Vol. 44 n. 3 May . Jun, 2018

Volume 44 | number 3 | May . June, 2018 – Urological myriad – The internationality and diversity of subjects have been remarkable characteristics of International
Braz J Urol, an open free access urological journal, as is this issue

The history of varicocele: from antiquity to the modern ERA

Vol. 44 (3): 563-576, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0386 ORIGINAL ARTICLE Antonio Marte 1 1 Unità di Chirurgia Pediatrica, Università della Campania – Luigi Vanvitelli, Napoli, Italia   ABSTRACT Men have most likely been affected by varicocele since the assumption of the upright position. In De Medicina, written during the first century AD, Celsus credits the Greeks with the first description of a varicocele, and he recorded his own acute observation: “The veins are swollen and twisted over the testicle, which becomes smaller”. Celsus himself is credited with the distinction between varicocele (dilation of surface veins) and “cirsocele” (dilation of deep veins). There has been a long history of treatment attempts and failures, some of which are remarkably strange, that have sometimes cul­minated in tragedy, as in the case of French professor Jacques-Mathieu Delpech (1772- 1832). Although some questions regarding the etiopathology and treatment of varico­cele remain unanswered, a succession of more or less conservative attempts involving all medical cultures has been performed throughout history. The report by W.S. Tull­och in 1952 brought varicocele into the era of modern evidence-based medicine, and varicocele surgery finally progressed beyond the aim of merely relieving scrotal pain and swelling. From 1970 to 2000, varicocelectomies gained worldwide attention for the treatment of male infertility. Several innovative procedures to correct varicoceles began to appear in the world’s literature as interventional radiology, microsurgery, laparoscopy, and robotics, while comprehensive review articles were also published on the subject of varicocelectomies. Microsurgery is nowadays used worldwide and it can be considered to be the gold standard for correcting infertility linked to varicocele. Keywords:  Varicocele; history of medicine [Full...

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99mTc-DTPA Diuretic Renography with 3 hours late output fraction in the evaluation of hydronephrosis in children

Vol. 44 (3): 577-584, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0131 ORIGINAL ARTICLE Carlos J. R. Simal 1, 2 1 Departamento de Anatomia e Imagem, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brasil; 2 Divisão de Medicina Nuclear, Hospital Felicio Rocho, Belo Horizonte, Minas Gerais, Brasil ABSTRACT Objective: Dynamic renal scintigraphy complemented by late gravity assisted postvoid images to 60 minutes is a frequently used diagnostic test in the evaluation of hydrone­phrosis. The objective of this study is to evaluate the effectiveness in acquiring images at 180 minutes to calculate the late output fraction (LOF) of 99mTc-DTPA in the diagno­sis of ureteropelvic junction obstruction (UPJO). Materials and Methods: A retrospective study of 177 patients (196 renal units) of sus­pected cases of clinical UPJO was conducted. The patients were submitted to at least two dynamic renal scintigraphies of 99mTc-DTPA, with the addition of furosemide (F0), with a mean age of 4.3+3.8 years for the first study, and a follow-up of 2.7+2.5 years. Results: For diagnosis based on renal curves, a 100% sensitivity, 82.2% specificity, positive predictive value (PPV) of 10.4% and negative predictive value (NPV) of 100% were estimated. For diagnosis based on LOF, a 100% sensitivity, 96.3% specificity, PPV of 35.7% and NPV of 100% were estimated. Conclusion: A LOF <10% is indicative of UPJO, and a LOF >15% is indicative of no UPJO. The data demonstrate that LOF presents equivalent sensitivity and NPV, and higher specificity and PPV in comparison to diagnosis based on renal curves, and is useful in the evaluation and follow-up of suspected cases of UPJO. Keywords: Hydronephrosis; Ureteral Obstruction; Cakut [Supplementary Concept]; Technetium Tc 99m Pentetate [Full Text]...

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Durasphere® EXP: a non-biodegradable agent for treatment of primary Vesico-Ureteral reflux in children

Vol. 44 (3): 585-590, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0514 ORIGINAL ARTICLE Unsal Ozkuvanci 1, Muhammet Irfan Donmez 2, Faruk Ozgor 1, Akif Erbin 1, Özge Pasin 3, Ahmet Yaser Muslumanoglu 1 1 Department of Urology Haseki Training and Research Hospital, Fatih, Istanbul, Turkey; 2 Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey; 3 Department of Biostatistics, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey ABSTRACT   Introduction: Durasphere® EXP (DEXP) is a compound of biocompatible and non­-biodegradable particles of zirconium oxide covered with pyrolytic carbon. The aim of this study is to evaluate the durability of off-label use of DEXP in the treatment of primary vesicoureteral reflux in children. Materials and Methods: Patients who underwent subureteric injection of DEXP for the correction of primary VUR were retrospectively reviewed . Patients aged >18 years as well as those who had grade-I or -V VUR, anatomic abnormalities (duplicated system, hutch diverticulum), neurogenic bladder or treatment refractory voiding dysfunction were excluded. Radiologic success was defined as the resolution of VUR at the 3rd month control. Success was radiographically evaluated at the end of the first year. Results: Thirty-eight patients (9 boys, 29 girls; mean age, 6.3±2.7 years) formed the study cohort. Forty-six renal units received DEXP (grade II: 22; grade III: 18; grade IV: 6). Mean volume per ureteric orifice to obtain the mound was 0.70±0.16mL. First con­trol VCUG was done after 3 months in all patients. After the first VCUG, 6 patients had VUR recurrence. Short-term radiologic success of DEXP was 84.2%. Rate of radiologic success at the end of the first year was 69.4% (25/32). Lower age (p:0.006) and lower amount of injected material (p:0.05) were associated with higher success rates at the end of 1 year. Conclusion: This is the first study to assess the outcomes of DEXP for treatment of primary VUR in children. After 1 year of follow-up, DEXP had a 69.4% success rate. Keywords: Durasphere [Supplementary Concept]; Vesico-Ureteral Reflux; Child [Full Text]...

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Preoperative care of Polypoid exposed mucosal template in bladder exstrophy: the role of high-barrier plastic wraps in reducing inflammation and polyp size

Vol. 44 (3): 591-599, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0196 ORIGINAL ARTICLE Nastaran Sabetkish 1, Shabnam Sabetkish 1, Abdol-Mohammad Kajbafzadeh 1 1 Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI) ABSTRACT Objective: To assess the role of high-barrier plastic wrap in reducing the number and size of polyps, as well as decreasing the inflammation and allergic reactions in exstrophy cases, and to compare the results with the application of low-barrier wrap. Materials and Methods: Eight patients with bladder exstrophy-epispadias complex (BEEC) that had used a low density polyethylene (LDPE) wrap for coverage of the exposed polypoid bladder in preoperative care management were referred. The main complaint of their parents was increase in size and number of polyps. After a period of 2 months using the same wrap and observing the increasing pattern in size of polyps, these patients were recommended to use a high-barrier wrap which is made of polyvinylidene chloride (PVdC), until closure. Patients were monitored for the number and size of polyps before and after the change of barriers. The incidence of para-exstrophy skin infection/inflammation and skin allergy were assessed. Biopsies were taken from the polyps to identify histopathological characteristics of the exposed polyps. Results: The high barrier wrap was applied for a mean ± SD duration of 12±2.1 months. Polyps’ size and number decreased after 12 months. No allergic reaction was detected in patients after the usage of PVdC; three patients suffered from low-grade skin allergy when LDPE was applied. Also, pre-malignant changes were observed in none of the patients in histopathological examination after the application of PVdC. Conclusion: Polyps’ size and number and skin allergy may significantly decrease with the use of a high-barrier wrap. Certain PVdC wraps with more integrity and less evaporative permeability may be more “exstrophy-friendly”.   Keywords: Bladder Exstrophy; Cosmetics; Infection; Polyps [Full Text]...

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Evaluation of apoptosis indexes in currently used oral alpha-blockers in prostate: a pilot study

Vol. 44 (3): 600-607, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0668 ORIGINAL ARTICLE Mehmet Demir 1, Yigit Akin 1, 2, Kubra Asena Kapakin Terim 3, Mehmet Gulum 4, Evren Buyukfirat 5, Halil Ciftci 1, Ercan Yeni 1 1 Department of Urology, Harran University School of Medicine, Sanliurfa, Turkey; 2 Department of Urology, Izmir Katip Celebi University School of Medicine, Izmir, Turkey; 3 Department of Pathology, Ataturk University School of Veterinary Medicine, Erzurum, Turkey; 4 Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey; 5 Department of Anaesthesiology, Harran University School of Medicine, Sanliurfa, Turkey   ABSTRACT Objectives: Apoptosis effect of oral alpha-blockers is known in the prostate. Apoptosis index of silodosin has not been proved, yet. Aims are to present apoptosis index of silodosin in prostate and to compare this with other currently used alpha-blocker’s apoptosis indexes together with their clinical effects. Materials and Methods: Benign prostatic hyperplasia (BPH) patients were enrolled among those admitted to urology outpatient clinic between June 2014 and June 2015. Study groups were created according to randomly prescribed oral alpha-blocker drugs as silodosin 8mg (Group 1; n=24), tamsulosin 0.4mg (Group 2; n=30), alfuzosin 10mg (Group 3; n=25), doxazosin 8mg (Group 4; n=22), terazosin 5mg (Group 5; n=15). Pa­tients who refused to use any alpha-blocker drug were included into Group 6 as control group (n=16). We investigated apoptosis indexes of the drugs in prostatic tissues that were taken from patient’s surgery (transurethral resection of prostate) and/or prostate biopsies. Immunochemical dyeing, light microscope, and Image Processing and Analy­sis in Java were used for evaluations. Statistical significant p was p<0.05. Results: There were 132 patients with mean follow-up of 4.2±2.1 months. Pathologist researched randomly selected 10 areas in each microscope set. Group 1 showed statisti­cal significant difference apoptosis index in immunochemical TUNEL dyeing and im­age software (p<0.001). Moreover, we determined superior significant development in parameters as uroflowmetry, quality of life scores, and international prostate symptom score in Group 1. Conclusions: Silodosin has higher apoptosis effect than other alpha-blockers in pros­tate. Thus, clinic improvement with silodosin was proved by histologic studies. Besides, static factor of BPH may be overcome with creating apoptosis. Keywords: Prostate; Prostatic Hyperplasia; 5-alpha Reductase Inhibitors [Full...

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The role of fetal-maternal microchimerism as a natural-born healer in integrity improvement of maternal damaged kidney

Vol. 44 (3): 608-616, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0324 ORIGINAL ARTICLE Abdol-Mohammad Kajbafzadeh 1, Shabnam Sabetkish 1, Nastaran Sabetkish 1 1 Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran ABSTRACT Purpose: To identify the fetal stem cell (FSC) response to maternal renal injury with emphasis on renal integrity improvement and Y chromosome detection in damaged maternal kidney. Materials and Methods: Eight non-green fluorescent protein (GFP) transgenic Sprague- Dawley rats were mated with GFP-positive transgenic male rats. Renal damage was induced on the right kidney at gestational day 11. The same procedure was performed in eight non-pregnant rats as control group. Three months after delivery, right ne­phrectomy was performed in order to evaluate the injured kidney. The fresh perfused kidneys were stained with anti-GFP antibody. Polymerase chain reaction (PCR) assay was also performed for the Y chromosome detection. Cell culture was performed to detect the GFP-positive cells. Technetium-99m-DMSA renal scan and single-photon emission computed tomography (SPECT) were performed after renal damage induction and 3 months later to evaluate the improvement of renal integrity. Results: The presence of FSCs was confirmed by immune histochemical staining as well as immunofluorescent imaging of the damaged part. Gradient PCR of female rat purified DNA demonstrated the presence of Y-chromosome in the damaged maternal kidney. Moreover, the culture of kidney cells showed GPF- positive cells by immuno­fluorescence microscopy. The acute renal scar was repaired and the integrity of dam­aged kidney reached to near normal levels in experimental group as shown in DMSA scan. However, no significant improvement was observed in control group. Conclusion: FSC seems to be the main mechanism in repairing of the maternal renal injury during pregnancy as indicated by Y chromosome and GFP-positive cells in the sub-cultured medium. Keywords:  Fetal Stem Cells; Y Chromosome; Technetium Tc 99m Dimercaptosuccinic Acid; Green Fluorescent Proteins [Full...

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The protective effect of Papaverine and Alprostadil in rat testes after ischemia and reperfusion injury

Vol. 44 (3): 617-622, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0600 ORIGINAL ARTICLE Mehmet Ali Karagoz 1,Omer Gokhan Doluoglu 1, Hatice Ünverdi 2, Berkan Resorlu 3, Mehmet Melih Sunay 4, Arif Demirbas 4, Tolga Karakan 1, 4, Arif Aydin 5 1 Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey; 2 Deparment of Pathology Ankara Training Research Hospital, Ankara, Turkey; 3 Department of Urology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey; 4 Saglik Bakanligi Ankara Egitim ve Arastirma Hastanesi Ankara, Ankara, Turkey; 5 Department of Urology, Faculty of Medicine, Necmettin Erbakan University Meram, Konya, Turkey ABSTRACT   Objective: To investigate the effect of papaverine and alprostadil on testicular torsion-detorsion injury in rats. Materials and Methods: A total of 40 male Wistar-Albino rats were used in this study. Four hours of right testicular torsion was applied to each group, excluding sham oper­ated group. The torsion-detorsion (T/D), T/D + papaverine and T/D + alprostadil groups received saline, papaverine and alprostadil at the same time as surgical detorsion, respectively. At 14 days after the surgical detorsion, ischaemic changes and the degree of damage were evaluated with Cosentino scoring and the Johnson tubular biopsy score (JTBS). Results: JTBS was determined as 8.8±2.7 in the Sham group, 5.08±1.9 in the T/ D+papaverine group, 5.29±2.3 in the T/D +alprostadil group and 2.86±1.9 in the TD group. The JTBS was determined to be statistically significantly high in both the T/D + papaverine group and the T/D + alprostadil group compared to the T/D group (p=0.01, p=0.009). In the T/D + papaverine group, 3 (43 %) testes were classified as Cosentino 2, 3 (43%) as Cosentino 3 and 1 (14 %) as Cosentino 4. In the T/D +alprostadil group, 5 (50 %) testes were classified as Cosentino 2, 3 (30 %) as Cosentino 3 and 2 (20%) as Cosentino 4. Conclusion: The present study indicated that spermatic cord administration of alprosta­dil and papaverine showed a protective effect against ischemia/reperfusion injury after right-side testes torsion and histological changes were decreased after testicular isch­emia reperfusion injury. Keywords: Papaverine; Alprostadil; Spermatic Cord Torsion [Full...

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Editorial Comment: The protective effect of Papaverine and Alprostadil in rat testes after ischemia and reperfusion injury

Vol. 44 (3): 623-623, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0600.1 EDITORIAL Fernando Lorenzini 1 1 Centro de Reprodução Humana Curitiba, PR, Brasil ABSTRACT Not Available [Full Text]...

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Ureteroileal bypass: a new technic to treat ureteroenteric strictures in urinary diversion

Vol. 44 (3): 624-628, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0014 SURGICAL TECHNIQUE Guilherme P. Padovani 1, Marcos F. Mello 1, Rafael F. Coelho 1, Leonardo L. Borges 1, Adriano Nesrallah 1, Miguel Srougi 1, William C. Nahas 1 Guilherme P. Padovani 1, Marcos F. Mello 1, Rafael F. Coelho 1, Leonardo L. Borges 1, Adriano Nesrallah 1, Miguel Srougi 1, William C. Nahas 1 1 Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil   ABSTRACT Objective: To present our technique of ureteroileal bypass to treat uretero-enteric strictures in urinary diversion. Materials and Methods: One hundred and forty-one medical records were reviewed from patients submitted to radical cystectomy to treat muscle-invasive bladder cancer between 2013 and 2015. Twelve (8.5%) patients developed uretero-enteric anastomotic stricture during follow-up. Five patients were treated with endoscopic dilatation and double J placement. Four were treated surgically with standard terminal-lateral implantation. Three patients with uretero-enteric anastomotic stricture were treated at our institution by “ureteroileal bypass”, one of them was treated with robotic surgery. Results: All patients had the diagnosis of uretero-enteric anastomotic stricture via computerized tomography and DTPA renal scan. Time between cystectomy and diagnosis of uretero-enteric anastomotic stricture varied from five months to three years. Mean operative time was 120±17.9 minutes (98 to 142 min) and hospital stay was 3.3±0.62 days (3 to 4 days). Mean follow-up was 24±39.5 months (6 to 72 months). During follow-up, all patients were asymptomatic and presented improvement in ureterohydronephrosis. Serum creatinine of all patients had been stable. Conclusions: Latero-lateral ureter re-implantation is feasible by open or even robotic surgery with positive results, reasonable operation time, and without complications. Keywords: Urinary Diversion, Cystectomy, Urinary Bladder [Full...

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Laparoscopic approach to pheochromocytoma in pregnancy: case report

Vol. 44 (3): 629-633, May – June, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0540 CHALLENGING CLINICAL CASES Felipe de Almeida e Paula 1,2,3, Ravisio Israel dos Santos Junior 1,2,3, Odivaldo Antonio Ferruzzi 2, Rafael Osti de Melo 3, Mariana Takaku 1,2 1 Hospital Regional do Câncer de Presidente Prudente, Presidente Prudente, SP, Brasil; 2 Santa Casa de Misericórdia de Presidente Prudente, Presidente Prudente, SP, Brasil; 3 Faculdade de Medicina de Presidente Prudente, Universidade do Oeste Paulista, Presidente Prudente, SP, Brasil ABSTRACT A 32-year-old 22-week pregnant hypertensive woman with sporadic episodes of headaches, sweating, and facial flushing was diagnosed with pheochromocyto­ma through biochemical and imaging tests. Perioperative management included a multidisciplinary approach, symptom stabilization with ɑ blockade followed by ß blockade, and tumor resection by laparoscopic adrenalectomy at 24 weeks gesta­tion. The diagnosis was confirmed by histopathological examination and immuno­histochemistry tests. The decision for surgical removal of the tumor was based on maternal symptoms, tumor size, gestational age, the possibility of doing a laparos­copy, and the expertise of the surgical team. Keywords: Pheochromocytoma; Pregnancy; Laparoscopy [Full...

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