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Prevalence and surgical management of pubic hypertrophy in hypospadias patients: results from a high-volume surgeon

Vol. 45 (x): 2019 Setember 9.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2019.0267


ORIGINAL ARTICLE

Marco Bandini 1, 2, Sasha Sekulovic 1, Nikola Stanojevic 1, Bogdan Spiridonescu 1, 3, Vladislav Pesic 1, Salvatore Sansalone 4, Milan Slavkovic 1, Alberto Briganti 2, Andrea Salonia 2, Francesco Montorsi 2, Rados Djinovic 1
1 Sava Perovic Foundation, Center for Genito-Urinary Reconstructive Surgery, BelMedic General Hospital, Belgrade, Serbia; 2 Division of Oncology and Unit of Urology, URI, IRCCS Ospedale San Raffaele, Vita- Salute San Raffaele University, Milan, Italy; 3 Clinical Institute Fundeni, Center for Uronephrology and Renal Transplantation, Bucharest, Romania; 4 Department of Experimental Medicine and Surgery, University of Tor Vergata, Rome, Italy

ABSTRACT

Introduction: Pubic hypertrophy, defined as an abnormal and abundant round mass of fatty tissue located over the pubic symphysis, is frequently underestimated in patients with hypospadias. We examined the prevalence of this condition, as well as the out­comes associated with its surgical treatment.
Material and methods: Within 266 hypospadias patients treated at our clinic, we as­sessed the prevalence of pubic hypertrophy, and we schematically described the surgi­cal steps of pubic lipectomy. Multivariable logistic regression (MLR) tested for predic­tors of pubic hypertrophy. Finally, separate MLRs tested for predictors of fistula and any complications after pubic lipectomy.
Results: Of 266 hypospadias patients, 100 (37.6%) presented pubic hypertrophy and underwent pubic lipectomy. Patients with pubic hypertrophy more frequently had proximal hypospadias (44 vs. 7.8%), disorders of sex development (DSD) (10 vs. 0.6%), cryptorchidism (12 vs. 2.4%), and moderate (30°-60°) or severe (>60°) penile curvature (33 vs. 4.2%). In MLR, the location of urethral meatus (proximal, Odds ratio...

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Simultaneous use of oxalate-degrading bacteria and herbal extract to reduce the urinary oxalate in a rat model: A new strategy

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

doi: 10.1590/S1677-5538.IBJU.2019.0167


ORIGINAL ARTICLE

Rouhi Afkari 1, Mohammad Mehdi Feizabadi 2, Alireza Ansari-Moghadam 3, Tahereh Safari 4, Mohammad Bokaeian 1
1 Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran; 2 Tehran University of Medical Sciences (TUMS), Tehran, Iran; 3 School of Health, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran; 4 Zahedan University of Medical Sciences, Zahedan, Iran

ABSTRACT

Objective: Urinary stones with oxalate composition can cause kidney failure. Recent findings evidenced that probiotics are effective in reducing oxalate absorption in these subjects based on their high colonic absorption levels at baseline. The purpose of this study was to evaluate the effect of the simultaneous use of oxalate-degrading bacteria, Urtica dioica and T. terrestris extract in reducing urinary oxalate.
Materials and Methods: Anti-urolithiatic activity of Urtica dioica and T. terrestris ex­tract and probiotic by using ethylene glycol induced rat model. In this study, 4 strains of Lactobacillus and 2 strains of Bifidobacterium and also 2 strains of L. paracasei (that showed high power in oxalate degrading in culture media) were used. Male Wistar rats were divided into four groups (n=6). The rats of group-I received normal diet (positive control group) and groups-II (negative control group), III, IV rats received diet con­taining ethylene glycol (3%) for 30 days. Groups III rats received Urtica dioica and T. terrestris extract. Groups IV rats received extracts + probiotic for 30 days.
Findings: The results show that the use of herbal extracts (Urtica dioica and T. ter­restris) reduced the level of urinary oxalate and other parameters of urine and serum. Also,...

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Factors affecting fluoroscopy time during percutaneous nephrolithotomy: Impact of stone volume distribution in renal collecting system

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

doi: 10.1590/S1677-5538.IBJU.2019.0111


ORIGINAL ARTICLE

Sait Ozbir 1, Hasan Anıl Atalay 1, Halil Lutfi Canat 1, Mehmet Gokhan Culha 1, Suleyman Sami Cakır 1, Osman Can 1, Alper Otunctemur 1
1 Department of Urology, Okmeydani Training and Research Hospital, Şişli, Istanbul, Turkey

ABSTRACT

Purpose: To identify the factors increased fluoroscopy time during percutaneous nephrolithotomy and investigate the relationship between the 3D segmentation volume ratio of stone to renal collecting system and fluoroscopy time.
Materials and Methods: Data from102 patients who underwent percutaneous nephrolithotomy were analyzed retrospectively. Volume segmentation of both the renal collecting system and stones were obtained from 3D segmentation software with the images on CT data. Analyzed stone volume (ASV), renal collecting system volume (RCSV) measured and the ASV-to-RCSV ratio was calculated. Several parameters were evaluated for their predictive ability with regard to fluoroscopy time.
Results: The stone-free rate was 55.9% after the percutaneous nephrolithotomy. Complications occurred in 31(30.4%) patients. The mean fluoroscopy time was 199.4±151.1 seconds. The fluoroscopy time was significantly associated with the ASV-to-RCSV ratio (p<0.001, r=0.614). The single tract was used in 77 ( 75.5%) cases while multiple tracts were used in 25 (24.5%) cases. Fluoroscopy time was significantly associated with multiple access (p<0.001, r=0.689). On univariate linear regression analysis, longer fluoroscopy time was related with increased stone size, increased stone volume, increased number of access, increased calyx number with stone, increased ASV-to-RCSV, increased operative time and decreased stone essence. On multivariate linear regression analysis, the number of access and the ASV-to-RCSV were independent...

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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...

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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...

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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...

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