Vol. 44 n. 1 Jan . Feb, 2018

Volume 44 | number 1 | January . February, 2018 -Int Braz J Urol Annual Report – 2017

Retroperitoneal approach for robot-assisted partial nephrectomy: technique and early outcomes

Vol. 44 (1): 63-68, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0104 ORIGINAL ARTICLE Porreca 1, D. D’Agostino 1, D. Dente 1, M. Dandrea 1, A. Salvaggio 1, E. Cappa 1, A. Zuccala 1, A. Del Rosso 1, F. Chessa 2, D. Romagnoli 2, F. Mengoni 2, M. Borghesi 2 , R. Schiavina 2 1 Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy; 2 Department of Urology, University of Bologna, Bologna, Italy   ABSTRACT Objectives: The aim of our study is to present early outcomes of our series of retroper­itoneal-RAPN (Robot Assisted Partial Nephrectomy). Materials and methods: From September 2010 until December 2015, we performed 81 RAPN procedures (44 at left kidney and 37 at right). Average size was 3cm (1-9). Average PADUA score 7.1 (5-10). Average surgical time (overall and only robot time), ischemia time, blood loss, pathological stage, complications and hospital stay have been recorded. Results: All of the cases were completed successfully without any operative complica­tion or surgical conversion. Average surgical time was 177 minutes (75-340). Operative time was 145 minutes (80-300), overall blood loss was 142cc (60-310cc). In 30 cases the pedicle was late clamped with an average ischemia time of 4 minutes (2-7). None of the patient had positive surgical margins at definitive histology (49pT1a, 12pT1b, 3pT2a, 2pT3a). Hospital stay was 3 days (2-7). Conclusions: The retroperitoneal robotic partial nephrectomy approach is safe and al­lows treatment of even quite complex tumors. It also combines the already well known advantages guaranteed by the da Vinci® robotic surgical system, with the advantages of the retroperitoneoscopic approach. Keywords:  Nephrectomy; Video-Assisted Surgery; Laparoscopy [Full Text] Related Post A new technique, combined plication-incision (CPI), for correction of ... views 214 PCA3 rs544190G>A and prostate cancer risk in an eastern Chinese popula... views 232 Costs analysis of surgical treatment of stress urinary incontinence in... views 218 Does a previous prostate biopsy-related acute bacterial prostatitis af... views...

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The impact of metformin use on the risk of prostate cancer after prostate biopsy in patients with high grade intraepithelial neoplasia

Vol. 44 (1): 69-74, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0046 ORIGINAL ARTICLE Lucio Dell’Atti 1, Andrea B. Galosi 2 1 Department of Urology, University Hospital “St. Anna”, Ferrara, Italy; 2 Department of Urology, Marche Polytechnic University, Ancona, Italy   ABSTRACT   Purpose: We report our experience on metformin use in diabetic patients and its impact on prostate cancer (PCa) after a high-grade prostatic intraepithelial neoplasia (HGPIN) diagnosis. Materials and Methods: We retrospectively analyzed 551 patients with a diagnosis of HGPIN without PCa in a first prostate biopsy. The cohort of the study consisted of 456 nondiabetic subjects, and 95 diabetic patients. Among the patients with diabetes 44 were treated with metformin, and 51 with other antidiabetic drugs. A transrectal ultrasound prostate biopsy scheme with 22 cores was carried out 4-6 months after the first diagnosis of HGPIN. Results: Among 195 (35.4%) patients with cancer, there were statistically significant differences in terms of PCa detection (p<0.001), Gleason score distribution (p<0.001), and number of positive biopsy cores (p<0.002) between metformin users and non-users. Metformin use was associated with a decreased risk of PCa compared with neveruse (p<0.001). Moreover, increasing duration of metformin assumption (≥2 years) was associated with decreasing incidence of PCa and higher Gleason score ≥7 compared with assumption <2 years. Conclusions: This preliminary experience suggests that metformin use may have some beneficial effects in patients with diabetes and HGPIN; metformin should not be overlooked in these patients because it is neither new nor expensive.  Keywords: Diabetes Mellitus; Prostatic Neoplasms; Prostatic Intraepithelial Neoplasia [Full Text] Related Post Spermatozoa retrieval for cryopreservation after death views 159 Effects of Copaiba oil in the healing process of urinary bladder in ra... views 168 Implant of ATOMS® system for the treatment of postoperative male stres... views 110 Lysozyme gene treatment in testosterone induced benign prostate hyperp... views...

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Endourologic strategies for a minimally invasive management of urinary tract stones in patients with urinary diversion

Vol. 44 (1): 75-80, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0431 ORIGINAL ARTICLE FangLing Zhong 1, Gurioli Alberto 2, GuangMing Chen 1, Wei Zhu 1, FuCai Tang 1, Guohua Zeng 1, Ming Lei 1 1 Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China; 2 Department of Urology, Turin University of Studies, Turin, Italy ABSTRACT Objective: To present our experience in minimally invasive management of urinary tract stones in patients with urinary diversion. Materials and Methods: We retrospectively reviewed 26 patients with urinary tract stones after cystectomy and urinary diversion. The types of urinary diversion were ileal conduit, colon conduit, ileal orthotopic neobladder in 19, 4, and 3 patients, re­spectively. At postoperative days 2, a plain KUB and urinary ultrasonography were performed in order to assess stone fragmentation or hydronephrosis. According to postoperative imaging, stone free rate (SFR) was defined as complete absence of frag­ments or residual stones less than 4mm. Results: 19 patients were treated with minimally invasive percutaneous lithotripsy (MPCNL) and 2 patients required second-look MPCNL. Anterograde flexible ureteros­copy was performed in 2 patients, while in 2 patients a combined anterograde and retrograde approach was required. Three reservoir stones were treated by transurethral neo-bladder lithotripsy. Postoperative significant complications occurred in 2 patients (7.7%). The highest percentage of stone composition was struvite, as a result of chronic urinary tract infection (UTI). SFR was 88.5% (23 of 26). Conclusions: Our experience showed that MPCNL is a safe and effective treatment modality with little morbidity for renal and upper ureteral stones in patients with urinary diversion. For middle and lower ureteral stones, an anterograde approach could be also considered as a first line treatment, but a combined anterograde and retrograde approach was required when the anterograde access alone cannot pro­vide acceptable results. Keywords: Urinary Calculi; Urinary Diversion; Cystectomy [Full Text] Related Post Acute kidney injury following radical cystectomy and urinary diversion... views 207 Implantation of a biodegradable rectum balloon implant: tips, Tricks a... views 212 Myiasis associated with penile carcinoma: a new trend in developing co... views 184 Low serum melatonin levels are associated with erectile dysfunction views...

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Does a previous prostate biopsy-related acute bacterial prostatitis affect the results of radical prostatectomy?

Vol. 44 (1): 81-85, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0270 ORIGINAL ARTICLE Hakan Türk 1, Sitki Ün 2, Erkan Arslan 3, Ferruh Zorlu 4 1 Department of Urology, Kutahya, Dumlupinar University Evliya Celebi training and Research Hospital, Turkey; 2 Department of Urology, Sivas State of Hospital, Sivas, Turkey; 3 Department of Urology, Harran University Medical School, Sanliurfa, Turkey; 4 Senior Urologist, Izmir, Turkey ABSTRACT Objective: To The standard technique for obtaining a histologic diagnosis of prostatic carcinomas is transrectal ultrasound guided prostate biopsy. Acute prostatitis which might develop after prostate biopsy can cause periprostatic inflammation and fibrosis. In this study, we performed a retrospective review of our database to determine whether ABP history might affect the outcome of RP. Materials and Methods: 441 RP patients who were operated in our clinic from 2002 to 2014 were included in our study group. All patients’ demographic values, PSA levels, biopsy and radical prostatectomy specimen pathology results and their perioperative/ postoperative complications were evaluated. Results: There were 41 patients in patients with acute prostatitis following biopsy and 397 patients that did not develop acute prostatitis. Mean blood loss, transfusion rate and operation period were found to be significantly higher in ABP patients. Hospitalization period and reoperation rates were similar in both groups. However, post-op complications were significantly higher in ABP group. Conclusion: Even though it does not affect oncological outcomes, we would like to warn the surgeons for potential complaints during surgery in ABP patients. Keywords: Prostatitis; Prostate; Prostatectomy [Full Text] Related Post Trends in renal calculus composition and 24-hour urine analyses in pat... views 17 Does the experience of the bedside assistant effect the results of rob... views 138 Costs analysis of surgical treatment of stress urinary incontinence in... views 218 Impact of personalized three-dimensional (3D) printed pelvicalyceal sy... views...

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Magnetic resonance imaging and clinical findings in seminal vesicle pathologies

Vol. 44 (1): 86-94, January – February, 2018 10.1590/S1677-5538.IBJU.2017.0153 ORIGINAL ARTICLE Zafer Ozmen 1, Fatma Aktas 1, Nihat Uluocak 2, Eda Albayrak 1, Ayşegül Altunkaş 1, Fatih Çelikyay 1 1 Department of Radiology, School of Medicine, Gaziosmanpaşa University, Tokat, Turkey; 2 Department of Urology, School of Medicine, Gaziosmanpaşa University, Tokat, Turkey ABSTRACT Purpose: Congenital and acquired pathologies of the seminal vesicles (SV) are rare dis­eases. The diagnosis of SV anomalies is frequently delayed or wrong due to the rarity of these diseases and the lack of adequate evaluation of SV pathology. For this reason, we aimed to comprehensively evaluate SV pathologies and accompanying genitouri­nary system abnormalities. Materials and Methods: Between March 2012 and December 2015, 1455 male patients with different provisional diagnosis underwent MRI. Congenital and acquired pathol­ogy of the SV was identified in 42 of these patients. The patients were categorized ac­cording to their SV pathologies. The patients were analyzed in terms of genitourinary system findings associated with SV pathologies. Results: SV pathologies were accompanied by other genitourinary system findings. Congenital SV pathologies were bilateral or predominantly in the left SV. Patients with bilateral SV hypoplasia were diagnosed at an earlier age compared to patients with unilateral SV agenesis. There was a significant association between abnormal signal intensity in the SV and benign prostate hypertrophy (BPH) and patient age. Conclusion: SV pathologies are rare diseases of the genitourinary system. The asso­ciation between seminal vesicle pathology and other genitourinary system diseases requires complete genitourinary system evaluation that includes the seminal vesicles. Keywords: Seminal Vesicles; Pathology; Magnetic Resonance Imaging   [Full Text]   Related Post Tissue-based molecular markers in upper tract urothelial carcinoma and... views 162 Diagnostic relevance of metastatic renal cell carcinoma in the head an... views 150 The effect of AST/ALT (De Ritis) ratio on survival and its relation to... views 219 The burden of chronic ureteral stenting in cervical cancer survivors views...

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Risk factors for mortality in fournier’s gangrene in a general hospital: use of simplified founier gangrene severe index score (SFGSI)

Vol. 44 (1): 95-101, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0193 ORIGINAL ARTICLE Carlos Eugênio Lira Tenório 1, 2, Salvador Vilar Correia Lima 1, 3, Amanda Vasconcelos de Albuquerque 3, Mariana Pauferro Cavalcanti 2, Flávio Teles 2 1 Serviço de Urologia do Hospital das Clínicas, Departamento de Cirurgia do Centro de Ciências da Saúde da Universidade Federal de Pernambuco, UFPE, Recife, PE, Brasil; 2 Faculdade de Medicina da Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL), Maceió, AL, Brasil; 3 Núcleo de Cirurgia Experimental, Programa de Pós-Graduação em Cirurgia, Departamento de Cirurgia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, UFPE, Recife, PE, Brasil ABSTRACT Objective: To evaluate risk factors for mortality in patients with Fournier’s gangrene (FG), with emphasis in the Simplified Fournier Gangrene Severe Index Score (SFGSI). Materials and Methods: This was a cross-sectional study that was carried out from January 2010 to December 2014, with 124 patients treated for FG in a General Hospital. Several clinical and laboratory variables, including SFGSI, were evaluated and corre­lated with mortality through univariate analysis and logistic regression. Results: Of the 124 patients, 99 were men (79.8%), the mean age was 50.8±19.5 years and the main comorbidity was diabetes mellitus (51.6%). The mortality rate was 25.8%. Variables that presented independent correlation with mortality were the extension of the lesion to the abdomen (OR=4.0, CI=1.10-14.68, p=0.03), hematocrit (OR=0.81, CI=0.73-0.90, p<0.0001), potassium (OR=2.41, CI=1.13-5.10, p=0.02) and creatinine (OR=2.15, CI=1.04-4.41, p=0.03). When hematocrit, potassium and creatinine were tested together, as part of the SFGSI, a >2 result was the largest of the independent predictors of mortality (OR=50.2; CI=13.18-191.47; p<0.0001). Conclusion: The SFGSI >2 presented a higher correlation with mortality than any variable tested alone. It seems to be a promising alternative to evaluate predictors of mortality in Fournier’s gangrene. The main advantage is easy applicability because it contains only three parameters and can be used immediately after patient’s admission. Keywords: Fournier Gangrene; Risk Factors; Mortality; Fasciitis, Necrotizing [Full Text] Related Post SCUBE1: a promising biomarker in renal cell cancer views 158 Research prioritization of men’s health and urologic diseases views 149 The burden of chronic ureteral stenting in cervical cancer survivors views 139 Which intraperitoneal insufflation pressure should be used for less po... views...

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Effectiveness and durability of solifenacin versus percutaneous tibial nerve stimulation versus their combination for the treatment of women with overactive bladder syndrome: a randomized controlled study with a follow-up of ten months

Vol. 44 (1): 102-108, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2016.0611 ORIGINAL ARTICLE Carlo Vecchioli-Scaldazza 1, Carolina Morosetti 2 1 Division of Urogynecology, ASUR, Jesi, Italy; 2 Clinical Pathology, ASUR, Jesi, Italy ABSTRACT Purpose: To assess effectiveness and durability of Solifenacin (SS) versus tibial nerve stimulation (PTNS) versus combination therapy (PTNS + SS) in women with overactive bladder syndrome (OAB). Materials and Methods: 105 women with OAB were divided randomly into three groups of 35 patients each. In group A women received SS, in group B women under­went PTNS, in group C women underwent combination of PTNS + SS. Improvements in OAB symptoms were assessed with OABSS questionnaire; patients’ quality of life was assessed with OAB-q SF questionnaire. Evaluation of effectiveness of treatments was performed with PGI-I questionnaire. OABSS and PGI-I were also assessed monthly for ten months. Results: All treatments were effective on symptoms. PTNS showed a greater effective­ness than SS, but PTNS + SS was more effective than SS and PTNS. Furthermore, PTNS + SS showed a greater duration of effectiveness than PTNS and SS. Conclusions: Combination of PTNS with SS showed more effectiveness and more du­rability than PTNS and SS alone. Keywords:  Urinary Bladder, Overactive; Combined Modality Therapy; Solifenacin Succinate [Full Text] Related Post Prospective comparison of the novel visual prostate symptom score (VPS... views 117 Efficacy and safety of Elevate® system on apical and anterior compartm... views 188 Int Braz J Urol Annual Report – 2017 views 203 The awareness of patients with non – muscle invasive bladder can... views...

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Costs analysis of surgical treatment of stress urinary incontinence in a brazilian public hospital, comparing burch and synthetic sling techniques

Vol. 44 (1): 109-113, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0232 ORIGINAL ARTICLE Leo Francisco Limberger 1, Fernanda Pacheco Faria 1, Luciana Silveira Campos 1, Karin Marise Jaeger Anzolch 2, Alexandre Fornari 2, 3 1 Serviço de Ginecologia do Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brasil; 2 Hospital Moinhos de Vento, Porto Alegre, RS, Brasil; 3 Ambulatório de Disfunções miccionais da Santa Casa de Porto Alegre, Porto Alegre, RS, Brasil ABSTRACT Introduction: Surgical treatment of urinary incontinence progressed significantly with the introduction of synthetic slings. However, in some public Brazilian hospitals, the costs of these materials prevent their routine use. Objective: To compare the costs of ambulatory synthetic sling surgery with an historical series of patients submitted to Burch surgery in a Brazilian public hospital. Materials and Methods: Twenty nine incontinent patients were selected to synthetic sling surgery. Demographic data were prospectively collected and also the costs of the procedure, including drugs and materials, use of surgical and recovery wards, medical staff and hospitalization. These data were compared to the costs of 29 Burch surgeries performed before the introduction of synthetic slings. Results: Demographic data were similar, although median age was lower in the group submitted to Burch surgery (46.3±8.6 versus 56.2±11.3 (p<0.001)). Cost was signifi­cantly lower in patients submitted to sling in all items, except for time spent in recov­ery ward. Total value of 29 Burch surgeries was R$ 217.766.12, and of R$ 68.049.92 of 29 patients submitted to sling surgery (p<0.001). Conclusion: Burch surgery was more expensive than ambulatory synthetic transobtu­rator sling surgery, even when the cost of the synthetic sling was considered. Keywords:  Urinary Incontinence; Suburethral Slings; Costs and Cost Analysis [Full Text]   Related Post Do we have enough evidences that make you safe to treat a man with hyp... views 183 Impact of patient position on the outcomes of percutaneous neprolithot... views 210 Purpose: To evaluate the impact of the patient position on the outcomes of PCNL among patients with complex renal stones. Material and Methods: Fro... Assessment of satisfaction and Quality of Life using self -reported qu... views 149 Robot assisted radical prostatectomy in kidney transplant recipients: ... views...

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Long-term results of the implantation of the AMS 800 artificial sphincter for post-prostatectomy incontinence: a single-center experience

Vol. 44 (1): 114-120, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0165 ORIGINAL ARTICLE Carlos Alberto Ricetto Sacomani 1, Stênio de Cássio Zequi 1, Walter Henriques da Costa 1, Bruno Santos Benigno 1, Rodrigo Sousa Madeira Campos 1, Wilson Bachega Jr. 1, Gustavo Cardoso Guimarães 2 1 AC. Camargo Cancer Center– Fundação Antonio Prudente, São Paulo, SP, Brasil   ABSTRACT Objectives: Report the long-term outcomes of the AMS 800 artificial sphincer (AS) for the treatment post-prostatectomy incontinence (PPI) in a single center in Brazil. Materials and Methods: Clinical data from patients who underwent the procedure were retrieved from the medical records of individuals with more than 1 year of follow-up from May 2001 to January 2016. Continence status (number of pads that was used), complications (erosion or extrusion, urethral atrophy, and infection), malfunctions, and need for secondary implantation were evaluated. The relationship between com­plications and prior or subsequent radiation therapy (RT) was also examined. Results: From May 2001 to January 2016, 121 consecutive patients underwent AS implantation for PPI at an oncological referral center in Brazil. At the last visit, the AS remained implanted in 106 patients (87.6%), who reported adequate continence status (maximum of 1 pad/day). Eight-two subjects (67.8%) claimed not to be using pads on a regular basis at the final visit (completely dry). Revision occurred in 24 patients (19.8%).Radiation therapy (RT) for prostate cancer following radical prostatectomy was used in 47 patients before or after AS placement. Twelve patients with a history of RT had urethral erosion compared with 3 men without RT (p=0.004). Conclusion: Considering our outcomes, we conclude that AS implantation yields satis­factory results for the treatment of PPI and should remain the standard procedure for these patients. Radiation therapy is a risk factor for complication. Keywords:  Urinary Incontinence; Urinary Sphincter, Artificial; Therapeutics [Full Text] Related Post Metastatic prostate cancer in the modern era of PSA screening views 163 ECLAMC Study: Prevalence patterns of hypospadias in South America: Mul... views 167 Comparison of inflammatory markers between brucella and non-brucella e... views 215 A new technique, combined plication-incision (CPI), for correction of ... views...

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Can hydrophilic coated catheters be beneficial for the public healthcare system in Brazil? – A cost-effectiveness analysis in patients with spinal cord injuries

Vol. 44 (1): 121-131, January – February, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0221 ORIGINAL ARTICLE José Carlos Truzzi 1,2, Vanessa Teich 3, Camila Pepe 3 1 Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brasil; 2 Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil; 3 Sense Company, São Paulo, SP, Brasil ABSTRACT Introduction: Detrusor sphincter dyssynergia affects 70% to 80% of all spinal cord in­jury patients, resulting in increased risk of urinary tract infections (UTIs) and potential exposure to antimicrobial resistance. In Brazil, local guidelines recommend intermit­tent catheterization as the best method for bladder emptying, and two catheter types are available: the conventional uncoated PVC and the hydrophilic coated catheters. Objective: To evaluate the cost-effectiveness of two types of catheters for intermittent catheterization from the perspective of the Brazilian public healthcare system. Materials and Methods: A Markov model was used to evaluate cost-effectiveness in those with spinal cord injuries. A primary analysis was conducted on all possible ad­verse events, and a secondary analysis was performed with urinary tract infections as the only relevant parameter. The results were presented as cost per life years gained (LYG), per quality-adjusted life years (QALY) and per number of urinary tract infections (UTIs) avoided. Results: The base scenario of all adverse events shows a cost-effective result of hydro­philic coated catheters compared to uncoated PVC catheters at 57,432 BRL (Brazilian Reais) per LYG and 122,330 BRL per QALY. The secondary scenario showed that the use of hydrophilic coated catheters reduces the total number of UTIs, indicating that an additional cost of hydrophilic coated catheters of 31,240 BRL over a lifetime will reduce lifetime UTIs by 6%. Conclusions: Despite the higher unit value, the use of hydrophilic coated catheters is a cost-effective treatment from the perspective of the Brazilian public healthcare system. Keywords: Cost-Benefit Analysis; Spinal Cord Injuries; Intermittent Urethral Catheterization; Urinary Tract Infections [Full Text]   Related Post Artificial urinary sphincter revision for urethral atrophy: Comparing ... views 152 Comparison of perioperative outcomes with or without renorrhaphy durin... views 208 Emergency percutaneous nephrostomy versus emergency percutaneous nephr... views 148 Early term effect of ureterorenoscopy (URS) on the Kidney: research me... views...

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