Original Article

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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Assessment of long term outcomes after buccal mucosal graft urethroplasty: the impact of chronic kidney disease

Vol. 45 (5): 981-988, September – October, 2019

doi: 10.1590/S1677-5538.IBJU.2019.0176


ORIGINAL ARTICLE

Manoj Kumar 1, Ajay Aggarwal 1, Siddharth Pandey 1, Samarth Agarwal 1, Satya Narayan Sankhwar 1
1 Department of Urology, King George’s Medical University, Lucknow, INDIA

ABSTRACT

Objectives: To compare and assess various outcomes and success of buccal mucosal graft urethroplasty (BMGU) in patients with CKD versus patients having normal renal function.
Material and Methods: This was a retrospective, single centre study, during period 2013 to 2017. Patients were grouped into two groups. Group 1 had patients with estimated Glomerular Filtration Rate (eGFR)>60mL/min/1.73m2 while group 2 had patients with eGFR <60mL/min/1.73m2. eGFR was calculated according to the MDRD equation. The two groups were compared with regard to various outcomes like length, location of stricture, technique of graft placement, intra-operative blood loss (haemoglobin drop), duration of hospital stay, post-operative complications and recurrence.
Results: A total of 223 patients were included in study with group 1 had 130 patients and group 2 had 93 patients. Mean age of patients with CKD were higher (47.49 years versus 29.13 years). The mean follow-up period was comparable between both groups (23.29 months and 22.54 months respectively). Patients with CKD had more post-operative Clavien Grade 2 or higher complications (p=0.01) and a greater recurrence rates (p<0.001) than in non-CKD patients. On multivariate analysis, age and CKD status was signifi cant predictor of urethroplasty success (p=0.004) (OR= 14.98 (1.952-114.94, 95% CI).
Conclusions: CKD patients are more prone to post-operative complications in terms of wound infection, graft uptake and graft failure and higher recurrence rates following BMGU.

Keywords: Oral Mucosal...

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Comparison of the outcomes of laparoscopic pyeloplasty with and without concomitant pyelolithotomy

Vol. 45 (5): 965-973, September – October, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0781


ORIGINAL ARTICLE

Mustafa Kadihasanoglu 1, Ugur Yucetas 1, Emre Karabay 1, Erkan Sönmezay 1
1 Department of Urology, Istanbul Training & Research Hospital, Istanbul, Turkey

ABSTRACT

Objective: We aimed to evaluate the results of laparoscopic pyeloplasty with concomitant pyelolithotomy and compare results with a cohort of patients undergoing laparoscopic pyeloplasty without pyelolithotomy.
Materials and Methods: We retrospectively reviewed records of 43 patients undergoing transperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty between December 2012 and July 2018 at our department. Eighteen patients (42%) underwent laparoscopic pyeloplasty with concomitant pyelolithotomy. The results of patients with renal stones were compared with 25 matched patients undergoing laparoscopic pyeloplasty without concomitant renal stones. Demographic data, operative and stone parameters were compared between the groups.
Results: The groups were similar regarding to demographic characteristics. All operations were completed laparoscopically with no conversions to open surgery. In 3 cases without renal stones and 15 cases with renal stones, transposition of the ureter due to crossing vessels was performed. The mean stone size was 13±5.24 mm, and the median number of stones was 1 (1-18). The success of laparoscopic pyeloplasty with and without pyelolithotomy was 93.3% and 92.9%, respectively, as confirmed by negative diuretic renogram at postoperative 3rd months. Overall stone-free rate after laparoscopic pyelolithotomy was 93.3%. Mean operative time was 222.6765.71 minutes vs. 219.11±75.63 minutes for the pyeloplasty with concomitant pyelolithotomy vs. pyeloplasty, respectively (p=0.88).
Conclusions: Laparoscopic pyeloplasty...

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Macroplastique for women with stress urinary incontinence secondary to intrinsic sphincter deficiency

Vol. 45 (5): 989-998, September – October, 2019

doi: 10.1590/S1677-5538.IBJU.2019.0070


ORIGINAL ARTICLE

Timothy F. Carroll 1, Alana Christie 1, Melissa Foreman 1, Gaurav Khatri 1, Philippe E. Zimmern 1
1 University of Texas Southwestern Medical Center, TX, USA

ABSTRACT

Objective: To evaluate the subjective and objective outcomes of Macroplastique® (MPQ) in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter de­ficiency (ISD).
Materials and Methods: Following Institutional Review Board (IRB) approval, charts of non-neurogenic women with SUI secondary to ISD who underwent MPQ injection and had 6 months minimum follow-up were reviewed from a prospectively maintained database. Patients were divided into 3 groups: Naïve (Group I), Prior Anti-Incontinence Surgery (Group II), and combined Prior Bulking Agent and Anti-Incontinence Surgery (Group III). Data collected included SUI self-report, Urogenital Distress Inventory (UDI- 6) Question 3, and VAS Quality of Life (QoL) Questionnaire scores at baseline and in follow-up. Three-dimensional ultrasound (3DUS) evaluated volume/configuration of MPQ. Success was defined after the last MPQ injection as a UDI-6 Question 3 score of 0 (dry) or 1, and no reoperation for SUI.
Results: From 2011-2017, 106 of 142 women met study criteria. At a median follow-up of 20 months (mean=26 months; range: 6-71), success rate was 41% for Group I, 40% for Group II, and 65% for Group III (p = 0.22). QoL scores were significantly improved over baseline in all groups. There was no significant difference in clinical outcome between the asymmetrical and symmetrical group on 3DUS. The completely dry rate was highest in Group III at 29%, compared to 4% for Group I and 15% for Group II (p = 0.05).
Conclusion: Macroplastique® improved subjective and objective outcome measures for SUI secondary to ISD as...

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