Current Issue

Volume 45 | number 4 | Jul . Aug, 2019. – The July-August 2019 issue of the International Brazilian Journal of Urology presents original contributions…

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

Vol. 45 (4): 763-764, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0559.1


EDITORIAL

Luciano A. Favorito 1, 2, 3
1 Professor Titular, Unidade Urogenital da Univ. Est. do Rio de Janeiro – UERJ, RJ, Brasil; 2 Urologista do Hospital da Lagoa Federal, Rio de Janeiro , RJ, Brasil; 3 Editor Associado do International Braz J Urol

ABSTRACT

Not available

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

Vol. 45 (4): 679-680, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0756.1


EDITORIAL

Luciano A. Favorito 1, 2, 3
1 Professor Titular, Unidade Urogenital da Univ. Est. do Rio de Janeiro – UERJ, RJ, Brasil; 2 Urologista do Hospital da Lagoa Federal, Rio de Janeiro , RJ, Brasil; 3 Editor Associado do International Braz J Urol

ABSTRACT

Not available

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A comprehensive literature-based equation to compare cost-effectiveness of a flexible ureteroscopy program with single-use versus reusable devices

Vol. 45 (4): 658-670, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0880


REVIEW ARTICLE

Giovanni S. Marchini 1,2, Fabio C. Torricelli 1,2, Carlos A. Batagello 1,2, Manoj Monga 1,2, Fabio C. Vicentini 1, Alexandre Danilovic 1, Miguel Srougi 1, William C. Nahas 1, Eduardo Mazzucchi 1
1 Seção de Endourologia da Divisão de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil; 2 Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, United States

ABSTRACT 

Purpose: to critically review all literature concerning the cost-effectiveness of flexible ureteroscopy comparing single-use with reusable scopes.

Materials and Methods: A systematic online literature review was performed in PubMed, Embase and Google Scholar databases. All factors potentially affecting surgical costs or clinical outcomes were considered. Prospective assessments, case control and case series studies were included.

Results: 741 studies were found. Of those, 18 were duplicated and 77 were not related to urology procedures. Of the remaining 646 studies, 59 were considered of relevance and selected for further analysis. Stone free and complication rates were similar between single-use and reusable scopes. Operative time was in average 20% shorter with digital scopes, single-use or not. Reusable digital scopes seem to last longer than optic ones, though scope longevity is very variable worldwide. New scopes usually last four times more than refurbished ones and single-use ureterorenoscopes have good resilience throughout long cases. Longer scope longevity is achieved with Cidex and if a dedicated nurse takes care of the sterilization process. The main surgical factors that negatively impact device longevity are lower pole pathologies, large stone burden and non-use of a ureteral access sheath. We have built a comprehensive fi nancial costeffective decision model to fl exible ureteroscope acquisition.

Conclusions: The cost-effectiveness of a fl exible ureteroscopy program is dependent of several aspects. We have developed a equation to allow a literature-based and adaptable decision model to every interested stakeholder. Disposable devices are already a reality and will progressively become the standard as manufacturing price falls.

Keywords: Cost-Benefi t Analysis; Ureteroscopy; Kidney Calculi

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Enhanced recovery after surgery (ERAS) in radical cystectomy patients: from consensus to evidences

Vol. 45 (4): 655-657, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2019.04.02


EDITORIAL

Marco Moschini 1,2, Armando Stabile 1,3, Agostino Mattei 2, Francesco Montorsi 3, Xavier Cathelineau 1, Rafael Sanchez-Salas 1

1 Department of Urology, L’Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France; 2 Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland; 3 Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy

Bladder cancer (BCa) is the second most common genitourinary malignancy with 81,190 estimated new diagnoses for 2018 in the United States alone (1). Radical cystectomy (RC) with bilateral pelvic lymph node dissection (PLND) and perioperative chemotherapy is the standard treatment recurrent high risk non-muscle invasive and for muscle invasive BCa (2). However, RC as well as perioperative chemotherapy represent a complex procedure associated with high perioperative morbidity and mortality as a consequence also of the characteristics of the population which is generally affected by multiple comorbidities when compared to other surgical procedures (3, 4).

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Age and Body Mass Index: the most important factors of urinary and erectile function recovery after robotic assisted radical prostatectomy

Vol. 45 (4): 653-654, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2019.04.01


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 July-August 2019 issue of the International Brazilian Journal of Urology presents original contributions with a lot of interesting papers in different fields: Infertility, Bladder augmentation, Bladder Cancer, PCNL, Prostate Cancer, Renal Cell Carcinoma, Partial nephrectomy, Renal stones, Nocturnal Enuresis, Basic Research, Laparoscopic Surgery, Penile Cancer, Stress Urinary Incontinence and Adrenalectomy. The papers come from many different countries such as Italy, Brazil, USA, UK, Turkey, China, France, Iran, Republic of Korea, Argentina, India and Spain, and as usual the editor´s comment highlights some papers. We decided to comment the paper about a very interesting topic: Robotic-Assisted Radical Prostatectomy (RARP).

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Vol. 45 N. 04, 2019

Int Braz J Urol. Vol. 45 N. 04 – 2019



EDITORIAL IN THIS ISSUE

653 | Age and Body Mass Index: the most important factors of urinary and erectile function recovery after robotic assisted radical prostatectomy

Luciano A. Favorito [view article]

EDITORIAL

655 | Enhanced recovery after surgery (ERAS) in radical cystectomy patients: from consensus to evidences

Marco Moschini, Armando Stabile, Agostino Mattei, Francesco Montorsi, Xavier Cathelineau, Rafael Sanchez-Salas [view article]

REVIEW ARTICLE

658 | A comprehensive literature-based equation to compare cost-effectiveness of a flexible ureteroscopy program with single-use versus reusable devices

Giovanni S. Marchini, Fábio C. Torricelli, Carlos A. Batagello, Manoj Monga, Fábio C. Vicentini, Alexandre Danilovic, Miguel Srougi, William C. Nahas, Eduardo Mazzucchi [view article]

ORIGINAL ARTICLE

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

Carlos Vaz de Melo Maciel, Roberto Dias Machado, Mariana Andozia Morini, Pablo Aloisio Lima Mattos, Ricardo dos Reis, Rodolfo Borges dos Reis, Gustavo Cardoso Guimarães, Isabela Werneck da Cunha, Eliney Ferreira Faria [view article]

679 | Editorial Comment: External validation of nomogram to predict inguinal lymph node metastasis in patients with penile cancer and clinically negative lymph nodes

Luciano A. Favorito [view article]

681 | Nonsecretory intestinocystoplasty: postoperative outcomes of 25 years

Rose A. F. Dantas, Fernanda C. F. S. Calisto, Fabio O. Vilar, Luiz A. P. Araujo, Salvador V. C. Lima [view article]

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

Yun-Sok Ha, Sang Won Kim, Tae Gyun Kwon, Sung Kwang Chung, Eun Sang Yoo [view article]

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

Feng Qi, Shangqian Wang, Haoxiang Xu, Yiren Gao, Gong Cheng, Lixin Hua [view article]

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

Mark Fernando Neumaier, Carlos Henrique Segall Júnior, Marcelo Hisano, Flávio Eduardo Trigo Rocha, Sam Arap, Marco A. Arap [view article]

713 | Detection of clinically significant prostate cancer with PI-RADS v2 scores, PSA density, and ADC values in regions with and without mpMRI visible lesions

Antonio C. Westphalen,, Farhad Fazel, Hao Nguyen,, Miguel Cabarrus, Katryana Hanley-Knutson, Katsuto Shinohara,, Peter R. Carroll [view article]

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

Publio Cesar Cavalcanti Viana, Natally Horvat, Valter Ribeiro dos Santos Júnior, Thais Carneiro Lima, Davi dos Santos Romão, Luciana Mendes de Oliveira Cerri, Marilia Germanos de Castro, Herbert Alberto Vargas, Júlia Azevedo Miranda, Claudia da Costa Leite, Giovanni Guido Cerri [view article]

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

Marcos Flávio Holanda Rocha, Rafael Ferreira Coelho, Anibal Wood Branco, Pedro Henrique de Oliveira Filgueira, Rômolo Guida Júnior [view article]

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

Ju Guo, Zhigang Zeng, Runfu Cao, Jieping Hu [view article]

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

Kadir Omur Gunseren, Mehmet Cagatay Cicek, Hakan Vuruskan, Yakup Kordan, Ismet Yavascaoglu [view article]

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

Angela Mazzeo, Anna Paula Weinhardt Baptista Sincos, Katia Ramos Moreira Leite, Miguel Angelo Góes Jr., Oscar Fernando Santos dos Pavão, Oskar Grau Kaufmann [view article]

763 | Editorial Comment: Study of kidney morphologic and structural changes related to different ischemia times and types of clamping of the renal vascular pedicle

Luciano A. Favorito [view article]

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

Rohan Patel, Samarth Agarwal, S. N. Sankhwar, Apul Goel, B. P. Singh, Manoj Kumar [view article]

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

Orestes Mazzariol Jr., Leonardo O. Reis, Paulo R. Palma [view article]

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

Mete Özkidik, Alper Coşkun, Mehmet Kazim Asutay, Tuncer Bahçeci, Nurullah Hamidi [view article]

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

Yanli Ma, Ying Shen, Xiaomei Liu [view article]

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

Juan Pablo Valdevenito, José Flores, Rodrigo Guzman Rojas, Valentin Manriquez, Leandro Arribillaga, Juan de Benito [view article]

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

Kelly J. Nast, George Chiang, Sarah Marietti [view article]

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

Lanna Beatriz Neves Silva Corrêa, Carlos Alberto Soares da Costa, José Antônio Silva Ribas, Gilson Teles Boaventura, Mauricio Alves Chagas [view article]

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

Amir Fattahi, Zeinab Latifi, Masoud Darabi, Ali Salmassi, Laya Farzadi, Maghsood Shaaker, Amir Mehdizadeh, Tohid Ghasemnejad, Leila Roshangar, Mohammad Nouri [view article]

CHALLENGING CLINICAL CASES

834 | Thyroid-like follicular carcinoma of the kidney presenting on a ten year-old prepubertal girl

Lisieux Eyer de Jesus, Celine Fulgêncio, Thais Leve, Samuel Dekermacher [view article]

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

Cem Basatac, Fatma Aktepe, Sezer Sağlam, Haluk Akpınar [view article]

RADIOLOGY PAGE

847 | Spontaneous gas in a retroperitoneal mass: check the testis!

Jérémy Dana, Florian Maxwell, David. Eiss, Laurence Rocher, [view article]

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

Francisco Javier García-Gómez, Pablo Antonio de la Riva-Pérez, Ana Agudo-Martínez, Gertrudis Sabatel–Hernández, María Cinta Calvo-Morón [view article]

VIDEO SECTION

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

Daniele Castellani, Luca Gasparri, Redi Claudini, Maria Pia Pavia, Alessandro Branchi, Marco Dellabella [view article]

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

Juan Garisto, Riccardo Bertolo, Eddie Chan, Jihad Kaouk [view article]

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

Arnold P. P. Achermann, Éder S. Brazão Junior, Cássio L. Z. Riccetto, Paulo C. R. Palma [view article]

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

Marcos Tobias-Machado, Cristiano Linck Pazeto, Eliney Ferreira Faria, Breno Dauster, William Enrique Pertuz Genes, Ricardo Hissashi Nishimoto [view article]

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

Juan D. Garisto, Julien Dagenais, Daniel Sagalovich, Riccardo Bertolo, Brian Rini, Jihad Kaouk [view article]

LETTER TO THE EDITOR

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

Michael S. Floyd Jr., Rauf N. Khadr [view article]

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

Marcello Torres da Silva, André Luis Barboza, Maria Malen Pijoán, Paulo Sergio Siebra Beraldo [view article]

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

Yasemin Benderli Cihan [view article]

866 | INFORMATION FOR AUTHORS [view]

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

Vol. 45 (4): 790-797, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0603


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Nocturnal Enuresis; Behavior Therapy; Treatment Failure

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

Vol. 45 (4): 798-806, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0556


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Urination; Women; Retrospective Studies

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Nonsecretory intestinocystoplasty: postoperative outcomes of 25 years

Vol. 45 (4): 681-685, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0595


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Hypopituitarism; Urinary Bladder; Disease

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

Vol. 45 (4): 754-762, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0559


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Kidney; Ischemia; Nephrectomy

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

Vol. 45 (4): 732-738, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0724


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Education; Robotic Surgical Procedures; Urology

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

Vol. 45 (4): 815-824, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0774


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

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

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

Vol. 45 (4): 862-862, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2019.0193.1


LETTER TO THE EDITOR

Marcello Torres da Silva 1, André Luis Barboza 2, Maria Malen Pijoán 3, Paulo Sergio Siebra Beraldo 4
1 Serviço de Urologia, Rede Sarah de Hospitais de Reabilitação, São Luís, MA, Brasil; 2 Serviço de Urologia, Rede Sarah de Hospitais de Reabilitação, Brasília, DF, Brasil; 3 Instituto Universitario Italiano de Rosario – Ciências Biomédicas, Rosario, Santa Fe, Argentina; 4 Serviço de Lesão Medular, Rede Sarah de Hospitais de Reabilitação, Brasília, DF, Brasil

ABSTRACT

Not available

[Full Text]


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

Vol. 45 (4): 860-861, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2019.0193


LETTER TO THE EDITOR

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

ABSTRACT

Not available

[Full Text]


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

Vol. 45 (4): 863-865, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2019.0130


LETTER TO THE EDITOR

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

ABSTRACT

Not Available

[Full Text]


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

Vol. 45 (4): 747-753, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2019.0131


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Laparoscopy; Adrenalectomy; Risk Factors

[Full Text]


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

Vol. 45 (4): 724-731, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0382


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

[Full Text]


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

Vol. 45 (4): 782-789, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0518


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

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

[Full Text]


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

Vol. 45 (4): 713-723, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0768


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Radiology; Prostate; Magnetic Resonance Imaging

[Full Text]


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

Vol. 45 (4): 671-678, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0756


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

Keywords: Nomograms; Lymph; Lymphatic Metastasis; Penile Neoplasms

[Full Text]


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

Vol. 45 (4): 775-781, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0706


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

 

Keywords: Prostatic Hyperplasia; Prostate; Transurethral Resection of Prostate

[Full Text]


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

Vol. 45 (4): 765-774, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0816


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

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

[Full Text]


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

Vol. 45 (4): 703-712, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0704


ORIGINAL ARTICLE

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

ABSTRACT

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

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

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

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

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

Keywords: Prostatic Neoplasms; Adenocarcinoma; Urinary Incontinence

[Full Text]


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

Vol. 45 (4): 807-814, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0686


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Cystostomy; Gastrostomy; Quality of Life

[Full Text]


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

Vol. 45 (4): 834-842, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0471


CHALLENGING CLINICAL CASES

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

ABSTRACT

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

Keywords: Kidney Neoplasms; Carcinoma; Pediatrics

[Full Text]


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

Vol. 45 (4): 851-852, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0573


RADIOLOGY PAGE

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

ABSTRACT

Not Available

[Full Text]


Spontaneous gas in a retroperitoneal mass: check the testis!

Vol. 45 (4): 847-850, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0606


RADIOLOGY PAGE

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

ABSTRACT

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

[Full Text]


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

Vol. 45 (4): 739-746, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0601


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Urology; Laparoscopy; Intraoperative Complications

[Full Text]


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

Vol. 45 (4): 843-846, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0815


CHALLENGING CLINICAL CASES

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

ABSTRACT

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

Keywords: Mesothelioma; Peritoneum; Neoplasms

[Full Text]


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

Vol. 45 (4): 825-833, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0485


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Uterus; Seminal Vesicles; Male

[Full Text]


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

Vol. 45 (4): 859-859, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0240


VIDEO SECTION

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

ABSTRACT

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

ARTICLE INFO

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

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

Vol. 45 (4): 686-694, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0530


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Urinary Bladder Neoplasms; Sarcopenia; Survival

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

Vol. 45 (4): 695-702, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0367


ORIGINAL ARTICLE

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

ABSTRACT

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

Keywords: Robotics; Laparoscopy; Prostatic Neoplasms

[Full Text]


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

Vol. 45 (4): 858-858, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0611


VIDEO SECTION

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

ABSTRACT

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

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

ARTICLE INFO

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

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

Vol. 45 (4): 856-857, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0555


VIDEO SECTION

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

ABSTRACT

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

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

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

Vol. 45 (4): 854-855, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0524


VIDEO SECTION

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

ABSTRACT

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

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

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

Vol. 45 (4): 853-853, July – August, 2019

doi: 10.1590/S1677-5538.IBJU.2018.0229


VIDEO SECTION

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

ABSTRACT

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

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

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