: On the day after treatment initiation, serum and urine HCG was detected in 61% and 73% of patients, respectively. Markedly strong correlations were observed between serum/urine HCG and FSH/LH. In particular, receiver operating characteristic curve analysis indicated excellent area under the curve (0.977, 95% confidence interval 0.951–1.003)) for serum HCG-detectable LH. At the cutoff value of 21.07 mIU/mL for serum HCG-detectable LH, the sensitivity and specificity were 96.7% and 95.3%, respectively. Serum HCG-β was not detectable at any times in any patients.

Conclusions: Suggested pituitary-derived HCG can be frequently detected in patients with elevated gonadotropins, and there is a firm association between HCG detection and gonadotropin levels.

Keywords: Chorionic Gonadotropin; Neoplasms, Germ Cell and Embryonal; Androgens; Luteinizing Hormone

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Prognostic significance of the dynamic changes of systemic inflammatory response in metastatic renal cell carcinoma

Vol. 44 (x): 2018 March 3.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0500


ORIGINAL ARTICLE

Beihe Wang 1, 2, Weijie Gu 1, 2, Fangning Wan 1, 2, Guohai Shi 1, 2, Dingwei Ye 1, 2
1 Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

 

ABSTRACT  

Purpose: To elucidate the prognostic value of systemic inflammatory response in pa­tients with metastatic renal cell carcinoma (mRCC) who are treated with sunitinib, we evaluated the prognostic role of C-reactive protein (CRP) kinetics. This study also compared prognostic models containing CRP kinetics and neutrophil-to-lymphocyte ratio (NLR) kinetics.

Materials and Methods: A consecutive cohort of 94 patients with mRCC who were treated with sunitinib was retrospectively included from Fudan University Shanghai Cancer Center. According to dynamic changes in CRP and the NLR, patients were divided into three groups for analysis of CRP and NLR kinetics. The associations between survival and potential prognostic factors were assessed. The incremental value of prognostication was evaluated.

Results: A significant difference (P<0.001) in overall survival (OS) was observed among the three groups of CRP kinetics. The median OS of the non-elevated group was nearly 1.3-fold longer than that of the normalized group (33.0 vs. 26.3 months), and two times longer than that of the non-normalized group (33.0 vs. 14.0 months). Multivari­ate analysis showed that CRP and NLR kinetics were independent prognostic indica­tors. The model containing CRP kinetics had a better predictive accuracy than that with NLR kinetics, which was supported by the C-index (0.731 vs. 0.684) and the likelihood ratio χ² test (79.9% vs. 44.9%).

Conclusion: Our study suggests that dynamic changes in CRP can better predict surviv­al in patients with mRCC who are treated with sunitinib. Routine assessment of CRP be­fore and after targeted therapy would help identify patients at risk of a poor outcome.

Keywords:  Carcinoma, Renal Cell; Molecular Targeted Therapy; Prognosis

[Full Text]


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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]


 

Related Post

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.


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