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Association between calcitonin receptor gene polymorphisms and calcium stone urolithiasis: A meta-analysis

Vol. 45 (x): 2019 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2019.0061


ORIGINAL ARTICLE


Jiaxuan Qin 1, Zonglong Cai 2, Jinchun Xing 1, Bo Duan 1, Peide Bai 1
1 Department of Urology Surgery, the First Affiliated Hospital of Xiamen University; Center of Diagnosis and Treatment of Urinary System Diseases, the First Affiliated Hospital of Xiamen University; the Key Laboratory of Urinary Tract Tumors and Calculi of Xiamen City, the First Affiliated Hospital of Xiamen University. Xiamen, Fujian, China; 2 The First Clinical Medical School of Fujian Medical University. Xiamen, Fujian, China

ABSTRACT

Purpose: It has been reported that calcitonin receptor (CALCR) gene polymorphisms might be associated with calcium stone urolithiasis. Owing to mixed and inconclusive results, we conducted a meta-analysis to summarize and clarify this association.
Materials and Methods: A systematic search of studies on the association between CALCR gene polymorphisms and calcium stone urolithiasis susceptibility was con-ducted in databases.
Results: Odds ratios and 95% confi dence intervals were used to pool the effect size. Five articles were included in our meta-analysis.
Conclusions: CALCR rs1801197 might be associated with increased risk of calcium stone urolithiasis. There is insuffi cient data to fully confi rm the association between CALCR rs1042138 and calcium stone urolithiasis susceptibility. Well-designed studies with larger sample size and more subgroups are required to validate the risk identifi ed in the current meta-analysis.

Keywords: Receptors, Calcitonin; Urolithiasis; Meta-Analysis [Publication Type]

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Prevalence of enuresis and its impact in quality of life of patients with sickle cell disease

Vol. 45 (x): 2019 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2019.0026


ORIGINAL ARTICLE

Alana de Medeiros Nelli 1, Flávia Cristina de Carvalho Mrad 2, Mateus de Andrade Alvaia 1, Heros Aureliano Antunes da Silva Maia 1, Carina Oliveira Silva Guimarães 3, Evanilda Souza de Santana Carvalho 3, Cristiano Mendes Gomes 3, José Murillo Bastos Netto 4,5,6, José de Bessa Junior 1,3
1 Departamento de Cirurgia Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil; 2 Departamento de Pediatria, Unidade de Nefrologia Pediátrica, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.; 3 Programa de Pós-Graduação em Saúde Coeltiva, Universidade Federal de Juiz de Fora, Juiz de For a, MG, Brasil; 4 Departamento de Cirurgia, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora; 5 Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, MG, Brasil; 6 Hospital e Maternidade Terezinha de Jesus de Juiz de Fora, Juiz de Fora, MG, Brasil

 ABSTRACT

Introduction: Evidence indicates an increase in the prevalence of enuresis in individu-als with sickle cell disease. The present study aims to evaluate the prevalence and im- pact of enuresis on quality of life in individuals with sickle cell disease. Materials and Methods: This cross-sectional study evaluated individuals with sickle cell disease followed at a reference clinic, using a questionnaire designed to evaluate the age of complete toilet training, the presence of enuresis and lower urinary tract, and the impact on quality of life of these individuals. Results: Fifty children presenting SCD (52% females, mean age ten years) were in-cluded in the study. Of those, 34% (17/50) presented as HbSC, 56% with HbSS (28/50), 2% S_-thalassemia (1/5) and 8% the type of SCD was not determined. The prevalence of enuresis was 42% (21/50), affecting 75% of subjects at fi ve years and about 15% of adolescents at 15 years of age. Enuresis was classifi ed as monosymptomatic in 33.3% (7/21) and nonmonosymptomatic in 66.6% (14/21) of the cases, being primary in all subjects. Nocturia was identifi ed in 24% (12/50), urgency in 20% (10/50) and daytime incontinence 10% (5/50) of the individuals. Enuresis had a signifi cant impact on the quality of life of 67% of the individuals. Conclusion: Enuresis was highly prevalent among children with SCD, and continues to be prevalent throughout early adulthood, being more common in males. Primary nonmonosymptomatic enuresis was the most common type, and 2/3 of the study popu-lation had a low quality of life.

Keywords: Quality of Life; Sickle Cell Trait; Enuresis

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Improvement of fertility parameters with tribulus terrestris and Anacyclus Pyrethrum treatment in male rats

Vol. 45 (x): 2019 August 8.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2018.0843


ORIGINAL ARTICLE

Dariush Haghmorad 1,2, Mohammad Bagher Mahmoudi 3, Pardis Haghighi 4, Paria Alidadiani 4, Ensieh Shahvazian 4, Parsova Tavasolian 4, Mahmoud Hosseini 5, Mahmoud Mahmoudi 4
1 Department of Pathology and Laboratory Medicine, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran; 2 Department of Immunology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran; 3 Department of Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 4 Immunology Research Center, BuAli Research Institute, Department of Immunology and Allergy, School of Medicine, Mashhad University of Medical Sciences; 5 Neuroscience Research Center, Department of Physiology, School of Medicine, Mashhad University of Medical Sciences

ABSTRACT

Objective: Anacyclus Pyrethrum (AP) and Tribulus Terrestris (TT) have been reported as male infertility treatment in several studies; however, in Iranian traditional medicine these two plants are prescribed simultaneously. In this study, we aimed to determine the effects of AP and TT extracts both separately and simultaneously on the male Wi-star rat fertility parameters. Materials and Methods: 32 male Wistar rats were divided into 4 groups: Control, TT, AP, and AT treated groups. Treatment continued for 25 days and rats were weighed daily. Their testes were dissected for histological studies. Sperm analysis including sperm count, viability and motility were performed. Serum was obtained to evaluate testosterone, LH and FSH levels. Histological studies were conducted to study Leydig, and Sertoli cells, spermatogonia and spermatid cell numbers, and to measure seminif-erous diameter and epithelium thickness. Results: Sperm count increased in all the treatment groups. Sperm viability and mo-tility in AT and AP groups were elevated. TT and AT groups showed signifi cantly increased testosterone level compared to control group (P=004, P=0.000, respectively) and TT, AP and AT treatment groups showed increased LH level (P=0.002, P=0.03 and P=0.000, respectively) compared to control, while only AT group showed increased FSH (p=0.006) compared to control. Histological studies showed signifi cant increase of spermatogonia, Leydig and Sertoli cell numbers and epithelial thickness in AT group compared to other groups. All the treatment groups had higher number of Leydig, spermatogonia and spermatid cells. Conclusion: TT and AP improved sexual parameters; however, their simultaneous ad- ministration had higher improving effects on studied parameters.

Keywords: Tribulus; Testosterone; Receptors, FSH; Receptors, LH

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Analysis of surgeon biometrics during open and robotic radical cystectomy with electromyography and motion capture analysis

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

doi: 10.1590/S1677-5538.IBJU.2019.0163


VIDEO SECTION

Adam Baumgarten 1, Joon Kim 1, Jeff Robison 1, John Mayer 2, Dustin Hardwick 2, Trushar Patel 1
1 Department of Urology, University of South Florida, CA, United States; 2 Department of Physical Therapy, University of South Florida, CA, United States

ABSTRACT

Purpose: To determine feasibility of measuring surgeon physical stress during both open radical cystectomy (ORC) and robotic radical cystectomy (RRC).
Materials and Methods: One patient underwent ORC, while the other underwent RRC by a single surgeon. The diversion was excluded from this study. Noraxon® myoMOTION™ kinematics sensors were used to quantify the amount of joint and segmental motion of the spine, shoulders, and head. myoMUSCLE™ EMG sensors were used to measure activation levels, patterns, and fa­tigue characteristics of key muscle groups. The Prone Static Plank Test (PSPT) and Modified Biering-Sorensen Test (MBST) were used to assess surgeon strength and endurance of core musculature.
Results: The surgeries were represented in five stages. During ORC, the percentage of time spent in cervical flexion was 98%, 91.8%, 87.5%, 100%, and 97.1%, respectively. During RRC, 100% of the time was spent in cervical flexion. Activation of key muscle groups was examined across all stages and expressed as a percentage of peak activation. MBST times were both 25 sec­ond pre-and post-surgery ORC and 25.1 seconds pre-surgery and 32.4 seconds post-surgery for RRC. PSPT times were 68 second pre-surgery and 48 seconds post-surgery for ORC, and 59 second pre-surgery and 51 seconds post-surgery for RRC.
Conclusion: We were able to identify meaningful data using kinematic and EMG analysis during ORC and RRC. We were able to identify target muscle groups that will be used to conduct a larger study with multiple surgeons to help determine if there is an ergonomic advantage to RRC over traditional ORC.
 

Available at: https://www.intbrazjurol.com.br/video-section/20190163_ Baumgarten_et_al

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Apical sling for laparoscopic sacrohisteropexy in a young virgin patient with joint hypermobility syndrome

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

doi: 10.1590/S1677-5538.IBJU.2018.0746


VIDEO SECTION

Alcidézio Farias Santana 1, Raquel Doria Ramos Richetti 2, Susane Mey Hwang 3, Tatenda Nzenza 4, Luis Gustavo M. Toledo 5
1 Departamento de Cirurgia, Hospital Irmandade da Santa Casa de Misericórdia de São Paulo, SP, Brasil; 2 Departamento de Ginecologia, Hospital Maternidade Vila Nova Cachoeirinha, São Paulo, SP, Brasil; 3 Departamento de Uroginecologia, Hospital Maternidade Vila Nova Cachoeirinha, São Paulo, SP, Brasil; 4 Austin Health, Urology Heidelberg, Victoria, Australia; 5 Departamento de Urologia, Faculdade de Medicina da Santa Casa de São Paulo, SP, Brasil

ABSTRACT

Introduction: We are faced with a young patient with uterine prolapse and urinary difficulties due to Joint Hypermobil­ity Syndrome, a congenital collagen disease that predisposes woman to the development of pelvic organ prolapse. The patient had urinary difficulty requiring standing and bowing to reduce prolapse and then start urination. This video demonstrates that videolaparoscopic technique is feasible for the treatment of uterine prolapse in young and sexually virgin woman.
Materials and Methods: We separated the bladder from vagina and opened the peritoneum anterior to the uterus. Next, we attached the sigmoid colon to the left abdominal wall in order to better expose the promontory. We then opened the peri­toneum posterior to the uterus and medially tunnelled the right uterosacral ligament, transfixing the broad ligament and passing the end of a polypropylene mesh through this tunnel to the posterior region of the uterus. The same maneuver was performed on the other side so that the mesh surrounded the anterior portion of the cervix while its two extremities were posterior to the uterus. The mesh was fixed on the anterior surface of the uterine cervix and its two extremities were fixed to the promontory in the anterior longitudinal ligament of the spine. Finally, we closed the peritoneum.
Results: Uterine prolapse was corrected, with good recovery.
Conclusions: Videolaparoscopic technique is feasible for correction of uterine prolapse, being effective and safe in virgin woman.

Available at: https://www.intbrazjurol.com.br/video-section/20180746_Santana_et_al

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Brazilian consensus in enuresis–recomendations for clinical practice

Vol. 45 (x): 2019 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2019.0080


REVIEW ARTICLE

José Murillo B. Netto 1, Atila Victal Rondon 2, George Rafael Martins de Lima 3, Miguel Zerati Filho 4, Edison Daniel Schneider-Monteiro 5, Carlos Augusto F. Molina 6, Adriano de Almeida Calado 7, Ubirajara Barroso Jr. 8
1 Universidade Federal de Juiz de Fora (UFJF) e Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (HMTJ-SUPREMA), Juiz de Fora, MG, Brasil; 2 Universidade do Estado do Rio de Janeiro (UERJ) e Hospital Federal Cardoso Fontes (HFCF), Rio de Janeiro, RJ, Brasil; 3 Hospital Infantil Albert Sabin, Fortaleza, CE, Brasil; 4 Instituto de Urologia e Nefrologia de São José do Rio Preto (IUN) e Faculdade Regional de Medicina(FAMERP), Hospital de Base, São José do Rio Preto, SP, Brasil; 5 Hospital da Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brasil; 6 Hospital das Clinicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brasil; 7 Faculdade de Medicina da Universidade de Pernambuco (UPE), Recife, PE, Brasil ; 8 Universidade Federal da Bahia (UFBA) e Escola Bahiana de Medicina (BAHIANA), Salvador, BA, Brasil

ABSTRACT

Introduction: Enuresis, defi ned as an intermittent urinary incontinence that occurs dur- ing sleep, is a frequent condition, occurring in about 10% of children at 7 years of age. However, it is frequently neglected by the family and by the primary care provider, leaving many of those children without treatment. Despite of many studies in Enuresis and recent advances in scientifi c and technological knowledge there is still considerable heterogeneity in evaluation methods and therapeutic approaches.

Materials and Methods: The board of Pediatric Urology of the Brazilian Society of Urology joined a group of experts and reviewed all important issues on Enuresis and elaborated a draft of the document. On September 2018 the panel met to review, discuss and write a consensus document.

Results and Discussion: Enuresis is a multifactorial disease that can lead to a diversity of problems for the child and family. Children presenting with Enuresis require careful evaluation and treatment to avoid future psychological and behavioral problems. The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies.

Keywords: Enuresis; Urinary Incontinence; Lower Urinary Tract Symptoms

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Human Chorionic Gonadotropin monotherapy for the treatment of hypogonadal symptoms in men with total testosterone > 300 ng/dL

Vol. 45 (x): 2019 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2019.0132


ORIGINAL ARTICLE

Vinayak Madhusoodanan 1, Premal Patel 2, Thiago Fernandes Negris Lima 2, Jabez Gondokusumo 3, Eric Lo 3, Nannan Thirumavalavan 3, Larry I. Lipshultz 3, Ranjith Ramasamy 2
1 University of Miami Miller School of Medicine, Miami, FL, USA; 2 Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA; 3 Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA

ABSTRACT

Purpose: The 2018 American Urological Association guidelines on the Evaluation and Management of Testosterone Defi ciency recommended that 300 ng/dL be used as the threshold for prescribing testosterone replacement therapy (TRT). However, it is not un- common for men to present with signs and symptoms of testosterone defi ciency, despite having testosterone levels greater than 300 ng/dL. There exists scant literature regarding the use of hCG monotherapy for the treatment of hypogonadism in men not interested in fertility. We sought to evaluate serum testosterone response and duration of therapy of hCG monotherapy for men with symptoms of hypogonadism, but total testosterone levels > 300 ng/dL. Materials and Methods: We performed a multi-institutional retrospective case series of men receiving hCG monotherapy for symptomatic hypogonadism. We evaluated patient age, treatment indication, hCG dosage, past medical history, physical exam fi ndings and serum testosterone and gonadotropins before and after therapy. Descriptive analysis was performed and Mann Whitney U Test was utilized for statistical analysis. Results: Of the 20 men included in the study, treatment indications included low libido (45%), lack of energy (50%), and erectile dysfunction (45%). Mean testosterone improved by 49.9% from a baseline of 362 ng/dL (SD 158) to 519.8 ng/dL (SD 265.6), (p=0.006). Median duration of therapy was 8 months (SD 5 months). Fifty percent of patients reported symptom improvement. Conclusions: Treatment of hypogonadal symptoms with hCG for men who have a baseline testosterone level > 300 ng/dL appears to be safe and effi cacious with no adverse events.

Keywords: Testosterone; Chorionic Gonadotropin; Hypogonadism

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Intermediate-term outcomes of laparoscopic pectopexy and vaginal sacrospinous fi xation: a comparative study

Vol. 45 (x): 2019 July 7.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2019.0103


ORIGINAL ARTICLE

Bahar Sariibrahim Astepe 1, Aybike Karsli 1, Işil Köleli 2, Orhan Seyfi Aksakal 3, Hasan Terzi 1, Ahmet Kale 1
1 Department of Obstetrics and Gynecology, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey; 2 Department of Obstetrics and Gynecology, Inönü University Medicine Faculty, Malatya, Turkey; 3 Urogynecology Clinics, Zekai Tahir Burak Training and Research Hospital, Ankara, Turkey

ABSTRACT

Objective: To compare the intermediate-term follow-up results of laparoscopic pecto- pexy and vaginal sacrospinous fi xation procedures. Materials and Methods: Forty-three women who had vaginal sacrospinous fi xations(SSF) using Dr. Aksakal’s Desta suture carrier and 36 women who had lapa- roscopic pectopexies were re-examined 7 to 43 months after surgery. The PISQ-12 and P-QOL questionnaires were answered by all of the women. Results: The apical descensus relapse rates did not differ between the groups (14% in the SSF vs. 11.1% in the pectopexy group). The de novo cystocele rates were higher in the SSF group (25.6% in the SSF vs. 8.3% in the pectopexy group). There were no signifi cant differences in the de novo rectocele numbers between the groups. The treatment satisfaction rates were high in both groups (93% in the SSF vs. 91.7% in the pectopexy group), which was not statistically signifi cant. Moreover, the postoperative de novo urge and stress urinary incontinence rates did not differ; however, the postop- erative sexual function scores (PISQ-12) (36.86±3.15 in the SSF group vs. 38.21±5.69 in the pectopexy group) were better in the pectopexy group. The general P-QOL scores were not signifi cantly different between the surgery groups. Conclusion: The vaginal sacrospinous fi xation maintains its value in prolapse surgery with the increasing importance of native tissue repair. The new laparoscopic pectopexy technique has comparable positive follow-up results with the conventional sacrospi-nous fi xation procedure.

Keywords: Pelvic Organ Prolapse; Hand-Assisted Laparoscopy; Treatment Outcome

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Multiple renal tumorectomy in a Von Hipple Lindau patient. Combined retro/transperitoneal approach with intracorporeal hypotermia

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

doi: 10.1590/S1677-5538.IBJU.2018.0803


VIDEO SECTION

Valentí Tubau 1, Jose Luis Bauza 1, Enrique Pieras 1, Xavier Brugarolas 1, Pedro Pizà 1
1 Department of Urology, Hospital Universitario Son Espases, Palma de Mallorca, Illes Balears, Spain

ABSTRACT

Objective & Introduction: To show the feasibility of a combined transperitoneal (TP) and retroperitoneal (RP) laparoscopic approach in a Von Hipple-Lindau (VHL) patient with multiple kidney tumors. VHL is an autosomal dominant inherited syndrome characterized by a high incidence of benign and malignant tumors and cysts in many organs. Renal cell carcinoma is one of the most common and a leading cause of mortality (1). Surgical approach is usually complex because of its multiplicity and the need of maximum kidney function preservation due to the risk of future recurrences (2, 3).
Intracorporeal renal hypothermia may be useful in these cases to prevent permanent renal function loss (4).
Materials and Methods: A 40 years old male was being monitored for multiple bilateral renal masses. Family history included a VHL syndrome affecting his mother and sister.
Past medical history included a VHL syndrome with multiple cerebellar and medular hemangioblastomas, a pancreatic cystoadenoma and bilateral kidney tumors which had significantly grown up during follow-up.
The patient was scheduled for laparoscopic multiple partial nephrectomy. A combined TP and RP approach with intracorporeal hypothermia was chosen.
Results: A total of six right kidney tumors were removed. Operative time was 240 min. Cold ischemia time was 50 min.
Average kidney temperature was 23.7ºC. Blood losses were negligible. The patient was discharged after 72 hours. No major changes in serum creatinine were found during the follow-up. Final pathology revealed a clear cell renal cell carcinoma, pT1a, ISUP grade 2 in most of the tumors but one ISUP grade 3. Surgical margins were negative.
Conclusions: Combined TP and RP is a feasible alternative for the treatment of multiple renal tumors. It’s safe and effective, allowing the use of intracorporeal hypothermia which may improve postoperative renal function. Consistent experience is needed before embarking on this surgery.

Available at: https://www.intbrazjurol.com.br/video-section/20180803_Tubau_et_al

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3D Reconstruction and physical renal model to improve percutaneous punture during PNL

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

doi: 10.1590/S1677-5538.IBJU.2018.0799


VIDEO SECTION

Lorenzo Bianchi 1, 2, Riccardo Schiavina 1, 2, Umberto Barbaresi 1, Andrea Angiolini 1, Cristian V. Pultrone 1, 2, Fabio Manferrari 1, 2, Barbara Bortolani 3, Laura Cercenelli 3, Marco Borghesi 1, 2, Francesco Chessa 1, 2, Elisa Sessagesimi 4, Caterina Gaudiano 4, Emanuela Marcelli 3, Eugenio Brunocilla 1, 2
1 Department of Urology, University of Bologna, Bologna, Italy; 2 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy; 3 Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Laboratory of Bioengineering, University of Bologna, Bologna, Italy; 4 Department of Radiology, Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

ABSTRACT

Introduction and Objectives: We aim to present the use of 3D digital and physical renal model (1-5) to guide the percutaneous access during percutaneous nephrolithotripsy (PNL).
Materials and Methods: We present the clinical case of a 30 years old man with left renal stone (25×15 mm). A virtual 3D reconstruction of the anatomical model including the stone, the renal parenchyma, the urinary collecting system (UCS) and the skeletal landmarks (lumbar spine and ribs) was elaborated. Finally, a physical 3D model was created with a 3D printer including the renal parenchyma, UCS and the stone. The surgeon evaluated the 3D virtual reconstruction and manipulated the printed model before surgery to improve the anatomical knowledge and to facilitate the percutaneous access. In prone position, combining ultrasound and fl uoroscopy implemented by the preoperative anatomical planning based on the 3D virtual and printed model, an easy and safe access of the inferior calyx was achieved. Then, the patient underwent PNL using a 30 Fr Amplatz sheet with semi-rigid nephroscope and ultrasound energy to achieve a complete lithotripsy of the pelvic stone.
Results: The procedure was safely completed with 1 single percutaneous puncture (time of puncture 2 minutes). Overall surgical time was 90 min. No intra and postoperative complications were reported. The CT scan performed before discharge confi rmed a complete stone free state.
Conclusion: The 3D-guided approach to PNL facilitates the preoperative planning of the puncture with better knowledge of the renal anatomy and may be helpful to reduce operative time and improve the learning curve.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180799_Bianchi_et_al

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A new Surgical Technique: Transvesical Prostate Resection

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

doi: 10.1590/S1677-5538.IBJU.2018.0488


VIDEO SECTION

Hakan Türk 1, Erkan Arslan 2
1 Department of Urology, Evliya Celebi Training and Research Hospital, Kutahya, Turkey; 2 Department of Urology, Harran University Medical School, Sanliurfa, Turkey

ABSTRACT

Objectives: Surgical treatment is indicated in patients where medical therapy fails to prove benefi cial or in patients who develop complications related with bladder outlet obstruction. In our study, we developed a new surgical technique which can be defi ned as Transvesical Resection of Prostate (TVRP) without using the urethra. This method was previously described in our articles (1).
Materials and Methods: A 62-years-old male patient, using an alpha blocker agent for 5 years, reported increased discomfort with urination. His fi ndings were as follows: PSA: 1.2 ng/dL, prostate volume: 45 cc, digital rectal examination: benign, IPSS: 30, QoL: 5, Qmax: 6, urine volume: 225 cc, post-mictional residue: 65 cc. Eventually the patient was informed and prostate resection decision was made.
Results: Suprapubic catheter was removed 1 day after surgery and the patient was discharged. Urethral catheter was removed 4 days after urine output became clear. No complications developed after the operation. At postoperative 1st month, Qmax was 22, urine volume was 260 cc, post-mictional residue was 40 cc, IPSS was 8, QoL was 1, and the pathology was benign prostate tissue.
Conclusions: Urethral stricture is one of the most important postoperative complications of TURP. The incidence of urethral stricture is reported between 2.2% and 9.8% in different series (2-5). In this technique which we developed, urethra is not used and prostate is removed through the bladder, similar to open prostatectomies. For this reason, we suggest that it has an advantage over TURP, regarding urethral stricture development.

ARTICLE INFO
Available at: https://www.intbrazjurol.com.br/video-section/20180488_Turk_et_al

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Comparison of supine and prone miniaturized percutaneous nephrolithotomy in the treatment of lower pole, middle pole and renal pelvic stones: A matched pair analysis

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

doi: 10.1590/S1677-5538.IBJU.2019.0049


ORIGINAL ARTICLE

Harun Ozdemir 1, Akif Erbin 1, Murat Sahan 1, Metin Savun 1, Alkan Cubuk 1, Ozgur Yazici 1, Mehmet Fatih Akbulut 1, Omer Sarilar 1
1 Harun Ozdemir 1, Akif Erbin 1, Murat Sahan 1, Metin Savun 1, Alkan Cubuk 1, Ozgur Yazici 1, Mehmet Fatih Akbulut 1, Omer Sarilar

ABSTRACT

Purpose: We aimed to compare the outcomes of supine and prone miniaturized percutaneous nephrolithotomy (m-PNL) in the treatment of lower pole, middle pole and renal pelvic stones.
Materials and Methods: 54 patients who performed supine m-PNL between January 2017 and March 2018 and 498 patients who performed prone m-PNL between April 2015 and January 2018 were included in the study. Of the 498 patients, 108 matching 1: 2 in terms of age, gender, body mass index, American Association of Anesthesiology score, stone size, stone localization and hydronephrosis according to the supine m-PNL group were selected as prone m-PNL group. The patients with solitary kidney, upper pole stone, urinary system anomaly or skeletal malformation and pediatric patients (<18 years old) were excluded from the study. The success was defi ned as ‘complete stone clearance’ and was determined according to the 1st month computed tomography.
Results: The operation time and fl uoroscopy time in supine m-PNL was signifi cantly shorter than prone m-PNL group (58.1±45.9 vs. 80.1±40.0 min and 3.0±1.7 min vs. 4.9±4.5 min, p=0.025 and p=0.01, respectively). When post-operative complications were compared according to the modifi ed Clavien-Dindo classifi cation, overall and subgroup complication rates were comparable between groups. There was no significant difference between the groups in terms of the success rates (supine m-PNL; 72.2%, prone m-PNL; 71.3%, p=0.902).
Conclusions: Supine m-PNL procedure is more advantageous in terms of operation time and fl uoroscopy time in the treatment of lower pole, middle pole and renal pelvic stones.

Keywords: Supine Position; Nephrolithotomy, Percutaneous; Pelvis

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Evaluation of relaxant responses properties of cinnamon essential oil and its major component, cinnamaldehyde on human and rat corpus cavernosum

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

doi: 10.1590/S1677-5538.IBJU.2019.0016


ORIGINAL ARTICLE

Alev Onder 1, Didem Yilmaz-Oral 2, 3, Igor Jarkovic 4, Alp Ozgur Akdemir 5, Serap Gur 2
1 Department of Pharmacognosy, Faculty of Pharmacy, Ankara University, Ankara, Turkey; 2 Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey; 3 Department of Pharmacology, Faculty of Pharmacy, Cukurova University, Adana, Turkey; 4 Department of Organic Chemistry, Faculty of Chemistry and Technology, University of Split, Split, Croatia; 5 Department of Urology, Ankara Numune Education and Research Hospital, Ankara, Turkey

ABSTRACT

Cinnamomum cassia (Cinnamon) is a well-known traditional medicine with therapeutic benefi ts for centuries. We evaluated the effects of cinnamon essential oil (CEO) and its main component cinnamaldehyde (CA) on human corpus cavernosum (HCC) and rat CC. The essential oil of cinnamon was analyzed for the confi rmation of the oil profi le. HCC specimens from patients undergoing penile prosthesis surgery (age 48-69 years) were utilized for functional studies. In addition, erectile responses in anesthetized control and diabetic rats were evaluated in vivo after intracavernosal injection of CEO and CA, and rat CC strips were placed in organ baths. After precontraction with phenylephrine (10μM), relaxant responses to CEO and CA were investigated. CA (96.9%) was found as the major component. The maximum relaxation responses to CEO and CA were 96.4±3.5% and 96.0±5.0% in HCC and 97.5±5.5% and 96.8±4.8% in rat CC, respectively. There was no difference between control and diabetic rats in relaxation responses to CEO and CA. The relaxant responses obtained with essential oil and CA were not attenuated in the presence of nitric oxide synthase (NOS) inhibitor, and soluble guanylate cyclase inhibitor (sGS) in CC. In vivo, erectile responses in diabetic rats were lower than in control rats, which was restored after intracavernosal injection of CEO and CA. CEO and CA improved erectile function and relaxation of isolated strips of rat CC and HCC by a NO/cGMP-independent mechanism. Further investigations are warranted to fully elucidate the restorative effects of CEO and CA on diabetic erectile dysfunction.

Keywords: cinnamic aldehyde [Supplementary Concept]; Penile Induration; Humans

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An augmented patient-specific approach to administration of contrast agent for CT renal angiography

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

doi: 10.1590/S1677-5538.IBJU.2018.0366


ORIGINAL ARTICLE

Charbel Saade 1, Nadine Hamieh 1, Ibrahim Al-Sheikh Deeb 1, Maurice Haddad 1, Alain S. Abi-Ghanem 1, Diamond Ghieh 1, Fadi El-Merhi 1
1 Department of Radiology, American University of Beirut, Beirut, Lebanon

ABSTRACT

Purpose: This hybrid retrospective and prospective study performed on 200 consecu­tive patients undergoing renal CTA, investigates the opacification of renal vasculature, radiation dose, and reader confidence.

Materials and Methods: 100 patients were assigned retrospectively to protocol A and the other 100 were allocated prospectively to protocol B. Both protocols implemented a contrast material and saline flow rate of 4.5 mL/sec. Protocol A utilized a 100 mL of low-osmolar nonionic IV contrast material (Ioversol 350 mg I/mL) while protocol B employed a patient-tailored contrast media formula using iso-osmolar non-ionic (Iodixanol 320 mg I/mL).

Results: Arterial opacification in the abdominal aorta and in the bilateral main proxi­mal renal arteries demonstrated no statistical significance (p>0.05). Only the main dis­tal renal artery of the left kidney in protocol B was statistically significant (p<0.046). In the venous circulation, the IVC demonstrated a significant reduction in opacification in protocol B (59.39 HU ± 19.39) compared to A (87.74 HU ± 34.06) (p<0.001). Mean CNR for protocol A (22.68 HU ± 13.72) was significantly higher than that of protocol B (14.75 HU ± 5.76 p< 0.0001). Effective dose was significantly reduced in protocol B (2.46 ± 0.74 mSv) compared to A (3.07 ± 0.68 mSv) (p<0.001). Mean contrast media volume was reduced in protocol B (44.56 ± 14.32 mL) with lower iodine concentration. ROC analysis demonstrated significantly higher area under the ROC curve for protocol B (p< 0.0001), with inter-reader agreement increasing from moderate to excellent in renal arterial visualization.

Conclusion: Employing a patient-tailored contrast media injection protocol shows a significant refinement in the visualization of renal vasculature and reader confidence during renal CTA.

Keywords: Computed Tomography Angiography; Kidney; Radiation Dosage

[Full Text]


 

Computed tomography window affects kidney stones measurements

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

doi: 10.1590/S1677-5538.IBJU.2018.0819


ORIGINAL ARTICLE

Alexandre Danilovic 1, Bruno Aragão Rocha 2, Giovanni Scala Marchini 1, Olivier Traxer 3, Carlos Batagello 1, Fabio Carvalho Vicentini 1, Fábio César Miranda Torricelli 1, Miguel Srougi 1, William Carlos Nahas 1, Eduardo Mazzucchi 1
1 Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil; 2 Departamento de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil; 3 Sorbonne Université, GRC n 20 Lithiase Renale, AP-HP, Hôpital Tenon, F-75020 Paris, France. University, Paris, France University, Paris, France

ABSTRACT

Objectives: Measurements of stone features may vary according to the non-contrast computed tomography (NCCT) technique. Using magnified bone window is the most accurate method to measure urinary stones. Possible differences between stone mea­surements in different NCCT windows have not been evaluated in stones located in the kidney. The aim of this study is to compare measurements of kidney stone features between NCCT bone and soft tissue windows in patients submitted to retrograde intra­renal surgery (RIRS).

Materials and Methods: Preoperative and 90th postoperative day NCCT were performed in 92 consecutive symptomatic adult patients (115 renal units) with kidney stones be­tween 5 mm to 20 mm (< 15 mm in the lower calyx) treated by RIRS. NCCT were evalu­ated in the magnified bone window and soft tissue window in three axes in a different time by a single radiologist blinded for the measurements of the NCCT other method.

Results: Stone largest size (7.92±3.81 vs. 9.13±4.08; mm), volume (435.5±472.7 vs. 683.1±665.0; mm3) and density (989.4±330.2 vs. 893.0±324.6; HU) differed between bone and soft-tissue windows, respectively (p<0.0001) 5.2% of the renal units (6/115) were reclassified from residual fragments > 2 mm on soft tissue window to 0-2 mm on bone window.

Conclusion: Kidney stone measurements vary according to NCCT window. Measurements in soft tissue window NCCT of stone diameter and volume are larger and stone density is lesser than in bone window. These differences may have impact on clinical decisions.

Keywords: Kidney Calculi; Nephrolithiasis; Patient Outcome Assessment

[Full Text]


One-sided anterior Urethroplasty for panurethral stricture: step-by-step

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

doi: 10.1590/S1677-5538.IBJU.2018.0174


VIDEO SECTION

Willian Eduardo Ito 1, Marco Aurélio Rodrigues 1, Silvio Henrique Maia de Almeida 1
1 Disciplina de Urologia, Universidade Estadual de Londrina Centro de Ciencias da Saude, Londrina, PR, Brasil

ABSTRACT

Not available

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180174_Ito_et_al

[Full Text]


 

New technologies for old procedures: when Firefly improves robotic bladder diverticulectomy

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

doi: 10.1590/S1677-5538.IBJU.2018.0495


VIDEO SECTION

Francesca Vedovo 1, Bernardino de Concilio 2, Guglielmo Zeccolini 2, Tommaso Silvestri 1, Antonio Celia 2
1 Department of Urology, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy; 2 Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy

ABSTRACT

Introduction: Several techniques have been described to aid in the intra-operative identifi cation of the bladder diverticula.
The video shows the peculiar advantage of using Firefl y Fluorescence Imaging da Vinci System® (FFIS) during bladder diverticula detection and dissection (BD).
Material and Methods: Patient is placed in the lithotomic position. A transperitoneal access to the bladder is preferred. A flexible cystoscopy with the FFIS is performed. This procedure facilitates the diverticulum detection. This near-infrared technology can be usefully utilized to facilitate the diverticulum dissection. Using sharp and blunt dissection, the diverticulum is totally resected. Bladder is sutured in two absorbable layers. Drainage is placed in the Retzius space and a peritoneum reconstruction is performed.
Results: Between 2016 and 2017, 4 BDs with intraoperative FFIS were performed in our Center. Median operative time was 110 minutes. Mean time of postoperative catheterization was 11 days and mean length of stay was 4 days. No significant post void residual neither urine extravasation after catheter removal occurred. No Clavien-Dindo post-operative complications ≥2 have been reported. Several approaches have been described for intra-operative diverticulum identification and its dissection: Parra used a cystoscopic transillumination of diverticulum; Das proposed the use of a Foley 50 mL balloon inserted in the diverticulum, while Nadler used a balloon catheter, placed in the diverticulum and bloated with 180 cc saline solution.
Conclusions: In our experience, intra-operative use of FFIS enhances the transillumination effect. The identification and dissection of the diverticulum is more rapid, safe and effective with no additional cost.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180495_Vedovo_et_al

[Full Text]


Robot-assisted repair for ureteroileal anastomosis stricture after cystectomy: technical points

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

doi: 10.1590/S1677-5538.IBJU.2018.0794


VIDEO SECTION

Juan Garisto 1, Riccardo Bertolo 1, Mohamed Eltemamy 1, Rebecca Campbell 1, Jihad Kaouk 1
1 Department of Urology, Cleveland Clinic, Cleveland, Ohio, United States

ABSTRACT

AIM: Uretero-ileal anastomosis strictures (UAS) occur in 3 to 11% of patients who undergo ileal conduit urinary diversion after cystectomy. We aimed to demonstrate our surgical technique for robotic repair of UAS after cystectomy, focusing on the technical points.
MATERIALS AND METHODS: We present the case of a 75 year-old male with right hydronephrosis status post cystectomy with ileal conduit urinary diversion. Da Vinci Si® surgical system (Intuitive Surgical, Sunnyvale, CA) was docked and access into the abdominal cavity was gained. Uretero-ileal anastomosis was identified followed by ureteral stent visualization guiding the dissection. Stent was cut and further ureteral dissection was performed to maximize the length. Ureter was spatulated and specimen was sent for frozen section. Ileal conduit was incised at the site of the planned ureteral reimplantation. A new ureteral stent was inserted and the uretero-ileal anastomosis was performed. Thereafter, the previous site of the right ureteral anastomosis was closed.
RESULTS: Operative time was 120 minutes. Blood loss was 60mL. No perioperative complications occurred. Patient was discharged on postoperative day 1. Technical points for outcomes optimization during UAS robotic repair: 1) Preoperative placement of a ureteral stent is required for guidance and urinary diversion, 2) Port placement should be tailored according to the previous surgical site, 3) Maximal ureteral dissection facilitates reimplantation, 4) Frozen section from the stricture is mandatory to rule out malignancy.
CONCLUSIONS: In our experience, UAS repair is feasible and reproducible using a minimally invasive robotic approach. Comparative studies with open surgical approach are warranted.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180794_Garisto_et_al

[Full Text]


Step-by-Step: Fusion-guided prostate biopsy in the diagnosis and surveillance of prostate cancer

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

doi: 10.1590/S1677-5538.IBJU.2018.0886


VIDEO SECTION

Nima Nassiri 1, Lauren Beeder 1, Azadeh Nazemi 1, Kian Asanad 1, John Um 1, Inderbir Gill 1, Masakatsu Oishi 1, 2, Suzanne L. Palmer 3, Manju Aron 4, Osamu Ukimura 1, 2, Andre Luis de Castro Abreu 1
1 Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; 2 Department of Urology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; 3 Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; 4 Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

ABSTRACT

Objective: To provide a step-by-step technique for fusion-guided biopsy for prostate cancer diagnosis and surveillance.
Materials and Methods: All men with clinical indications for image-guided biopsy undergo 3-Tesla multiparametric magnetic resonance imaging (mpMRI) first. Lesions identified on mpMRI are graded using the Prostate Imaging-Reporting and Data System version 2.0 (PI-RADS v2) grading system. At the time of biopsy, real-time 3-dimensional (3D) transrectal ultrasound (TRUS) imaging is acquired and elastically fused with the mpMRI. Both targeted biopsies of MRI-derived suspicious lesions (PI-RADS 3-5) and systematic 12-core biopsies are performed. Patients without suspicious lesion on mpMRI undergo 3D TRUS-guided biopsy in standard templated fashion. In men placed on active surveillance (AS), prior positive sites are revisited using the trajectory and tracking functions of the fusion biopsy software.
Results: The advantages of MRI/TRUS fusion biopsy for prostate cancer diagnosis and surveillance are numerous. The 3D model created by elastic fusion of real-time TRUS imaging to mpMRI provides excellent visualization of prostate anatomy. Suspicious lesions on mpMRI can be accurately targeted, increasing detection of clinically significant prostate cancer. Biopsy trajectory visualization provides spatial localization of the trajectory of the cores within the prostate. Systematic biopsies are also taken in addition to targeted cores to minimize the effect of the mpMRI-invisible lesion. Prior positive biopsy sites can be tracked in men on AS.
Conclusions: Combined, the added benefits of prior lesion identification, adequate mapping of prostate anatomy and suspicious lesions, biopsy-trajectory visualization, tracking of prior positive biopsy sites, and combined targeted and systematic cores may offer the most effective method for prostate cancer diagnosis and surveillance.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180886_Nassiri_et_al

[Full Text]


Outcomes of endovascular treatment of renal arterial stenosis in transplanted kidneys

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

doi: 10.1590/S1677-5538.IBJU.2018.0737


ORIGINAL ARTICLE

Alexandre Sallum Bull 1, Affonso Celso Piovesan 1, Giovanni Scala Marchini 1, Kleiton Gabriel Ribeiro Yamaçake 1, Ioannis Michel Antonopoulos 1, Renato Falci 1, Hideki Kanashiro 1, Gustavo Ebaid 1, Francisco César Carnevale 2, Gustavo Messi 1, William Carlos Nahas 1
1 Divisão de Urologia, Unidade de Transplante Renal, Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil; 2 Unidade de Radiologia Intervencionista da Faculdade de Medicina da Universidade de São Paulo – USP, São Paulo, SP, Brasil

ABSTRACT

Objective: To evaluate the effectiveness and outcomes of endovascular treatment of TRAS with PTA.

Materials and Methods: We searched our prospectively collected database looking at cases of TRAS between January 2005-December 2011. CCT was the gold-standart for diagnosis of TRAS. Parameters analysed comprised technical aspects, arterial blood pressure variation, and renal function. A minimum follow-up of 24 months was considered.

Results: Of the 2221 renal transplants performed in the selected period, 22 (0.9%) patients were identifi ed with TRAS. Fourteen (63.6%) were male and mean age was 377±14.8years (12-69). Kidney graft was from deceased donnors in 20 (80%) cases.

On doppler evaluation, mean blood fl ow speed after transplantation, at TRAS diagnosis and after TAP was 210.6±99.5, 417±122.7 and 182.5±81.6mL/sec, respectively (p<0.001). For SBP and DBP, there was a signifi cant difference between between preintervention and all post-treatment time points (p<0.001). After 1 month of the procedure, there was stabilization of the Cr level with a signifi cant difference between mean Cr levels along time (p<0.001). After a mean follow-up of 16±4.2 (3-24) months, overall success rate was 100%.

Conclusions: Endovascular treatment with PTA/stenting is a safe and effective option for managing TRAS, ensuring the functionality of the graft and normalization of blood pressure and renal function.

Keywords: Transplantation; Kidney; Arteries

[Full Text]


Portable model for vasectomy reversal training

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

doi: 10.1590/S1677-5538.IBJU.2019.0092


ORIGINAL ARTICLE

Luis Otávio Amaral Duarte Pinto 1, Charles Alberto Villacorta de Barros 1, Anderson Bentes de Lima 1, Deivid Ramos dos Santos 1, Herick Pampolha Huet de Bacelar 1
1 Programa de Mestrado Profissional em Cirurgia e Pesquisa Experimental, Universidade do Estado do Pará – Uepa, Belém, PA, Brasil

ABSTRACT

Objectives: to validate an experimental non-animal model for training of vasectomy reversal.

Materials and Methods: The model consisted of two artificial vas deferens, made with silicon tubes, covered by a white resin, measuring 10 cm (length) and internal and external diameters of 0.5 and 1.5 mm, respectively. The holder of the ducts is made by a small box developed with polylactic acid, using a 3D print. The objective of the invention is to simulate the surgical fi eld of vasovasostomy, when the vas deferens are isolated from other cord structures. For validation, it was verifi ed the acquisition of microsurgical skills during its use, in a capacitation course with 5 urology residents from a Hospital of the region. Along the training sessions, it was analyzed the time (speed) of microsurgical sutures, and quantifi cation of the performance using a checklist. Collected data were analyzed using de BioEstat®5.4 software.

Results: Medium time for the completion of microsurgical sutures improved considerably during the course, and reached a plateau after the third day of training (p=0.0365). In relation to the checklist, it was verified that during capacitation, there was significant improvement of the scores of each participant, that reached a plateau after the fourth day of training with the model (p=0.0035).

Conclusion: The developed model was able to allow the students that attended the course to gain skills in microsurgery, being considered appropriate for training vasectomy reversal.

Keywords: Vasovasostomy; Vas Deferens; Fertility

[Full Text]


Biological roles of filamin a in prostate cancer cells

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

doi: 10.1590/S1677-5538.IBJU.2018.0535


ORIGINAL ARTICLE

Xue-Chao Li 1, Chuan-Xi Huang 2, Shi-Kui Wu 1, Lan Yu 3, Guang-Jian Zhou 3, Li-Jun Chen 1
1 Department of Urology, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China; 2 College of Life Science, Hebei University, Hebei, China; 3 Laboratory of Medical Molecular Biology, Beijing Institute of Biotechnology, Beijing, China

ABSTRACT

Objective: This study aims to investigate the association of filamin A with the function and morphology of prostate cancer (PCa) cells, and explore the role of filamin A in the development of PCa, in order to analyze its significance in the evolvement of PCa.

Materials and Methods: A stably transfected cell line, in which filamin A expression was suppressed by RNA interference, was first established. Then, the effects of the sup­pression of filamin A gene expression on the biological characteristics of human PCa LNCaP cells were observed through cell morphology, in vitro cell growth curve, soft agar cloning assay, and scratch test.

Results: A cell line model with a low expression of filamin A was successfully con­structed on the basis of LNCaP cells. The morphology of cells transfected with plasmid pSilencer-filamin A was the following: Cells were loosely arranged, had less connec­tion with each other, had fewer tentacles, and presented a fibrous look. The growth rate of LNCap cells was faster than cells transfected with plasmid pSilencer-filamin A (P <0.05). The clones of LNCap cells in the soft agar cloning assay was significantly fewer than that of cells stably transfected with plasmid pSilencer-filamin A (P <0.05). Cells stably transfected with plasmid pSilencer-filamin A presented with a stronger healing and migration ability compared to LNCap cells (healing rate was 32.2% and 12.1%, respectively; P <0.05).

Conclusion: The expression of the filamin A gene inhibited the malignant development of LNCap cells. Therefore, the filamin A gene may be a tumor suppressor gene.

Keywords: Prostatic Neoplasms; Filamins; RNAi Therapeutics

[Full Text]


Preoperative proteinuria is associated with increased rates of acute kidney injury after partial nephrectomy

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

doi: 10.1590/S1677-5538.IBJU.2018.0776


ORIGINAL ARTICLE

Önder Kara 1, 2, Matthew J. Maurice 1, Pascal Mouracade 1, Ercan Malkoc 1, Julien Dagenais 1, Mustafa Çapraz 3, Jaya S. Chavali 1, Merve Yazici Kara 4, Jihad H. Kaouk 1
1 Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; 2 Kocaeli University, Medical School, Kocaeli, Turkey; 3 Amasya University, Medical School, Amasya, Turkey; 4 Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey

ABSTRACT

Purpose: We investigated the association between preoperative proteinuria and early postoperative renal function after robotic partial nephrectomy (RPN).

Patients and Methods: We retrospectively reviewed 1121 consecutive RPN cases at a single academic center from 2006 to 2016. Patients without pre-existing CKD (eGFR≥60 mL/min/1.73m2) who had a urinalysis within 1-month prior to RPN were included. The cohort was categorized by the presence or absence of preoperative proteinuria (trace or greater (≥1+) urine dipstick), and groups were compared in terms of clinical and func­tional outcomes. The incidence of acute kidney injury (AKI) was assessed using RIFLE criteria. Univariate and multivariable models were used to identify factors associated with postoperative AKI.

Results: Of 947 patients, 97 (10.5%) had preoperative proteinuria. Characteristics as­sociated with preoperative proteinuria included non-white race (p<0.01), preoperative diabetes (p<0.01) and hypertension (HTN) (p<0.01), higher ASA (p<0.01), higher BMI (p<0.01), and higher Charlson score (p<0.01). The incidence of AKI was higher in pa­tients with preoperative proteinuria (10.3% vs. 4.6%, p=0.01). The median eGFR pres­ervation measured within one month after surgery was lower (83.6% vs. 91%, p=0.04) in those with proteinuria; however, there were no significant differences by 3 months after surgery or last follow-up visit. Independent predictors of AKI were high BMI (p<0.01), longer ischemia time (p<0.01), and preoperative proteinuria (p=0.04).

Conclusion: Preoperative proteinuria by urine dipstick is an independent predictor of postoperative AKI after RPN. This test may be used to identify patients, especially those without overt CKD, who are at increased risk for developing AKI after RPN.

Keywords: Kidney Neoplasms; Proteinuria; Acute Kidney Injury

[Full Text]


 

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

[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]


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]


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]


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 Cassau de Sá 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

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The role of a novel decision aid to support informed decision making process in patients with a symptomatic non – lower pole renal stone < 20 mm in diameter: a prospective randomized study

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

doi: 10.1590/S1677-5538.IBJU.2018.0198


ORIGINAL ARTICLE

Mehmet İlker Gokce 1, Cağrı Akpınar 1, Barış Esen 1, Vahid Solak 1, Omer Gülpınar 1, Yaşar Bedük 1
1 Department of Urology, Ankara University School of Medicine, Ankara, Turkey

ABSTRACT

Objectives: To evaluate the efficacy of a novel decision aid (DA) in improving the patients’ level of knowledge and decreasing decisional conflicts while deciding for SWL vs. RIRS in case of a symptomatic renal stone <2 cm.

Materials and Methods: In this prospective randomized study patients were randomized to receive either standard informing process (group 1, n=57) or DA (group 2, n=58). Level of knowledge was assessed with a questionnaire of 10 questions before and after patient informing process. Level of decisional conflict was assessed with a previously validated scoring system. Logistic regression analysis was performed to identify factors associated with adequate level of knowledge.

Results: Level of knowledge increased significantly in both groups after patient informing process. The increase was significantly more prominent in group 2 (p=0.045). Percentage of patients with adequate knowledge was also higher in group 2 (56.1%vs.74.1%, p=0.04). Mean decisional conflict scale score (higher score indicates higher decisional conflict level) was also significantly higher in group1 (14.7±14.5 vs. 10.1±13.7, p=0.045). Multivariate logistic regression analysis revealed higher education level (college degree) and use of DA as factors associated with adequate level of knowledge.

Conclusions: In the current study, The DA was shown to have a positive impact on level of knowledge and diminish the level of decisional conflict for patients with a symptomatic non-lower pole renal stone <20 mm. We recommend development and use of DAs for particular clinic scenarios to aid in education of patients and shared decision making process in stone disease clinics.

 

Keywords: Kidney Calculi; Disease; Lithotripsy

[Full Text]


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

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

doi: 10.1590/S1677-5538.IBJU.2017.0052


ORIGINAL ARTICLE

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

ABSTRACT

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