Current Issue

Volume 45 | number 3 | May . Jun, 2019. – The May-June 2019 issue of the International Brazilian Journal of Urology presents original contributions…

Radical prostatectomy for high-risk prostate cancer | Opinion: NO

Vol. 45 (3): 428-434, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2019.03.03


DIFFERENCE OF OPINION

Saum Ghodoussipour 1, Giovanni Enrico Cacciamani 1, Andre Luis de Castro Abreu 1
1 USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California, Los Angeles, CA, USA.

Keywords: Prostatic Neoplasms; Prostatectomy; Radiotherapy


BACKGROUND

Prostate cancer (PC) is the most common solid malignancy in men. In 2019, there are expected to be 174,000 new diagnoses in the United States with 31,000 patients ultimately succumbing to their disease (1). Those with more aggressive disease are at a greater risk of local treatment failure and death (2), thus emphasis on the appropriate management for the subset of patients with high risk PC (HRPC) is paramount.

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Radical prostatectomy for high-risk prostate cancer | Opinion: YES

Vol. 45 (3): 424-427, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2019.03.02


DIFFERENCE OF OPINION

Leonardo O. Reis 1, 2, Rodrigo Montenegro 3, Quoc-Dien Trinh 3
1 UroScience, Pontificia Universidade de Campinas – PUC, Campinas, SP, Brasil; 2 Departamento de Urologia, Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil; 3 Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Keywords: Prostatic Neoplasms; Prostatectomy; Radiotherapy


INTRODUCTION

Prostate cancer is the commonest non-skin malignancy in men. In most cases, prostate cancer has an indolent course however approximately 30,000 still die from the disease every year. Indeed, a subset of men will present with potentially lethal high-risk prostate cancer at diagnosis. We believe that this proportion will increase as fewer men are screened for prostate cancer, amidst ongoing concerns about overdiagnosis and overtreatment.

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The multiparametric prostate resonance imaging with the prostate imaging-reporting and data system (PI-RADS): the state of art of prostate cancer diagnosis

Vol. 45 (3): 422-423, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2019.03.01


EDITORIAL In this issue

Luciano Alves Favorito 1, 2, 3
1 Unidade de Pesquisa Urogenital da Univ. Estadual do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil; 2 Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil; 3 Editor Associado da International Braz J Urol

The May-June 2019 issue of the International Brazilian Journal of Urology presents original contributions with a lot of interesting papers in different fields: Prostate Cancer, Renal stones, Renal Cell Carcinoma, Bladder Cancer, Prostate Biopsy, Kidney Transplant, Neurogenic Bladder and Upper Urinary tract urothelial carcinoma.

The papers come from many different countries such as Brazil, USA, Turkey, China, India, Taiwan, Spain, Poland, Japan, Portugal, Israel and United Kingdon, and as usual the editor ́s comment highlights some papers. In the present issue we had 7 papers about prostate cancer (1-7) and we decided to comment the paper about a very interesting topic: The impact of Prostate Imaging-Reporting and Data System (PI-RADS) in Prostate Biopsy.

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Vol. 45 N. 03, 2019

Int Braz J Urol. Vol. 45 N. 03 – 2019



EDITORIAL IN THIS ISSUE

422 | The multiparametric prostate resonance imaging with the prostate imaging-reporting and data system (PI-RADS): the state of art of prostate cancer diagnosis

Luciano Alves Favorito [view article]

DIFFERENCE OF OPINION

424 | Radical prostatectomy for high-risk prostate cancer | Opinion: YES

Leonardo O. Reis, Rodrigo Montenegro, Quoc-Dien Trinh [view article]

428 | Radical prostatectomy for high-risk prostate cancer | Opinion: NO

Saum Ghodoussipour, Giovanni Enrico Cacciamani, Andre Luis de Castro Abreu [view article]

REVIEW ARTICLE

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

Harindra Patel, Patricia Melo Aguiar, Adalberto Pessoa Jr., Silvia Storpirtis, Paul F. Long [view article]

 ORIGINAL ARTICLE

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

Andre Deeke Sasse, Rodolfo Borges dos Reis , Lucas Mendes Nogueira, Fernando Cotait Maluf, Daniel Herchenhorn, Oren Smaletz, Volney Soares Lima, Fabio Schutz, Diogo Bastos, Evanius Garcia Wiermann, Igor Alexandre Protzner Morbeck, Leonardo Fontes Jardim, Vinicius Carrera Souza, Icaro Thiago Carvalho, Elton Trigo Teixeira Leite, Archimedes Nardozza Jr., Antonio Carlos Lima Pompeo, Francisco Bretas, Marcos Lima de Oliveira Leal, Marcus Vinicius Sadi, Jose Ricardo Tuma da Ponte, Gustavo F. Carvalhal [view article]

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

Conrad Leitsmann, Paul Thelen, Marianne Schmid, Johannes Meller, Carsten-Oliver Sahlmann, Birgit Meller, Lutz Trojan, Arne Strauss [view article]

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

Mary E. Westerman, Vidit Sharma, George C. Bailey, Stephen A. Boorjian, Igor Frank, Matthew T. Gettman, R. Houston Thompson, Matthew K. Tollefson, Robert Jeffrey Karnes [view article]

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

Fernando Antonio Glasner da Rocha Araujo, Nairo Massakazu Sumita, Ubirajara de Oliveira Barroso Jr. [view article]

486 | Impact of PI-RADS v2 on indication of prostate biopsy

George de Queiroz Rozas, Lucas Scatigno Saad, Homero Jose de Farias e Melo, Henrique Armando Azevedo Gabrielle, Jacob Szejnfeld [view article]

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

Mehmet Solakhan, Hulya Cicek, Nuri Orhan, Mustafa Yildirim [view article]

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

Masayuki Tasaki, Takashi Kasahara, Itsuhiro Takizawa, Kazuhide Saito, Tsutomu Nishiyama, Yoshihiko Tomita [view article]

514 | Predictors of complication after adrenalectomy

Victor Srougi, João A. B. Barbosa, Isaac Massaud, Isadora P. Cavalcante, Fabio Y. Tanno, Madson Q. Almeida, Miguel Srougi, Maria C. Fragoso, José L. Chambô [view article]

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

Fei Li, HongFan Zhao, Lina Hou, Fengsheng Ling, Yue Zhang, WanLong Tan [view article]

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

Slawomir Poletajew, Piotr Zapała, Bartlomiej Kopczyński, Lukasz Białek, Sylwia Bender, Tomasz Mutrynowski, Mateusz Nowak, Julia Mroz, Grzegorz Pędzisz, Bartosz Dybowski, Piotr Radziszewski [view article]

541 | Prognostic significance of inflammation-based prognostic scoring in patients with upper urinary tract urothelial carcinoma

Taisuke Suyama, Shigeki Kanbe, Masanobu Maegawa, Hirofumi Shimizu, Koichi Nakajima [view article]

549 | lncRNA CCAT1 promotes bladder cancer cell proliferation, migration and invasion

Caixiang Zhang, Wenying Wang, Jun Lin, Jing Xiao, Ye Tian [view article]

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

Jianye Li, Feiya Yang, Qingbao He, Mingshuai Wang, Nianzeng Xing [view article]

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

Lee A. Hugar, Ilan Kafka, Thomas W. Fuller, Hassan Taan, Timothy D. Averch, Michelle J. Semins [view article]

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

Mehmet İlker Gokce, Omer Gulpinar, Arif Ibiş, Muratcan Karaburun, Eralp Kubilay, Evren Suer [view article]

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

Aderivaldo Cabral Dias Filho, Joao Ricardo Alves, Pedro Rincon Cintra da Cruz, Viviane Brandao Bandeira de Mello Santana, Cassio Luis Zanettini Riccetto [view article]

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

Lisley Keller Liidtke Cintra, Jose de Bessa Junior, Victor Ikky Kawahara, Thereza Phitoe Abe Ferreira, Miguel Srougi, Linamara Rizzo Battistella, Daniel Rubio de Souza, Homero Bruschini, Cristiano Mendes Gomes [view article]

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

Blayne Welk [view article]

617 | Balloon dilation for failed pyeloplasty in children?

Haifeng Duan, Wei Zhu, Wen Zhong, Xiaohang Li, Guohua Zeng [view article]

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

Lutfi Canat, Recep Burak Degirmentepe, Hasan Anil Atalay, Suleyman Sami Cakir, Ilter Alkan, Mehmet Gokhan Culha, Sait Ozbir, Masum Canat [view article]

CHALLENGING CLINICAL CASES

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

Syuan-Hao Syu, Chia-Lun Chang, Hung-Jen Shih [view article]

RADIOLOGY PAGE

634 | Tumor-like appearance of Spermatic Granuloma

Pablo Garrido-Abad, Ariel Diaz-Menendez, Luis Garcia-Martin, Isabel Senra-Bravo, Manuel Fernandez-Arjona [view article]

637 | Vasitis: a clinical confusion diagnosis with inguinal hernia

Chunhsuan Lin, Tsung-yi Huang [view article]

VIDEO SECTION

639 | Micro-ureteroscopy for treatment of pelvic ureteral stone in pediatric patient

Diogo Nunes-Carneiro, Joao Ferreira Cabral, Avelino Fraga, Vitor Cavadas [view article]

640 | Percutaneous resection of metastatic renal cell carcinoma

Amir Toussi, Deepak Agarwal, Bradley Leibovich, Aaron Potretzke [view article]

641 | Robotic simple prostatectomy plus panniculectomy and Giant umbilical hernia repair

Angelica Beatriz Hernandez, Luis G. Medina, Pierre A. Hueber, Felipe Placco Araujo Glina, Hannah Landsberger, Daniel Oberlin, Giovanni Cacciamani, Byron Lopez, Ketan Patel, Rene J. Sotelo [view article]

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

Jagdeesh N. Kulkarni, Nitesh Maurya, Sushrut Bhukte, Vrunda Karanjgaokar [view article]

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

Marek Roslan, Marcin Markuszewski, Wojciech Piaskowski, Wojciech Połom, Sławomir Letkiewicz [view article]

LETTER TO THE EDITOR

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

Beuy Joob, Viroj Wiwanitkit [view article]

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

Ibrahim Halil Bozkurt, Ertugrul Sefik, Ismail Basmaci, Serdar Celik [view article]

648 | INFORMATION FOR AUTHORS [view article]


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

Vol. 45 (3): 615-616, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0335.1


EDITORIAL COMMENT

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

ABSTRACT

Not available

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

Vol. 45 (3): 621-628, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0887


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Premature Ejaculation; Vitamin D; Likelihood Functions

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

Vol. 45 (3): 605-614, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0335


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Urinary Incontinence; Urinary Bladder; Quality of Life

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Impact of PI-RADS v2 on indication of prostate biopsy

Vol. 45 (3): 486-494, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0564


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Prostate; Biopsy; Magnetic Resonance Imaging

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lncRNA CCAT1 promotes bladder cancer cell proliferation, migration and invasion

Vol. 45 (3): 549-559, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0450


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

Vol. 45 (3): 435-448, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0553


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Prostate; Neoplasms; Quality of Life

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Prognostic significance of inflammation-based prognostic scoring in patients with upper urinary tract urothelial carcinoma

Vol. 45 (3): 541-548, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0251


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

Vol. 45 (3): 478-485, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0179


ORIGINAL ARTICLE


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

ABSTRACT

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

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

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

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

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

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

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

Vol. 45 (3): 449-458, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0798


ORIGINAL ARTICLE

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

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

Keywords: Prostatic Neoplasms; Therapeutics; Consensus

[Full Text]


Predictors of complication after adrenalectomy

Vol. 45 (3): 514-522, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0482


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

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

Keywords: Adrenalectomy; Morbidity; Pathology

[Full Text]


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

Vol. 45 (3): 588-604, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0701


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Kidney Transplantation; Nomograms; Delayed Graft Function

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

Vol. 45 (3): 629-633, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0523


CHALLENGING CLINICAL CASES

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

ABSTRACT

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

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

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

Vol. 45 (3): 646-647, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2019.0048


LETTER TO THE EDITOR

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

ABSTRACT

Not available

[Full Text]


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

Vol. 45 (3): 645-645, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0867


LETTER TO THE EDITOR

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

ABSTRACT

Not available

[Full Text]


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

Vol. 45 (3): 531-540, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0310


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Kidney Neoplasms; Survival; Delayed Graft Function

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

Vol. 45 (3): 560-571, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0262


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Laparoscopy; Urinary Diversion; Cystectomy

[Full Text]


Vasitis: a clinical confusion diagnosis with inguinal hernia

Vol. 45 (3): 637-638, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0457


RADIOLOGY PAGE

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

ABSTRACT

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

 

[Full Text]


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

Vol. 45 (3): 459-467, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0305


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Prostatic Neoplasms; Radiotherapy; Magnetic Resonance Imaging

[Full Text]


Tumor-like appearance of Spermatic Granuloma

Vol. 45 (3): 634-636, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0676


RADIOLOGY PAGE

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

ABSTRACT

Not available

[Full Text]


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

Vol. 45 (3): 581-587, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0695


ORIGINAL ARTICLE

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

ABSTRACT

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

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

[Full Text]


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

Vol. 45 (3): 503-513, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0235


ORIGINAL ARTICLE

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

ABSTRACT

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

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

[Full Text]


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

Vol. 45 (3): 523-530, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0186


ORIGINAL ARTICLE

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

ABSTRACT

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

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

[Full Text]


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

Vol. 45 (3): 643-644, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0086


VIDEO SECTION

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

ABSTRACT

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

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

[Full Text]


 

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

Vol. 45 (3): 642-642, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0351


VIDEO SECTION

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

ABSTRACT

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

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

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

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

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

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

ARTICLE INFO

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

[Full Text]


Robotic simple prostatectomy plus panniculectomy and Giant umbilical hernia repair

Vol. 45 (3): 641-641, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0565


VIDEO SECTION

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

ABSTRACT

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

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

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

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

ARTICLE INFO

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

[Full Text]


Balloon dilation for failed pyeloplasty in children?

Vol. 45 (3): 617-620, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0407


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

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

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

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

Vol. 45 (3): 495-502, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0469


ORIGINAL ARTICLE

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

ABSTRACT

Background: Our study investigates whether Native Thiol, Total Thiol and disulphide levels measured in serum of patients with prostate cancer and prostatitis and of healthy subjects, have any role in differential diagnosis.
Materials and Methods: Patients followed up for histopathologically verified diagnosis of prostate cancer and prostatitis in 2016-2017 at the Medicalpark Gaziantep Hospital Urology Clinic were included in the study. Native Thiol (NT), Total Thiol (TT), Dynamic Disulphide (DD) levels in serum were measured by a novel automated method.
Results: NT, TT, DD, NT / TT ratios, DD / TT ratio and DD / NT ratio were measured as 118.4 ± 36.8μmoL / L, 150.3 ± 45.3μmoL / L, 15.9 ± 7μmoL / L, 78.8 ± 7μmoL / L, 10.5 ± 3.5μmoL / L, 13.8 ± 5.8μmoL / L respectively in patients with prostate cancer; as 116.4 ± 40.5μmoL / L, 147.5 ± 50.1μmoL / L, 15.5 ± 8.7μmoL / L, 79.7 ± 9μmoL / L, 10.1 ± 4.5μmoL / L, 13.5 ± 7.2μmoL / L in patients with prostatitis and as 144.1 ± 21.2μmoL / L, 191 ± 32.3μmoL / L, 23.4 ± 10.1μmoL / L, 76.1 ± 98.3μmoL / L, 11.9 ± 4.1μmoL / L, 16.4 ± 6.9μmoL / L in healthy subjects. Significant difference was detected between groups of NT, TT and DD levels (p = 0.008, p = 0.001, p = 0.002). No significant difference was detected in terms of the NT / TT, DD / TT and DD / NT rates (p = 0.222, p = 0.222, p = 0.222).
Conclusions: Serum NT, TT, DD levels in patients with prostatitis and prostate cancer were found significantly lower compared to the control group. This indicates that just as inflammation, prostate cancer also increases oxidative stress on tissues.

Keywords: Prostatic Neoplasms; Oxidative Stress

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

Vol. 45 (3): 572-580, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0531


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Nephrolithiasis; Urinary Bladder, Neurogenic; Kidney Calculi

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

Vol. 45 (3): 468-477, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0196


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Surgical Procedures, Operative; Prostatectomy; Therapeutics

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Percutaneous resection of metastatic renal cell carcinoma

Vol. 45 (3): 640-640, May – June, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0490


VIDEO SECTION

Amir Toussi 1, Deepak Agarwal 1, Bradley Leibovich 1, Aaron Potretzke 1
1 Department of Urology, Mayo Clinic, Rochester, MN, United States

ABSTRACT

Introduction: Metastasis-directed therapy of small solitary foci of metastatic renal cell carcinoma has been associated with improved survival. Percutaneous resection of tumors in the upper tract urinary system has been widely used for treatment of localized urothelial carcinoma, however, its role in renal cell carcinoma has not been described.

Herein, we present the first case of patient undergoing percutaneous resection of renal cell carcinoma in the contralateral renal pelvis.

Materials and Methods: This is a case report describing the diagnosis, management and surgical approach to renal cell carcinoma recurrence in the contralateral renal pelvis.

Results: Our patient was a 75-year-old male with a history of renal cell carcinoma status post radical nephrectomy who developed a solitary 2 cm recurrence in the contralateral renal pelvis, which was found after he presented with gross hematuria. He underwent successful percutaneous resection of this recurrence with final pathology showing clear cell renal cell carcinoma.

Conclusion: We present the first case of renal cell carcinoma recurrence in the contralateral renal pelvis treated with percutaneous resection.

ARTICLE INFO

Available at: https://www.intbrazjurol.com.br/video-section/20180490_Toussi_et_al

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