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Association between enuresis and obesity in children with primary monosymptomatic nocturnal enuresis

Vol. 45 (x): 2019 June 6.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0603


ORIGINAL ARTICLE

Yanli Ma 1, 2, Ying Shen 1, 2, Xiaomei Liu 1, 2
1 Department of Nephrology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, China; 2 Beijing Key Laboratory of chronic kidney disease and blood purifi cation of children, South Lishi Road, Xicheng District, Beijing, China

ABSTRACT

Objective: The purpose of this study was to determine whether the presence of obesity was related with symptoms of nocturnal enuresis (NE) and the effi cacy of behavioral intervention in the treatment of NE.
Materials and Methods: The patients diagnosed with primary monosymptomatic nocturnal enuresis (PMNE) were studied retrospectively. NE severity was classified as mild, moderate, and severe according to the frequency of enuresis. The children were divided into three groups, namely normal weight (5th-84th percentile), overweight (85th-94th percentile), and obesity (≥95th percentile), according to their Body Mass Index (BMI) percentage. The relationship between obesity level and enuresis severity was analyzed.
After three months of behavioral therapy, the effi cacy of treatment among normal, overweight, and obese groups were evaluated. Moreover, the predictive risk factors for treatment failure were investigated.
Results: The rates of severe enuresis in patients with normal weight, overweight, and obesity were 63.9%, 77.5%, and 78.6%, respectively. Obese children depicted higher odds of having severe enuresis compared with normal-weight children (OR: 1.571; 95% confi dence interval [CI]: 1.196-2.065; P=0.001). The odds of presenting with severe enuresis were 1.99 times higher in children who are obese or overweight compared to children with normal weight (OR: 1.994; 95% CI: 1.349-2.946; P=0.001). The complete response of the normal group was higher than those of the overweight and obese groups (26.8% vs. 14.0%, P=0.010; 26.8% vs. 0.0%, P=0.000). Overweight children showed higher complete response than obese ones (14.0% vs. 0.0%, P=0.009). Logistic regression analysis revealed that obesity level and enuresis frequency were significantly related to the treatment failure of behavioral intervention.
Conclusions: Obesity is associated with severe enuresis and low effi cacy of behavioral therapy in children with nocturnal enuresis.

Keywords: Nocturnal Enuresis; Behavior Therapy; Treatment Failure

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Voiding symptoms obtained by open versus directed anamnesis as predictors of voiding dysfunction in women

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0556


ORIGINAL ARTICLE

Juan Pablo Valdevenito 1, 2, José Flores 1, Rodrigo Guzman Rojas 2, Valentin Manriquez 2, Leandro Arribillaga 3, Juan de Benito 4
1 Department of Urology, Urodynamics Unit, Hospital Clínico Universidad de Chile, Santiago, Chile; 2 Department of Obstetrics and Gynecology, Female Pelvic Floor Unit, Hospital Clínico Universidad de Chile, Santiago, Chile; 3 Centro Urológico Profesor Bengió, Córdoba, Argentina; 4 Department of Urology, Instituto Modelo de Cardiología SRL, Córdoba, Argentina

ABSTRACT

Objectives: To determine the differences between voiding symptoms obtained by open anamnesis (VS-Open) versus voiding symptoms obtained by directed anamnesis (VSDirected) to predict voiding dysfunction in women.
Materials and Methods: Retrospective study of women with prior anti-incontinence surgery evaluated during 5 years. In a standardized clinical history taking, each patient was asked to answer question number fi ve of the UDI-6 questionnaire (“Do you experience any diffi culty emptying your bladder?”). If the answer was positive, the following voiding symptoms spontaneously described by the patient were documented: slow urine stream, straining to void, intermittent stream and feeling of incomplete bladder emptying, which were considered VS-Open. If the answer to this question was negative or if the patient had not reported the four voiding symptoms, she was asked in a directed manner about the presence of each of them, which were considered VS-Directed.
Voiding dysfunction was considered the presence of a maximum fl ow ≤ 12 mL/s and/ or a postvoid residual > 100 mL.
Results: Ninety-one women are analyzed. Eighteen patients presented voiding dysfunction (19.8%), There was a statistical association between voiding dysfunction and the presence of any VS-Open (p = 0.037) and straining to void obtained by open anamnesis (p = 0.013). Sensitivity, specificity, PPV, NPV, positive likelihood ratio and negative likelihood ratio, respectively, were 44.4% and 27.8%, 80.8% and 94.5%, 36.3% and 55.6%, 85.5% and 84.1%, 2.324 and 5.129, and 0.686 and 0.764. There was no statistical association between voiding dysfunction and VS-Directed.
Conclusions: VS-Open may predict better voiding dysfunction than VS-Directed in women.

Keywords: Urination; Women; Retrospective Studies

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Nonsecretory intestinocystoplasty: postoperative outcomes of 25 years

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0595


ORIGINAL ARTICLE

Rose A. F. Dantas 1, Fernanda C. F. S. Calisto 1, Fabio O. Vilar 2, Luiz A. P. Araujo 3, Salvador V. C. Lima 4
1 Programa de Pós-Graduação em Cirurgia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco-UFPE, Pernanbuco, PE, Brasil; 2 Departamento de Urologia, Hospital das Clínicas da Universidade Federal de Pernambuco-UFPE, Pernanbuco, PE, Brasil; 3 Departamento de Cirurgia Pediátrica, Universidade Federal de Pernambuco-UFPE, Pernanbuco, PE, Brasil; 4 Departamento de Cirurgia, Centro de Ciências da Saúde da Universidade Federal de Pernambuco-UFPE, Pernanbuco, PE, Brasil

ABSTRACT

Objective: The objective of bladder augmentation (BA) is to create a low-pressure reservoir with adequate capacity. Despite its benefi ts, the use of intestinal patches in bladder enlargement provides a high risk of developing complications and BA with demucosalised bowel represents a potential alternative. Therefore, this study evaluated urological parameters and long-term clinical follow-up of patients submitted to nonsecretory BA in a single center with 25 years of experience.

Materials and Methods: Patients treated with BA underwent urological evaluation, which included history, physical examination and urodynamic study. The main urodynamic parameters (bladder capacity and bladder compliance) were assessed in the pre and postoperative moments, and compared by the Wilcoxon Signed Rank test. The main long-term complications were described.

Results: 269 patients (mean age 14±13 years, 47% male) underwent BA with the use of demucolised intestinal segments. Among the patients in the sample, 187 (69.52%) had neurogenic bladder, 68 (25.28%) had bladder exstrophy, nine had tuberculosis (3.34%), four had a posterior urethral valve (1.49%) and one with hypospadia (0.37%). After the surgical procedure, a signifi cant increment in both urodynamic parameters was found, with a 222% increase in bladder capacity and 604% in bladder compliance (p <0.001 in both analyzes). Mean follow-up time ranged from 2 to 358 months, with a median of 72 months (IQR 74-247). Among all patients, 5 presented spontaneous perforation.

Conclusion: The study showed statistically signifi cant increase in both compliance and bladder capacity after non-secretory BA, with a low rate of severe complications.

Keywords: Hypopituitarism; Urinary Bladder; Disease

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Study of kidney morphologic and structural changes related to different ischemia times and types of clamping of the renal vascular pedicle

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0559


ORIGINAL ARTICLE

Angela Mazzeo 1, Anna Paula Weinhardt Baptista Sincos 1, Katia Ramos Moreira Leite 2, Miguel Angelo Góes Jr. 1, 3, Oscar Fernando Santos dos Pavão 1, Oskar Grau Kaufmann 1
1 Hospital Israelita Albert Einstein, São Paulo, Brasil; 2 Laboratório de Urologia, Faculdade de Medicina da Universidade São Paulo – USP, SP, Brasil; 3 Disciplina de Nefrologia, Escola Paulista de Medicina, Universidade Federal de São Paulo – Unifesp, SP, Brasil

ABSTRACT

Purpose: This study aimed to study morphological and renal structural changes in relation to different ischemic times and types of renal vascular pedicle clamping.
Methods: Sixteen pigs were divided into two groups (n = 8): Group AV – unilateral clamping of the renal artery and vein and Group A – unilateral clamping of the renal artery only, both with the contralateral kidney used as control. Serial biopsies were performed at 0, 10, 20, 30, 40, 50, 60, 70, 80, and 90 minutes after clamping.
Results: there is a correlation between the occurrence of renal damage as a function of time (p <0.001), with a higher frequency of Group A lesions for cellular alterations (vascular congestion and edema, interstitial infl ammatory infi ltrate, interstitial hemorrhage and cell degeneration), with the exception of in the formation of pigmented cylinders that were evidenced only in the AV Group.
Conclusion: the number of lesions derived from ischemia is associated with the duration of the insult, there is a signifi cant difference between the types of clamping, and the AV Group presented a lower frequency of injuries than Group A. The safety time found for Group A was 10 minutes and for Group AV 20 minutes.

Keywords: Kidney; Ischemia; Nephrectomy

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A census of laparoscopic and robotic urological practice: a survey of minimally invasive surgery department of the Brazilian Society of Urology

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0724


ORIGINAL ARTICLE

Marcos Flávio Holanda Rocha 1, Rafael Ferreira Coelho 2, Anibal Wood Branco 3, Pedro Henrique de Oliveira Filgueira 1, Rômolo Guida Júnior 4
1 Hospital Monte Klinikum, Fortaleza, CE, Brasil; 2 Hospital Albert Einstein, São Paulo, SP, Brasil; 3 Hospital Marcelino Champagnat, Curitiba, PR, Brasil; 4 Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brasil

ABSTRACT

Minimally invasive urologic surgery has been developing in Brazil and now is a routine part of care in many regions and patients with different conditions benefi t from it. Training in laparoscopic and robotic surgery has evolved and concerns exist both over the quality of surgical training and the practical effect on results of the urological training. This is an unprecedented study which undertook a census to determinate the current state of laparoscopic and robotic urological practice and to know the mains barriers to adequate practice in Brazil. In august 2017, surveys, consisting of an anonymous questionnaire with 15 questions, were sent via internet to the mailing list of the Brazilian Society of Urology (SBU). With these data, activities related to laparoscopy and robotic surgery of our urologists and the mains diffi culties and barriers to practice laparoscopy and robotic surgery were evaluated. In our survey, 413 questionnaires were completed. Majority of the responders were currently working in the southeast region of Brazil (52.1%) and 75.5% of the surgeons performed laparoscopic surgery while, only 12.8%, robotic surgery. The lack of experience on the technique and the lack of equipment were the mains barriers and diffi culties for not executing laparoscopic and robotic surgeries, respectively. Proper longitudinal training and access to good equipment in minimally invasive surgery are still barriers for urologists in our country.

Keywords: Education; Robotic Surgical Procedures; Urology

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Novel homozygous mutation in a colombian patient with persistent müllerian duct syndrome: expanded phenotype

Vol. 45 (x): 2019 June 6.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0808


CHALLENGING CLINICAL CASES

Mary García Acero 1, Olga Moreno 1, Andrés Gutiérrez 2, Catalina Sánchez 2, Juan Guillermo Cataño 2, Fernando Suárez-Obando 1, 3, Adriana Rojas 1
1 Human Genetic Institute, Pontifi cia Universidad Javeriana, Bogotá, Colombia; 2 Department of Urology, Hospital Universitario San Ignacio, Bogotá, Colombia; 3 Genetic Service, Hospital Universitario San Ignacio, Bogotá, Colombia

ABSTRACT

The anti-Müllerian hormone triggers the regression of uterus and fallopian tubes in male embryos; if there are problems in the synthesis or action of this protein, Müllerian structures persist in an otherwise phenotypic male. The most frequent clinical presentation of Persistent Mullerian Duct syndrome is cryptorchidism and inguinal hernia.
The few cases reported in adults are incidental fi ndings or inguinal hernias. However, we present an adult male with history of bilateral cryptorchidism with unsuccessful orchidopexy, who presents with a large abdominal mass with the fi nding of a seminomatous tumor and persistence of Müllerian structures, in whom the variant c.916delC (p.Leu306Cysfs*29) in the AMHR2 gene not previously reported was documented.

Keywords: Mullerian Ducts; Anti-Mullerian Hormone; Persistent Mullerian duct syndrome [Supplementary Concept]; Disorders of Sex Development

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Antioxidant action of alpha lipoic acid on the testis and epididymis of diabetic rats: morphological, sperm and immunohistochemical evaluation

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0774


ORIGINAL ARTICLE

Lanna Beatriz Neves Silva Corrêa 1, Carlos Alberto Soares da Costa 2, José Antônio Silva Ribas 3, Gilson Teles Boaventura 2, Mauricio Alves Chagas 1
1 Departamento de Morfologia, Laboratório de Biomorfologia Celular e Extracelular, Universidade Federal Fluminense – UFF, Niterói, RJ, Brasil; 2 Departamento de Nutrição e Dietética, Nutrição Experimental, Universidade Federal Fluminense – UFF, Niterói, RJ, Brasil; 3 Departamento de Fisiologia e Farmacologia, Universidade Federal Fluminense – UFF, Niterói, RJ, Brasil

ABSTRACT

Introduction: Chronic hyperglycemia is caused by diabetes mellitus-committed genital morphophysiology, and oxidative stress is one of the main factors involved in this process. Alpha lipoic acid (ALA) can prevent metabolic and morphological changes in diabetic individuals.

Objectives: In present study, we evaluated the effects of regular ALA consumption on the spermatogenesis and histoarchitecture in the male genital system of diabetic rats.

Materials and Methods: Thirty-two Wistar rats were divided into groups: Control (CG); Diabetic Control (DCG), receiving commercial diet: ALA Group (ALAG) and Diabetic ALA Group (DALAG), fed diets with added ALA (300 mg/Kg bw). The diabetic groups received a single injection of streptozotocin (60 mg/kg). After sixty days of the diet, the animals were euthanized, and semen, testis and epididymis samples were collected. A histomorphometric analysis was performed to determine the epithelial height, tubular and luminal diameter, tubular and luminal area of seminiferous tubules and each epididymal region. Sertoli cells were evidenced using the antivimentin antibody and were quantifi ed. The results were statistically analyzed by the ANOVA test.

Results: At the end of the experiment, the DALAG glycemia was significantly lower than DCG. The histomorphometric parameters of the seminiferous and epididymal tubules did not show improvement in the DALAG. However, there was an improvement in the DALAG in terms of the concentration, motility and percentage of spermatic pathologies, as well as in the number of Sertoli cells (p<0.001).

Conclusions: The results demonstrated that supplementation with the ALA antioxidant retards testicular lesions and preserve the process of spermatogenesis in diabetes.

Keywords: Testis; Epididymis; Morphological and Microscopic Findings; Spermatozoa

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REPLY BY THE AUTHORS: Re: Antibiotic prophylaxis prior to urodynamic study in patients with traumatic spinal cord injury. Is there an indication?

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0193.1


LETTER TO THE EDITOR

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

Not available

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

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0193


LETTER TO THE EDITOR

Michael S. Floyd Jr. 1, Rauf N. Khadr 1
1 Department of Urology & Northwest Regional Spinal Cord Injury Unit Southport & Ormskirk NHS Foundation Trust, Town Lane, Kew, Southport, Merseyside, United Kingdom

ABSTRACT

Not available

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Re: The role of 68Ga-PSMA-PET/CT in radiotherapy planning in prostate cancer

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2019.0130


LETTER TO THE EDITOR

Yasemin Benderli Cihan 1
1 Kayseri Education and Research Hospital, Department of Radiation Oncology, Turkey

ABSTRACT

Not Available

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Challenging risk factors for right and left laparoscopic adrenalectomy: A single centre experience with 272 cases

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2019.0131


ORIGINAL ARTICLE

Kadir Omur Gunseren 1, Mehmet Cagatay Cicek 1, Hakan Vuruskan 1, Yakup Kordan 2, Ismet Yavascaoglu 1
1 Department of Urology, Uludag University, School of Medicine, Nilufer, Bursa, Turkey; 2 Departmet of Urology, Koc University, School of Medicine, Nilufer, Bursa, Turkey

ABSTRACT

Purpose: This study aimed to compare perioperative and postoperative results of right and left laparoscopic adrenalectomy (LA), and to evaluate the impact of challenging factors on these outcomes.

Materials and Methods: A total of 272 patient’s medical records that underwent single side LA between October 2006 and September 2017 were retrospectively reviewed. The patients were divided into 2 groups according to operation side. Moreover, pheochromocytoma, metastatic masses and adrenal lesions >5cm in size were considered to be difficult adrenalectomy cases and the outcomes of these cases were compared between two groups.

Results: 135 patients (49.6%) underwent right LA and 137 patients (50.4%) underwent left LA. Operation time, estimated blood loss (EBL) and hospitalization time were similar between the groups (p=0.415, p=0.242, p=0.741, respectively). Although EBL was higher on the right side than the left (p=0.038) in the fi rst 20 cases, after this learning period has been completed, there was no signifi cant difference between the groups. In patients with pheochromocytoma, metastatic mass and a mass >5cm in size, despite bleeding complications were clinically higher on the right side, this difference was not statistically significant.

Conclusions: During the learning period of LA, EBL is higher on the right side. Due to the greater risk of bleeding complications on the right side even on the hands of experienced surgeons, extra care and preoperative planning are required in patients with pheochromocytoma, metastatic masses and masses >5cm in size.

Keywords: Laparoscopy; Adrenalectomy; Risk Factors

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Is possible to rule out clinically significant prostate cancer using PI-RADS v2 for the assessment of prostate MRI?

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0382


ORIGINAL ARTICLE

Publio Cesar Cavalcanti Viana 1, Natally Horvat 1, Valter Ribeiro dos Santos Júnior 1, Thais Carneiro Lima 1, Davi dos Santos Romão 1, Luciana Mendes de Oliveira Cerri 1, Marilia Germanos de Castro 2, Herbert Alberto Vargas 3, Júlia Azevedo Miranda 1, Claudia da Costa Leite 1, Giovanni Guido Cerri 1
1 Departamento de Radiologia do Hospital Sírio-Libanês, São Paulo, SP, Brasil; 2 Departamento de Patologia do Hospital Sírio-Libanês, São Paulo, SP, Brasil; 3 Departamento de Radiologia, Memorial Sloan Kettering Cancer Center, Nova York, NY, EUA

ABSTRACT

Objectives: To evaluate the diagnostic performance and interobserver agreement of PI-RADS v2.

Materials and Methods: In this Institutional Review Board approved single-center retrospective study, 98 patients with clinically suspected PCa who underwent 3-T multiparametric MRI followed by MRI/TRUS fusion-guided prostate biopsy were included from June 2013 to February 2015. Two radiologists (R1 and R2) with 8 and 1 years of experience in abdominal radiology reviewed the MRI scans and assigned PI-RADS v2 scores in all prostate zones. PI-RADS v2 were compared to MRI/TRUS fusion-guided biopsy results, which were classifi ed as negative, PCa, and significant PCa (sPCa).

Results: Sensitivity, specifi city, NPV, PPV and accuracy for PCa was 85.7% (same for all metrics) for R1 and 81.6%, 79.6%, 81.2%, 80.0% and 80.6% for R2. For detecting sPCa, the corresponding values were 95.3%, 85.4%, 95.9%, 83.7% and 89.8% for R1 and 93.0%, 81.8%, 93.7%, 86.7% and 86.7% for R2. There was substantial interobserver agreement in assigning PI-RADS v2 score as negative (1, 2, 3) or positive (4, 5) (Kappa=0.78). On multivariate analysis, PI-RADS v2 (p <0.001) was the only independent predictor of sPCa compared with age, abnormal DRE, prostate volume, PSA and PSA density.

Conclusions: Our study population demonstrated that PI-RADS v2 had high diagnostic accuracy, substantial interobserver agreement, and it was the only independent predictor of sPCa.

Keywords: Prostate; Magnetic Resonance Imaging; Neoplasms; Prostatic Neoplasms

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Efficacy and tolerability of mirabegron in female patients with overactive bladder symptoms after surgical treatment for stress urinary incontinence

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0518


ORIGINAL ARTICLE

Mete Özkidik 1, Alper Coşkun 1, Mehmet Kazim Asutay 1, Tuncer Bahçeci 1, Nurullah Hamidi 2
1 Clinic of Urology, Şanliurfa Research and Training Hospital, Şanliurfa, Turkey; 2 Department of Urology, Ankara Atatürk Training and Research Hospital, Ankara, Turkey

ABSTRACT

Purpose: To evaluate the effi cacy and tolerability of mirabegron in females with overactive bladder (OAB) symptoms after surgical treatment for stress urinary incontinence (SUI).

Materials and Methods: The study was conducted with a prospective, randomized and double-blinded design. 62 patients over the age of 40 who met the inclusion-exclusion criterias of the study were enrolled and randomly divided into two groups as Group A (mirabegron 50mg) and B (solifenacin 5mg). Patients were compared based on efficacy of treatment [Patient Perception of Bladder Condition (PPBC) scale and micturition diaries], safety of treatment (heart rate, systolic and diastolic blood pressure, adverse events), number of micturitions per day, patient’s satisfaction status after treatment [Visual Analog Scale(VAS)] and quality of life.

Results: The mean age of the population was 48.2±3.8 years and the duration of OAB symptoms was 5.9±2.9 months. Baseline values for the mean number of micturitions, volume voided in each micturition, nocturia episodes, urgency and urgency incontinence episodes were 15.3±0.34, 128±3.88mL, 3.96±1.67, 5.72±1.35 and 4.22±0.69, respectively.

After treatment, values for these parameters were 11.7±0.29, 164.7±2.9mL, 2.25±0.6, 3.38±0.71, 2.31±0.49 respectively. Quality of life score, symptom bother score, VAS for treatment satisfaction score, PPBC score after treatment were 66.1±0.85, 43.7±0.77, 4.78±0.14, 4.78±0.14, respectively. There were no signifi cant differences between two groups on any parameter. However, mirabegron showed better tolerability than solifenacin, particularly after 6 months.

Conclusion: Mirabegron is safe, effective and tolerable in the long-term treatment of females with OAB symptoms after surgery for stress urinary incontinence.

Keywords: mirabegron [Supplementary Concept]; Urinary Bladder, Overactive; Solifenacin Succinate; Urinary Incontinence, Stress

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Detection of clinically signifi cant prostate cancer with PIRADS v2 scores, PSA density, and ADC values in regions with and without mpMRI visible lesions

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0768


ORIGINAL ARTICLE

Antonio C. Westphalen 1, 2, 3, Farhad Fazel 1, Hao Nguyen 2, 3, Miguel Cabarrus 1, Katryana Hanley- Knutson 1, Katsuto Shinohara 2, 3, Peter R. Carroll 2, 3
1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA; 2 Department of Urology, University of California, San Francisco, CA, USA; 3 Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA

ABSTRACT

Purpose: To determine if PSAD, PSADtz, and ADC values improve the accuracy of PI-RADS v2 and identify men whose concurrent systematic biopsy detects clinically signifi cant cancer on areas without mpMRI visible lesions.

Materials and methods: Single reference-center, cross-sectional, retrospective study of consecutive men with suspected or known low to intermediate-risk prostate cancer who underwent 3T mpMRI and TRUS-MRI fusion biopsy from 07/15/2014 to 02/17/2018. Cluster-corrected logistic regression analyses were utilized to predict clinically signifi cant prostate cancer (Gleason score ≥3+4) at targeted mpMRI lesions and on systematic biopsy.

Results: 538 men (median age=66 years, median PSA=7.0ng/mL) with 780mpMRI lesions were included. Clinically signifi cant disease was diagnosed in 371 men. PI-RADS v2 scores of 3, 4, and 5 were clinically signifi cant cancer in 8.0% (16/201), 22.8% (90/395), and 59.2% (109/184). ADC values, PSAD, and PI-RADS v2 scores were independent predictors of clinically signifi cant cancer in targeted lesions (OR 2.25-8.78; P values <0.05; AUROC 0.84, 95% CI 0.81-0.87). Increases in PSAD were also associated with upgrade on systematic biopsy (OR 2.39-2.48; P values <0.05; AUROC 0.69, 95% CI 0.64-0.73).

Conclusions: ADC values and PSAD improve characterization of PI-RADS v2 score 4 or 5 lesions. Upgraded on systematic biopsy is slightly more likely with PSAD ≥0.15 and multiple small PI-RADS v2 score 3 or 4 lesions.

Keywords: Radiology; Prostate; Magnetic Resonance Imaging

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External validation of nomogram to predict inguinal lymph node metastasis in patients with penile cancer and clinically negative lymph nodes

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0756


ORIGINAL ARTICLE

Carlos Vaz de Melo Maciel 1, Roberto Dias Machado 1, Mariana Andozia Morini 1, Pablo Aloisio Lima Mattos 2, Ricardo dos Reis 1, Rodolfo Borges dos Reis 1, Gustavo Cardoso Guimarães 3, Isabela Werneck da Cunha 3, Eliney Ferreira Faria 1
1 Departamento de Urologia, Hospital do Câncer de Barretos, Barretos, SP, Brasil; 2 Associação Piauiense de Combate ao Câncer, Teresina, PI. Brasil; 3 Fundação Antonio Prudente, A. C. Camargo Cancer Center, São Paulo, SP, Brasil

ABSTRACT

Introduction: Penile cancer (PC) occurs less frequently in Europe and in the United States than in South America and parts of Africa. Lymph node (LN) involvement is the most important prognostic factor, and inguinal LN (ILN) dissection can be curative; however, ILN dissection has high morbidity. A nomogram was previously developed based on clinicopathological features of PC to predict ILN metastases. Our objective was to conduct an external validation of the previously developed nomogram based on our population.

Materials and methods: We included men with cN0 ILNs who underwent ILN dissection for penile carcinoma between 2000 and 2014. We performed external validation of the nomogram considering three different external validation methods: k-fold, leave-oneout, and bootstrap. We also analyzed prognostic variables. Performance was quantified in terms of calibration and discrimination (receiver operator characteristic curve). A logistic regression model for positive ILNs was developed based on clinicopathological features of PC.

Results: We analyzed 65 men who underwent ILN dissection (cN0). The mean age was 56.8 years. Of 65 men, 24 (36.9%) presented with positive LNs. A median 21 ILNs were removed. Considering the three different methods used, we concluded that the previously developed nomogram was not suitable for our sample.

Conclusions: In our study, the previously developed nomogram that was applied to our population had low accuracy and low precision for correctly identifying patients with PC who have positive ILNs.

Keywords: Nomograms; Lymph; Lymphatic Metastasis; Penile Neoplasms

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Correlation of tools for objective evaluation of infravesical obstruction of men with lower urinary tract symptoms

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0706


ORIGINAL ARTICLE

Orestes Mazzariol Jr. 1, Leonardo O. Reis 1, Paulo R. Palma 1
1 Universidade Estadual de Campinas – Unicamp, Campinas, SP, Brasil

ABSTRACT

Purpose: To identify how the most frequently used parameters in daily clinical practice diagnosing bladder outlet obstruction (BOO) due to benign prostate hyperplasia (BPH) correlate to each other.

Materials and methods: The study included 452 patients with lower urinary tract symptoms (LUTS) of the UNICAMP urology outpatient clinic of LUTS. Inclusion criteria: patients with BOO due to BPH who agreed to participate in the study. Exclusion criteria: patients with urinary tract infection, neurological diseases that compromised the lower urinary tract, prior prostatic surgery, radiotherapy or urethral stenosis. Patient assessment: history, international prostate symptoms score (IPSS), nocturnal quality of life score (NQoL) questionnaires, physical and digital rectal examination (DRE), PSA, transabdominal ultrasound with intravesical prostate protrusion (IPP), post-mictional residue and free urofl owmetry.

Results: There was no strong Spearman correlation among the studied variables. The only moderate correlations occurred between IPSS and NQoL (p <0001; c=0.56) and between IPP and prostate volume (p <0001; c=0.57). Weak correlations between IPP and post-mictional residue (p <0001; c=0.31) and free urofl owmetry (p <0001; c=-0.26); and between IPSS and free urofl owmetry (p <0001, c=-0.21) were observed.

Conclusion: In this study, we found moderate, weak, very weak and absent correlation among the various parameters used in the diagnosis and management of BOO due to BPH.

As the value of these tools is variable, the creation of a logical and objective algorithm was not possible and the treatment is based on the interpretation of clinical symptoms.

 

Keywords: Prostatic Hyperplasia; Prostate; Transurethral Resection of Prostate

[Full Text]


A prospective study assessing feasibility of performing percutaneous nephrolithotomy in chronic kidney disease patients – What factors affect the outcome?

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

doi: 10.1590/S1677-5538.IBJU.2018.0816


ORIGINAL ARTICLE

Rohan Patel 1, Samarth Agarwal 1, S. N. Sankhwar 1, Apul Goel 1, B. P. Singh 1, Manoj Kumar 1
1 Department of Urology, King George’s Medical University, Lucknow, India

ABSTRACT

Objectives: To primarily evaluate the functional outcomes of PCNL for bilateral renal calculi/calculi in solitary functioning kidney with Chronic Kidney Disease(CKD). To identify factors affecting the renal replacement therapy following PCNL.

Materials and Methods: Patients with bilateral renal calculi/calculi in solitary kidney and CKD (eGFR<60/s.creatinine>2) and Good Performance Status [Eastern Cooperative Oncology Group (ECOG): 0–2] were included in the study.

Results: A total of 60 patients with CKD who had bilateral renal calculi/calculi in solitary functioning kidney underwent PCNL. At 6 months, eGFR improved or stabilized in 45 (75%) patients, while in 15 (25%) patients eGFR deteriorated. A total of 5 (14.28%) and 2 (25%) patients of CKD stage 4 and 5 respectively had improvement in eGFR as well as CKD stage. Fourteen (82.35%), 21 (60%), 3 (37.5%) patients of CKD stage 3, 4, 5 had improvement in eGFR but not signifi cant enough to cause stage migration.

Again 3 (17.65%) , 9 ( 40%) and 3 (37.5%) patients of CKD stage 3, 4, 5 had reduction in eGFR but not signifi cant enough to cause stage migration. None of the patients had worsening of CKD stage. Preoperative CKD stage and eGFR were compared with measurements made at the fi nal follow up visit (6 months).

Conclusion: Our results indicate that most patients of renal calculi with CKD show improvement or stabilization of renal function with aggressive stone removal. Improvement is more in patients who have mild to moderate CKD. Aggressive management of comorbidities, peri-operative UTI and complications may delay or avoid progression of CKD status in such patients.

Keywords: Nephrolithotomy, Percutaneous; Kidney Diseases; Urinary Tract Infections

[Full Text]


Factors affecting urinary continence and sexual potency recovery after robotic-assisted radical prostatectomy

Vol. 45 (x): 2019 May 5.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0704


ORIGINAL ARTICLE

Mark Fernando Neumaier 1, Carlos Henrique Segall Júnior 1, Marcelo Hisano 2, Flávio Eduardo Trigo Rocha 1, 2, Sami Arap 1, 2, Marco A. Arap 1, 2
1 Hospital Sírio-Libanês, São Paulo, SP. Brasil; 2 Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil

ABSTRACT

Introduction: Robot-assisted radical prostatectomy (RARP) is the most recent surgical technique for localized prostate cancer. The Da Vinci (Intuitive Surgical, Sunnyvale, CA) system was fi rst introduced in Brazil in 2008, with a fast growing number of surgeries performed each year.

Objective: Our primary endpoint is to analyze possible predictors of functional outcomes, related to patient and tumor features. As secondary endpoint, describe functional outcomes (urinary continence and sexual potency) from RARP performed in the Sírio-Libanês Hospital (SLH), a private institution, in São Paulo, from April 2008 to December 2015.

Materials and Method: Data from 104 consecutive patients operated by two surgeons from the SLH (MA and SA) between 2008 and 2015, with a minimum 12 months follow-up, were collected. Patient features (age, body mass index – BMI, PSA, date of surgery and sexual function), tumor features (tumor stage, Gleason and surgical margins) and followup data (time to reach urinary continence and sexual potency) were the variables collected at 1, 3, 6 and 12 month and every 6 months thereafter. Continence was defi ned as the use of no pad on medical interview and sexual potency defi ned as the capability for vaginal penetration with or without fosphodiesterase type 5 inhibitors.

Results: Mean age was 60 years old and mean BMI was 28.45 kg/m2. BMI >30kg/m2 (p<0.001) and age (p=0.011) were signifi cant predictors for worse sexual potency after surgery. After 1, 3, 6 and 12 months, 20.7%, 45.7%, 60.9% and 71.8% from patients were potent, respectively. The urinary continence was reached in 36.5%, 80.3%, 88.6% and 92.8% after 1, 3, 6 and 12 months, respectively. Until the end of the study, only one patient was incontinent and 20.7% were impotent.

Conclusion: Age was a predictor of urinary and erectile function recovery in 12 months. BMI was signifi cant factor for potency recovery. We obtained in a private hospital good functional results after 12 months of follow-up.

Keywords: Prostatic Neoplasms; Adenocarcinoma; Urinary Incontinence

[Full Text]


Laparoscopic nephroureterectomy as treatment in obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome

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

doi: 10.1590/S1677-5538.IBJU.2018.0430


VIDEO SECTION


María Medina-González 1, Jorge Panach-Navarrete 1, Lorena Valls-González 1, Ana Castelló-Porcar 1, Jose María Martínez-Jabaloyas 1
1 Department of Urology. University Clinic Hospital of Valencia, Facultat de Medicina i Odontologia, Universitat de València, Spain

ABSTRACT

Introduction: OHVIRA syndrome is a rare entity characterized by renal and Mullerian anomalies. The objective of the video is, through a clinical case, to discuss the importance of diagnosis, management and treatment, to avoid the complications that this syndrome entails, and to improve the long-term prognosis.
Materials and Methods: We report the case of a 10-year-old girl who consulted for abdominal pain, being diagnosed with OHVIRA syndrome. We describe the diagnosis and the surgical technique. In addition, we perform a systematic review in PubMed to report the published literature of this topic and we show the optimal management of this pathology.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180430_Medina-Gonzalez_et_al

[Full Text]


Indocyanine green – guided laparoscopic renal pedicle lymphatic disconnection: A novel, targeted treatment for chyluria

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

doi: 10.1590/S1677-5538.IBJU.2018.0415


VIDEO SECTION

Joshua Yi Min Tung 1, Kenneth Chen 1, Allen Soon Phang Sim 1
1 Singapore General Hospital, Singapore

ABSTRACT

Introduction and Objectives: Chyluria, or the passage of chyle into the urine from anomalous lymphatic connections, results in a characteristic milky urine. In severe cases, it can cause signifi cant morbidity from nutritional losses and immune suppression. Although predominantly associated with Wuchereria bancrofti infections, non-parasitic cases have also been described.

 

ARTICLE INFO
Available at: https://www.intbrazjurol.com.br/video-section/20180415_Tung_et_al

[Full Text]


Intracorporeal renal hypothermia with ice Slush for robot-assisted partial nephrectomy in a highly complex renal mass

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

doi: 10.1590/S1677-5538.IBJU.2018.0705


VIDEO SECTION

Jose Luis Bauza 1, Prithvi Murthy 2, Daniel Sagalovich 2, Riccardo Bertolo 2, Enrique Pieras 1, Pedro Piza 1, Jihad Kaouk 2
1 Department of Urology, Hospital Universitario Son Espases, Palma de Mallorca, Illes Balears, Spain; 2 Center for Laparoscopic and Robotic Surgery, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio – United States

ABSTRACT

To report our step-by-step technique for robotic partial nephrectomy using intracorporeal renal hypothermia (RPNIRH) in a highly complex renal mass. The robotic technology has allowed surgeons to recreate the principles of open surgery in a minimally invasive approach (1). With increasing experience, larger deeply infiltrative tumors can be treated with this technique (2). In complex cases, when a long warm ischemia time is expected, intracorporeal renal hypothermia can be useful to prevent permanent renal function loss (3).

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180705_Bauza_et_al

[Full Text]


Vesicostomy button: how is it placed, in whom, and how is quality of life affected?

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

doi: 10.1590/S1677-5538.IBJU.2018.0686


ORIGINAL ARTICLE

Kelly J. Nast 1,2, George Chiang 1,2, Sarah Marietti 1,2
1 University of California, San Diego, CA, USA; 2 Rady Children’s Hospital, San Diego, CA, USA

ABSTRACT

Purpose: The vesicostomy button has been shown to be a safe and effective bladder management strategy for short- or medium-term use when CIC cannot be instituted.
This study reports our use with the vesicostomy button, highlighting the pros and cons of its use and complications. We then compared the quality or life in patients with vesicostomy button to those performing clean intermittent catheterization.
Materials and Methods: Retrospective chart review was conducted on children who had a vesicostomy button placed between 2011 and 2015. Placement was through existing vesicostomy, open or endoscopically. We then evaluated placement procedure and complications. A validated quality of life questionnaire was given to patients with vesicostomy button and to a matched cohort of patients performing clean intermittent catheterization.
Results: Thirteen children have had a vesicostomy button placed at our institution in the 4 year period, ages 7 months to 18 years. Indications for placement included neurogenic bladder (5), non-neurogenic neurogenic bladder (3), and valve bladders (5). Five out of 7 placed via existing vesicostomy had leakage around button. None of the endoscopically placed buttons had leakage. Complications were minor including UTI (3), wound infection (1), and button malfunction/leakage (3). QOL was equal and preserved in patients living with vesicostomy buttons when compared to CIC.
Conclusion: The vesicostomy button is an acceptable alternative to traditional vesicostomy and CIC. The morbidity of the button is quite low. Endoscopic insertion is the optimal technique. QOL is equivalent in patients with vesicostomy button and those who perform CIC.

Keywords: Cystostomy; Gastrostomy; Quality of Life

[Full Text]


Editorial comment: Cross-cultural adaptation and validation of the neurogenic bladder symptom score questionnaire for Brazilian Portuguese

Vol. 45 (x): 2019 May 07.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0335.1


EDITORIAL COMMENT

Blayne Welk 1
1 Division of Urology and Epidemiology and Biostatistics, Western University, London, UK

ABSTRACT

Not available

[Full Text]


Thyroid-like follicular carcinoma of the kidney presenting on a 10 year-old prepubertal girl

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

doi: 10.1590/S1677-5538.IBJU.2018.0471


CHALLENGING CLINICAL CASES

Lisieux Eyer de Jesus 1, Celine Fulgêncio 1, Thais Leve 1, Samuel Dekermacher 1
1 Departamento de Cirurgia e Urologia Pediátrica, Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brasil

ABSTRACT

The very rare thyroid-like carcinoma of the kidney (TLCK) is microscopically similar to thyroid follicular cell carcinoma (TFCC). Differential diagnosis with secondary thyroid tumors depends on non-reactivity to immunohistochemical (IHC) markers for TFCC (thyroglobulin – TG and TTF1). We herein describe the fourth Pediatric case in literature and extensively review the subject. Only 29 cases were published to the moment. Most cases were asymptomatic and incidentally detected. Most tumors are hyperechoic and hyperdense with low grade heterogenous enhancement on CT and MRI. Most patients were treated with radical nephrectomy, but partial nephrectomy was used in some cases, apparently with the same results. Metastases are uncommon and apparently do not change prognosis, but follow-ups are limited. Up to the moment, TLCK presents as a low grade malignancy that may be treated exclusively with surgery and frequently with partial kidney renal preservation. A preoperative percutaneous biopsy is a common procedure to investigate atypical tumors in childhood and adult tumors. To recognize the possibility of TLCK is fundamental to avoid unnecessary thyroidectomies in those patients, supposing a primary thyroid tumor.

Keywords: Kidney Neoplasms; Carcinoma; Pediatrics

[Full Text]


Low serum vitamin D is associated with an increased likelihood of acquired premature ejaculation

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

doi: 10.1590/S1677-5538.IBJU.2018.0887


ORIGINAL ARTICLE

Lütfi Canat 1, Recep Burak Degirmentepe 1, Hasan Anil Atalay 1, Suleyman Sami Çakir 1, Ilter Alkan 1, Mehmet Gokhan Çulha 1, Sait Ozbir 1, Masum Canat 2
1 Department of Urology, Okmeydani Training and Research Hospital, Istanbul, Turkey; 2 Department of Endocrinology and Metabolism, Şişli Etfal Training and Research Hospital, Istanbul, Turkey

ABSTRACT

Purpose: To investigate the relationship between 25-hydroxyvitamin D (25 (OH) D) levels and acquired premature ejaculation (PE).
Materials and Methods: A total of 97 patients with acquired PE and 64 healthy men as a control group selected from volunteers without PE attending our Andrology Outpatient Clinic between November 2016 and April 2017 were included the study. All patients were considered to have acquired PE if they fulfi lled the criteria of the second Ad Hoc International Society for Sexual Medicine Committee. Premature ejaculation diagnostic tool questionnaires were used to assessment of PE and all participants were instructed to record intravaginal ejaculatory latency time. Vitamin D levels were evaluated in all participants using high performance liquid chromatography method included in the study.
Results: Compared to men without PE, the patients with acquired PE had signifi cantly lower 25 (OH) D levels (12.0 ± 4.5 ng/mL vs. 18.2 ± 7.4 ng/mL, p < 0.001). In the logistic regression analysis, 25 (OH) D was found to be an independent risk factor for acquired PE, with estimated odds ratios (95% CI) of 0.639 (0.460-0.887, p = 0.007) and the area under curve of the ROC curve of 25 (OH) D diagnosing acquired PE was 0.770 (95% CI: 0.695 to 0.844, p < 0.001). The best cut-off value was 16 ng/mL with a sensitivity of 60.9%, specifi city of 83.5%, PPV of 70.9%, and NPV of 76.4% to indicate acquired PE..
Conclusions: This study demonstrates that lower vitamin D levels are associated with the acquired PE. The result of our study showed that the role of serum vitamin D levels should be investigate in the etiology of acquired PE. Perhaps supplementation of vitamin D in men with acquired PE will ameliorate the sexual health of these patients.

Keywords: Premature Ejaculation; Vitamin D; Likelihood Functions

[Full Text]


Cross-cultural adaptation and validation of the neurogenic bladder symptom score questionnaire for Brazilian Portuguese

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

doi: 10.1590/S1677-5538.IBJU.2018.0335


ORIGINAL ARTICLE

Lisley Keller Liidtke Cintra 1, José de Bessa Junior 2, Victor Ikky Kawahara 2, Thereza Phitoe Abe Ferreira 1, Miguel Srougi 2, Linamara Rizzo Battistella 1, Daniel Rubio de Souza 1, Homero Bruschini 2, Cristiano Mendes Gomes 2
1 Instituto de Medicina Física e Reabilitação, Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil; 2 Divisão de Urologia da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil

ABSTRACT

Objective: To cross-culturally adapt and check for the reliability and validity of the neurogenic bladder symptom score questionnaire to Brazilian portuguese, in patients with spinal cord injury and multiple sclerosis.
Materials and Methods: The questionnaire was culturally adapted according to international guidelines. The Brazilian version was applied in patients diagnosed with neurogenic bladder due to spinal cord injury or multiple sclerosis, twice in a range of 7 to 14 days. Psychometric properties were tested such as content validity, construct validity, internal consistency, and test-retest reliability.
Results: Sixty-eight patients participated in the study. Good internal consistency of the Portuguese version was observed, with Cronbach α of 0.81. The test-retest reliability was also high, with an Intraclass Correlation Coeffi cient of 0.86 [0.76 – 0.92] (p<0.0001). In the construct validity, the Pearson Correlation revealed a moderate correlation between the Portuguese version of the NBSS and the Qualiveen-SF questionnaire (r = 0.66 [0.40-0.82]; p <0.0001).
Conclusions: The process of cross-cultural adaptation and validation of the NBSS questionnaire for the Brazilian Portuguese in patients with neurogenic lower urinary tract dysfunction was concluded.

Keywords: Urinary Incontinence; Urinary Bladder; Quality of Life

[Full Text]


Whole muscle 18F-choline uptake due to intense physical exercise

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

doi: 10.1590/S1677-5538.IBJU.2018.0573


RADIOLOGY PAGE

Francisco Javier García-Gómez 1, Pablo Antonio de la Riva-Pérez 1, Ana Agudo-Martínez 1, Gertrudis Sabatel-Hernández 1, María Cinta Calvo-Morón 1
1 Department of Nuclear Medicine, Virgen Macarena University Hospital,Seville, Spain

ABSTRACT

Not Available

[Full Text]


Impact of PI-RADS v2 on indication of prostate biopsy

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

doi: 10.1590/S1677-5538.IBJU.2018.0564


ORIGINAL ARTICLE

George de Queiroz Rozas 1, Lucas Scatigno Saad 1, Homero José de Farias e Melo 2, Henrique Armando Azevedo Gabrielle 3, Jacob Szejnfeld 1
1 Departamento de Diagnóstico por Imagem, Universidade Federal de São Paulo – USP, São Paulo, SP, Brasil; 2 Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil; 3 CURA Imagem e Diagnóstico, São Paulo, SP, Brasil

ABSTRACT

Objectives: To identify the group of patients who could safely avoid prostate biopsy based on the findings of multiparametric prostate resonance imaging (MRmp), param¬eterized with PI-RADS v2, using prostate biopsy as reference test and to assess the sensitivity and specificity of mpMR in identifying clinically significant prostate cancer using prostate biopsy as a reference test.
Patients and Methods: Three hundred and forty two patients with suspected prostate cancer were evaluated with mpMR and prostate biopsy. Agreement between imaging findings and histopathological findings was assessed using the Kappa index. The accuracy of mpMR in relation to biopsy was assessed by calculations of sensitivity, specific¬ity, positive predictive value (PPV) and negative predictive value (NPV).
Results: A total of 342 biopsies were performed. In 201 (61.4%), mpMR had a negative result for cancer, which was confirmed on biopsy in 182 (53%) of the cases, 17 (4.9%) presented non-clinically significant cancer and only 2 (0.5%) clinically significant cancer. 131 (38.3%) patients had a positive biopsy. Clinically significant cancer corre¬sponded to 83 (34.2%), of which 81 (97.5%) had a positive result in mpMR. Considering only the clinically significant cancers the mpMR had a sensitivity of 97.6%, specificity of 76.8%, PPV 57.4% and VPN of 99%.
Conclusions: mpMR is a useful tool to safely identify which patients at risk for prostate cancer need to undergo biopsy and has high sensitivity and specificity in identifying clinically significant prostate cancer.

Keywords: Prostate; Biopsy; Magnetic Resonance Imaging

[Full Text]


lncRNA CCAT1 promotes bladder cancer cell proliferation, migration and invasion

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

doi: 10.1590/S1677-5538.IBJU.2018.0450


ORIGINAL ARTICLE

Caixiang Zhang 1, Wenying Wang 1, Jun Lin 1, Jing Xiao 1, Ye Tian 1
1 Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China

ABSTRACT

Objective: To study the expression patterns of long noncoding RNA (lncRNA) colon cancer-associated transcript 1 (CCAT1) and the changes in cell proliferation, apoptosis, migration and invasion induced by silencing CCAT1 in bladder cancer cells.
Materials and Methods: The expression levels of CCAT1 were determined using realtime quantitative polymerase chain reaction in cancerous tissues and paired normal tissues from 34 patients with bladder cancer. The relationship between clinical characteristics and CCAT1 expression was analyzed. And then we conducted cell experiments.
Bladder urothelial carcinoma cell lines T24 and 5637 cells were transfected with CCAT1 small interfering RNA (siRNA) or scramble siRNA. Cell proliferation and apoptosis changes were determined using a Cell Counting Kit-8 (CCK-8) assay and a fl ow cytometry assay. Migration and invasion changes were measured using a wound healing assay and a trans-well assay. microRNAs (miRNAs) were predicted by Starbase 2.0, and their differential expression levels were studied.
Results: CCAT1 was signifi cantly upregulated in bladder cancer (P < 0.05). CCAT1 upregulation was positively related to tumor stage (P = 0.004), tumor grade (P = 0.001) and tumor size (P = 0.042). Cell proliferation, migration and invasion were promoted by abnormally expressed CCAT1. miRNAs miR-181b-5p, miR-152-3p, miR-24-3p, miR-148a-3p and miR-490-3p were potentially related to the aforementioned functions of CCAT1.
Conclusion: CCAT1 plays an oncogenic role in urothelial carcinoma of the bladder. In addition, CCAT1 may be a potential therapeutic target in this cancer.

Keywords: Urinary Bladder Neoplasms; CCAT1 long noncoding RNA, human [Supplementary Concept]; Cell Proliferation

[Full Text]


Identifying quality of life indicators to improve outpatient pharmacy services for prostate cancer patients: a comparison between Brazilian and British experiences

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

doi: 10.1590/S1677-5538.IBJU.2018.0553


ORIGINAL ARTICLE

Harindra Patel 1, Patrícia Melo Aguiar 2, 3, Adalberto Pessoa Jr. 4, Sílvia Storpirtis 2, 3, Paul F. Long 1, 4
1 School of Cancer & Pharmaceutical Sciences, King’s College London, United Kingdom, UK; 2 Departamento de Farmácia. Faculdade de Ciências Farmacêuticas da Universidade de São Paulo – USP, São Paulo, SP, Brasil; 3 Farmácia Universitária da Universidade de São Paulo – USP (FARMUSP), São Paulo, SP, Brasil; 4 Departamento de Tecnologia Bioquímico-Farmacêutica, Faculdade de Ciências Farmacêuticas da Universidade de São Paulo – USP, São Paulo, SP, Brasil

ABSTRACT

Objectives: Prostate cancer is the most common and fatal cancer amongst Brazilian males. The quality of prostate cancer care in Brazil was systematically reviewed and compared to United Kingdom (UK) National Institute for Health and Care Excellence (NICE) guidelines, which are considered an international benchmark in care, to determine any treatment gaps in Brazilian practice.
Materials and Methods: A systematic review of Brazilian and UK literature was undertaken.
Additionally, quality of life scores was measured using a FACT-P questionnaire of 36 prostate cancer patients attending the Farmácia Universitária da Universidade de São Paulo (FARMUSP). These scores were compared against NICE care measures for patient safety, clinical effi cacy and quality of life indicators determined by either quantitative or qualitative methods.
Key fi ndings: The quality of prostate cancer care in Brazil was considered good when compared to NICE guidelines. However, FACT-P data strongly indicated a poor understanding of treatment received by Brazilian patients and that their mental health needs were not being met.
Conclusions: NICE quality statements that address the holistic needs of patients should be implemented into Brazilian outpatient care plans. Addressing the non-medical concerns of patients may improve quality of life and can be easily rolled-out through existing Brazilian pharmacy services at no fi nancial cost to the Brazilian Unifi ed Health System (SUS).

Keywords: Prostate; Neoplasms; Quality of Life

[Full Text]


Prognostic signifi cance of infl ammation-based prognostic scoring in patients with upper urinary tract urothelial carcinoma

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

doi: 10.1590/S1677-5538.IBJU.2018.0251


ORIGINAL ARTICLE

Taisuke Suyama 1, Shigeki Kanbe 2, Masanobu Maegawa 1, Hirofumi Shimizu 1, Koichi Nakajima 2
1 Department of Genitourinary, Sanaikai General Hospital (IMS), Japan; 2 Department of Genitourinary, Toho University Omori Medical Center, Japan

ABSTRACT

Objectives: To investigate whether Glasgow Prognostic Score has prognostic significance in patients with upper urinary urothelial carcinoma.
Patients and methods: We retrospectively reviewed the clinical records of 74 patients with upper urinary urothelial carcinoma. We set the cut-off value for C-reactive protein as 1.0mg/dL, and 3.5mg/dL for albumin as Glasgow Prognostic Score. Their blood data including albumin and C-reactive protein for Glasgow Prognostic Score and cytokeratin 19 fragment 21-1 as a tumor marker were measured before starting treatment.
The patients were stratifi ed into three groups with Glasgow Prognostic Score: The Group-1, albumin ≥3.5g/dL and C-reactive protein < 1.0mg/dL; Group-2, albumin < 3.5g/dL or C-reactive protein ≥1.0mg/dL; Group-3, albumin < 3.5g/dL and C-reactive protein ≥1.0mg/dL.
Results: The median follow-up for all patients was 26.9 months (range: 10.9-91.1 months), during which 37 (50%) patients died. There was a signifi cant difference in the estimated survival rate among the 3 groups stratifi ed by Glasgow Prognostic Score.
The estimated survival rate in the Group-1 was signifi cantly higher than those in Groups 2 and 3.
In the univariate analysis C-reactive protein, serum cytokeratin 19 fragment 21-1 and Glasgow Prognostic Score were signifi cant predictors of overall survival. On the multivariate analysis, serum cytokeratin 19 fragment 21-1 and Glasgow Prognostic Score were independently associated with shorter overall survival.
Conclusion: Our review suggests Glasgow Prognostic Score may play as a prognostic predictor for upper urinary urothelial carcinoma.

Keywords: C-Reactive Protein; Keratin-19; Biomarkers; Urinary Tract

[Full Text]


A continuous fall of PSA use for prostate cancer screening among Brazilian doctors since 2001. Good or bad notice?

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

doi: 10.1590/S1677-5538.IBJU.2018.0179


ORIGINAL ARTICLE


Fernando Antônio Glasner da Rocha Araújo 1, Nairo Massakazu Sumita 2, Ubirajara de Oliveira Barroso Jr. 3, 4
1 Departamento de Medicina, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brasil; 2 Divisão de Química Clínica, Fleury Medicina e Saúde, São Paulo, SP, Brasil; 3 Departamento de Cirurgia Especial, Faculdade de Medicina da Universidade Federal da Bahia, Salvador, BA, Brasil; 4 Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil

ABSTRACT

Purpose: To evaluate the trend of use of Prostate Specifi c Antigen (PSA) for screening of prostate cancer (PC) among Brazilian doctors, from the beginning of its regular availability in clinical laboratories.

Material and Methods: A serial cross-sectional study was performed using data obtained from a large database between 1997 and 2016. The general PSA screening trend during this period, adjusted for the total number of exams performed in men, was analyzed.

Time-series analysis was performed through observation of the general regression curve using the generalized least squares method, and the impact of the recommendations was assessed with autoregressive integrated moving average (ARIMA) models.

Results: During the period studied 2,521,383 PSA determinations were done. The age of the participants ranged from 21 to 111 years, with an average of 56.7 ± 22.7 years. The relative number of PSA tests/100.000 exams in males showed a constant reduction since 2001, and this trend was more evident in the group aged 55-69 years. Although statistically signifi cant, the impact of reduced PSA screening after the 2012 USPSTF publication was clinically irrelevant.

Conclusions: Our results indicated a continuous reduction in the use of PSA screening over time, regardless of the publication of recommendations or clinical guidelines. The fact that this trend was more pronounced among those with a greater benefi t potential (55-69 years), relative to groups with a greater damage potential due to overdiagnosis and overtreatment (aged >74 years and <40 years), is a matter of concern. Follow-up studies of these trends are advisable.

Keywords: Prostatic Neoplasms; Prostate-Specifi c Antigen; Mass Screening

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0798


ORIGINAL ARTICLE

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

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

Keywords: Prostatic Neoplasms; Therapeutics; Consensus

[Full Text]


Penile skin flap: a versatile substitute for anterior urethral stricture

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

doi: 10.1590/S1677-5538.IBJU.2018.0652


SURGICAL TECHNIQUE

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

ABSTRACT

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

Keywords: Penis; Urethral Stricture; Bulbourethral Glands

[Full Text]


Spontaneous gas in a retroperitoneal mass: check the testis!

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

doi: 10.1590/S1677-5538.IBJU.2018.0606


RADIOLOGY PAGE

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

ABSTRACT

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

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0601


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Urology; Laparoscopy; Intraoperative Complications

[Full Text]


Non-functional paraganglioma of urinary bladder managed by transurethral resection

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

doi: 10.1590/S1677-5538.IBJU.2018.0604


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

period of 36.4 ± 24.8 months.

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

Keywords: Paraganglioma; Urinary Bladder; Transurethral Resection of Prostate

[Full Text]


Predictors of complication after adrenalectomy

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

doi: 10.1590/S1677-5538.IBJU.2018.0482


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

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

Keywords: Adrenalectomy; Morbidity; Pathology

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0701


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Kidney Transplantation; Nomograms; Delayed Graft Function

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0815


CHALLENGING CLINICAL CASES

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

ABSTRACT

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

Keywords: Mesothelioma; Peritoneum; Neoplasms

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0523


CHALLENGING CLINICAL CASES

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

ABSTRACT

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

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

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2019.0048


LETTER TO THE EDITOR

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

ABSTRACT

Not available

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0867


LETTER TO THE EDITOR

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

ABSTRACT

Not available

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0310


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Kidney Neoplasms; Survival; Delayed Graft Function

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0262


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Laparoscopy; Urinary Diversion; Cystectomy

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0485


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Uterus; Seminal Vesicles; Male

[Full Text]


Vasitis: a clinical confusion diagnosis with inguinal hernia

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

doi: 10.1590/S1677-5538.IBJU.2018.0457


RADIOLOGY PAGE

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

ABSTRACT

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

 

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0421


VIDEO SECTION

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

ABSTRACT

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

ACKNOWLEDGEMENTS

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

ARTICLE INFO

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

[Full Text]


 

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

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

doi: 10.1590/S1677-5538.IBJU.2018.0240


VIDEO SECTION

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

ABSTRACT

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

ARTICLE INFO

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

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0305


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Prostatic Neoplasms; Radiotherapy; Magnetic Resonance Imaging

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0530


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Urinary Bladder Neoplasms; Sarcopenia; Survival

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0367


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Robotics; Laparoscopy; Prostatic Neoplasms

[Full Text]


Tumor-like appearance of Spermatic Granuloma

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

doi: 10.1590/S1677-5538.IBJU.2018.0676


RADIOLOGY PAGE

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

ABSTRACT

Not available

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0695


ORIGINAL ARTICLE

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

ABSTRACT

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

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

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0611


VIDEO SECTION

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

ABSTRACT

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

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

ARTICLE INFO

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

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0235


ORIGINAL ARTICLE

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

ABSTRACT

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

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

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0186


ORIGINAL ARTICLE

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

ABSTRACT

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

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

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0555


VIDEO SECTION

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

ABSTRACT

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

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

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0524


VIDEO SECTION

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

ABSTRACT

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

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

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0229


VIDEO SECTION

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

ABSTRACT

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

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

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0086


VIDEO SECTION

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

ABSTRACT

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

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

[Full Text]


 

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

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

doi: 10.1590/S1677-5538.IBJU.2018.0351


VIDEO SECTION

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

ABSTRACT

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

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

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

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

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

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

ARTICLE INFO

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

[Full Text]


Robotic simple prostatectomy plus panniculectomy and Giant umbilical hernia repair

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

doi: 10.1590/S1677-5538.IBJU.2018.0565


VIDEO SECTION

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

ABSTRACT

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

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

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

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

ARTICLE INFO

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

[Full Text]


Balloon dilation for failed pyeloplasty in children?

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

doi: 10.1590/S1677-5538.IBJU.2018.0407


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

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

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

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0469


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Prostatic Neoplasms; Oxidative Stress

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0531


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Nephrolithiasis; Urinary Bladder, Neurogenic; Kidney Calculi

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2018.0196


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Surgical Procedures, Operative; Prostatectomy; Therapeutics

[Full Text]


 

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]


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]


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.