Vol. 44 n. 4 Jul . Aug, 2018

Volume 44 | number 3 | Jul . Aug, 2018 -The July-August 2018 issue of the International Braz J Urol presents original contributions with a lot of interesting papers…

Bladder diverticula with more than 5 cm increases the risk of acute urinary retention in BPH

Vol. 44 (4): 662-663, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2018.04.01 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 The July-August 2018 issue of the International Braz J Urol presents original contributions with a lot of interesting papers in different fields: Infertility, Bariatric Surgery, Bladder Cancer, Erectile Dysfunction, Prostate Cancer, Renal Cell Carcinoma, Prostate Biopsy, Renal stones, epididymo-orchitis, Pelvic Organ Prolapse, Penile Trauma, Nocturnal Enuresis, Prenatal Hydronephrosis, Basic Research, Prostatic Utricle Cyst, Urethral Stricture and Vesico-ureteral Reflux. The papers come from many different countries such as Canada, Egypt, Lebanon, Italy, Brazil, USA, UK, Turkey, China, Taiwan, India and Spain, and as usual the editor´s comment highlights some papers. We decided to comment the paper about a very interesting topic: Bladder Diverticula in BPH. [Full text]   Related Post Penile refracture: a preliminary report views 233 Low serum melatonin levels are associated with erectile dysfunction views 266 REPLY TO THE AUTHORS: Re: Endourologic strategies for a minimally inva... views 273 Editorial Comment: Lack of evidence of HPV etiology of prostate cancer... views...

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ICSI with testicular sperm for couples with sperm DNA damage

Vol. 44 (4): 664-666, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2018.04.02 EDITORIAL Armand Zini 1 1 Department of Surgery, St. Mary’s Hospital, McGill University, Montreal, Canada The advent of intracytoplasmic sperm injection (ICSI) has revolutionized the management of male factor infertility (1). Shortly after the technique was introduced, studies demonstrated that ICSI could successfully treat couples with severe male factor infertility. Several investigators reported that neither sperm concentration, morphology, nor progressive motility had any impact on ICSI outcomes (2-4). However, the only sperm characteristic that portended a negative ICSI outcome was the injection of a totally immotile (and presumably dead) spermatozoon (4-6).  [Full text]   Related Post Editorial Comment: Laparoscopic pectopexy: initial experience of singl... views 174 Ureteroscopy and stone treatment in the elderly (≥70 years): prospecti... views 370 The current status of renal cell carcinoma and prostate carcinoma grad... views 109 Testicular versus ejaculated sperm should be used for intracytoplasmic... views...

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Testicular versus ejaculated sperm should be used for intracytoplasmic sperm injection (ICSI) in cases of infertility associated with sperm DNA fragmentation | Opinion: Yes

Vol. 44 (4): 667-675, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2018.04.03 DIFFERENCE OF OPINION Sandro C. Esteves 1,2,3 1 ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, SP, Brasil; 2 Departamento de Cirurgia (Disciplina de Urologia), Faculdade de Ciências Médicas, Universidade de Campinas (UNICAMP), Campinas, SP, Brasil; 3 Faculty of Health, Aarhus University, 8000 Aarhus C, Denmark Keywords: Semen; Infertility, Male; Sperm Injections, Intracytoplasmic; Sperm DNA Fragmenttion; Testicular Sperm The use of testicular in preference over ejaculated sperm for intracytoplasmic sperm injection (ICSI) has gained increased attention due to reports of better pregnancy outcomes using testicular sperm for cases of infertility associated with high sperm DNA fragmentation (SDF) (reviewed by Esteves et al. (1)). Indeed, it has been a common practice to perform testicular sperm retrieval for ICSI (Testi-ICSI) in selected groups of non-azoospermic men. In a recent survey study involving infertility experts from 19 countries, 67% responders admitted that na abnormal SDF test result would affect their decision to utilize testicular instead of ejaculated sperm for ICSI (2). Interestingly, identical numbers were reported by attendees of an interactive debate session held during the 2017 annual meeting of the American Society for Reproductive Medicine (unpublished data). [Full text]   Related Post HPV vaccination is fundamental for reducing or erradicate penile cance... views 140 Do we have enough evidences that make you safe to treat a man with hyp... views 194 Comparing the short – term outcomes and complications of monopol... views 217 Polygamy, sexual behavior in a population under risk for prostate canc... views...

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Testicular versus ejaculated sperm should be used for intracytoplasmic sperm injection (ICSI) in cases of infertility associated with sperm DNA fragmentation | Opinion: No

Vol. 44 (4): 676-679, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2018.04.04 DIFFERENCE OF OPINION Mark Sigman 1 1 Department of Urology Brown University and The Miriam Hospitals, RI 02906, EUA Keywords: Semen; Infertility, Male; Sperm Injections, Intracytoplasmic; Sperm DNA Fragmenttion; Testicular Sperm   The argument for the use of testicular sperm instead of ejaculated sperm for infertility due to sperm DNA fragmentation (SDF) relies on several assumptions. When each assumption is examined, it becomes clear that the assumptions are either unproven, due to insufficient data, or just plain wrong. These assumptions are: 1) sperm DNA fragmentation assays are good diagnostic tests; 2) IVF/ICSI failed because of elevated SDF; and 3) testicular sperm will result in pregnancy or live birth when ejaculated sperm will not. It has been demonstrated that when comparing populations, SDF is greater in infertile than in fertile populations. In addition, SDF is negatively associated with pregnancy rates by IVF/ICSI with an odds ratio of 1.68 (1). [Full text]   Related Post Polygamy, sexual behavior in a population under risk for prostate canc... views 226 Radical Cystectomy is the best choice for most patients with muscle-in... views 208 Impact of PSA density of transition zone as a potential parameter in r... views 247 Penile refracture: a preliminary report views...

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Review of post bariatric surgery effects on common genitourinary physiology

Vol. 44 (4): 680-687, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0416 REVIEW ARTICLE Aline A. Yacoubian 1, Rami Nasr 1 1 Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon ABSTRACT Background: Obesity is a worldwide challenging health problem. Weight loss through medical management of obesity has not always been successful, thus, giving rise to the need for surgical intervention. Bariatric surgery has been shown to be helpful for morbidly obese patients. However, studies have also shown the effect of surgery on stone formation, fertility and erectile function. This review summarizes the main find­ings of several studies that analyze stone formation and fertility in men as well as erectile function post bariatric surgery. The underlying pathophysiologic alterations post bariatric surgery include increased absorption of oxalate leading to hyperoxaluria, hypocitraturia and increased urinary calcium oxalate supersaturation. Contradicting data exist on the effect of bariatric surgery on fertility and erectile function. Further studies are needed to analyze the mechanisms. Keywords: Obesity; Bariatric Surgery; Nephrolithiasis; Fertility [Full text]   Related Post Role of Adiponectin in prostate cancer views 67 Impact of local treatment on overall survival of patients with metasta... views 157 Comparison of inflammatory markers between brucella and non-brucella e... views 227 Isolated low grade prenatally detected unilateral hydronephrosis: do w... views...

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Diagnostic accuracy of multiparametric magnetic resonance imaging in detecting extracapsular extension in intermediate and high – risk prostate cancer

Vol. 44 (4): 688-696, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2016.0485 ORIGINAL ARTICLE Cristina Dominguez 1, Mauricio Plata 1, Juan Guillermo Cataño 1, Mauricio Palau 2, Diego Aguirre 3, Jorge Narvaez 3, Stephanie Trujillo 3, Felipe Gómez 1, Carlos Gustavo Trujillo 1, Juan Ignacio Caicedo 1, Camilo Medina 1 1 Department of Urology; 2 Department of Pathology; 3 Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Colombia, CO ABSTRACT Objectives: To evaluate the diagnostic performance of preoperative multiparametric magnetic resonance imaging (mp-MRI) as a predictor of extracapsular extension (ECE) and unfavorable Gleason score (GS) in patients with intermediate and high-risk pros­tate cancer (PCa). Materials and Methods: Patients with clinically localized PCa who underwent radi­cal prostatectomy (RP) and had preoperative mp-MRI between May-2011 and Decem­ber-2013. Mp-MRI was evaluated according to the European Society of Urogenital Ra­diology MRI prostate guidelines by two different readers. Histopathological RP results were the standard reference. Results: 79 patients were included; mean age was 61 and median preoperative prosta­te-specific antigen (PSA) 7.0. On MRI, 28% patients had ECE evidenced in the mp-MRI, 5% seminal vesicle invasion (SVI) and 4% lymph node involvement (LNI). At RP, 39.2% had ECE, 26.6% SVI and 12.8% LNI. Sensitivity, specificity, accuracy, positive predic­tive value (PPV), and negative predictive value (NPV) of mp-MRI for ECE were 54.9%, 90.9%, 76%, 81% and 74.1% respectively; for SVI values were 19.1%, 100%, 77.3%, 100% and 76.1% respectively and for LNI 20%, 98.4%, 86.7%, 66.7% and 88.7%. Conclusions: Major surgical decisions are made with digital rectal exam (DRE) and ultrasound studies before the use of Mp-MRI. This imaging study contributes to rule out gross extraprostatic extension (ECE, SVI, LNI) without competing with pathological studies. The specificity and NPV are reasonable to decide surgical approach. A highly experienced radiology team is needed to provide accurate estimations of tumor exten­sion and aggressiveness. Keywords: Prostatic Neoplasms; Magnetic Resonance Imaging; Prostatectomy [Full text] Related Post Comparison of two different suture techniques in laparoscopic partial ... views 197 Prospective Evaluation of Chondroitin Sulfate, Heparan Sulfate and Hya... views 143 Effects of body mass index on the outcomes of percutaneous nephrolitho... views 178 Transperitoneal laparoscopic pyeloplasty in children: does upper urina... views...

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Changes observed in prostate biopsy practices in an inner city hospital with a high risk patient population following the 2012 uspstf psa screening recommendations

Vol. 44 (4): 697-703, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0348 ORIGINAL ARTICLE Andrew W. Tam 1, Johnathan A. Khusid 1, Igor Inoyatov 1, Adan Z. Becerra 2, 3, Jonathan Davila 1, Jyoti D. Chouhan 1, Jeffrey P. Weiss 1, Llewellyn M. Hyacinthe 1, Brian K. McNeil 1, Andrew G. Winer 1 1 Department of Urology, University Hospital of Brooklyn, State University of New York Downstate College of Medicine, Brooklyn, NY, USA; 2 Department of Public Health Sciences and Division of Epidemiology, University of Rochester Medical Center, Rochester, NY, USA; 3 Department of Surgery, University of Rochester Medical Center, Surgical Health Outcomes and Research Enterprise (SHORE), Rochester, NY, USA ABSTRACT Introduction: We compared characteristics of patients undergoing prostate biopsy in a high-risk inner city population before and after the 2012 USPSTF recommendation against PSA based prostate cancer screening to determine its effect on prostate biopsy practices. Materials and Methods: This was a retrospective study including patients who received biopsies after an abnormal PSA measurement from October 2008-December 2015. Patients with previously diagnosed prostate cancer were excluded. Chi-square tests of independence, two sample t-tests, Mann-Whitney U tests, and Fisher’s exact tests were performed. Results: There were 202 and 208 patients in the pre-USPSTF and post-USPSTF recommendation cohorts, respectively. The post-USPSTF cohort had higher median PSA (7.8 versus 7.1ng/mL, p=0.05), greater proportion of patients who were black (96.6% versus 90.5%, p=0.01), and greater percentage of biopsy cores positive for disease (58% versus 29.5%, p<0.001). Multivariable analysis supported that the increase in PSA was independent of the increase in the proportion of patients who were black. The proportion of patients who were classified as D’Amico intermediate and high-risk disease increased in the post-USPSTF cohort and approached statistical significance (70.1% versus 58.8%, p=0.12). Conclusions: Our study suggests that the USPSTF recommendations may have led to na increase in pre-biopsy PSA as well as greater volume of disease. Also, a greater proportion of patients were being classified with intermediate or high risk disease. While the clinical significance of these findings is unknown, what the data suggests is somewhat troubling. Future research should further examine these changes in a larger cohort as well as resultant long-term outcomes. Keywords: Mass Screening; Prostatic Neoplasms; Prostate-Specific Antigen [Full text] Related Post Efficacy and safety of Elevate® system on apical and anterior compartm... views 207 Predictive factors for prolonged hospital stay after retropubic radica... views 188 Impact of overactive bladder on retrograde ejaculation views 168 Vaginal cuff recurrence after radical cystectomy: an under – stu... views...

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Polygamy, sexual behavior in a population under risk for prostate cancer diagnostic: an observational study from the Black Sea Region in Turkey

Vol. 44 (4): 704-708, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0525 ORIGINAL ARTICLE Abdullah Cirakoglu 1, Erdal Benli 1, Ahmet Yuce 1 1 Department of Urology, Ordu University, Faculty of Medicine, Ordu, Turkey   ABSTRACT Aim: Although prostate cancer (PCa) is the most common cancer type in men, a replaceable risk factor has not yet been established. In our study, we assessed the relationship between the number of sexual partners, age of first sexual experience and age of first masturbation and prostate cancer incidence. Materials and Methods: In Ordu University Department of Urology between January 2013 and September 2016, in PSA elevation and rectal examination, patients with prostate biopsy were evaluated due to nodule palpation in the prostate. At younger ages and at present, their first masturbation ages, first sexual debut ages, and total sexual partner numbers were recorded. The correlation between the obtained data and PCa frequency was evaluated. Results: The study included 146 patients with PCa identified on biopsy and 171 patients with benign biopsy results who answered the questions. 66.7% of the ones whose biopsy results were benign and 40.6% of cancer suspects had only one sexual partner. The median number of sexual partners was 1±4 (1-100) in the benign group and 2±6 (1-500) in the malignant group (p=0.039). There was a negative correlation between age of first sexual debut and number of partners (r: -0,479; p <0.001). Conclusion: In our study, it appears that there may be an association between the number of sexual partners and prostate cancer in the patient group with PSA level above 4ng/mL. Avoidance of sexual promiscuity or participation in protected sex may be beneficial to protect against prostate cancer. Keywords: Prostatic Neoplasms; Marriage; Sexual Behavior [Full Text] Related Post Transition to adulthood with a bladder augmentation: histopathologic c... views 182 Dramatic polarization in genitourinary expert opinions regarding the c... views 117 Changing bulking agent may require change in injection volume for endo... views 138 Skin to calyx distance is not a predictive factor for miniaturized per... views...

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Impact of PSA density of transition zone as a potential parameter in reducing the number of unnecessary prostate biopsies in patients with psa levels between 2.6 and 10.0 ng/mL

Vol. 44 (4): 709-716, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0506 ORIGINAL ARTICLE Hugo A. Socrates Castro 1, Wagner Iared 2, José Eduardo Mourão Santos 1, Raphael Sandes Solha 2, David Carlos Shigueoka 1, Sergio Aron Ajzen 2 1 Departamento de Diagnóstico por Imagem, 2 Departamento de Radiologia, Universidade Federal de São Paulo, Unifesp, São Paulo, SP, Brasil ABSTRACT Purpose: To assess the accuracy of prostate-specific antigen (PSA) adjusted for the transition zone volume (PSATZ) in predicting prostate cancer by comparing the ability of several PSA parameters in predicting prostate cancer in men with intermediate PSA levels of 2.6 – 10.0 ng/mL and its ability to reduce unnecessary biopsies. Materials and Methods: This study included 656 patients referred for prostate biopsy who had a serum PSA of 2.6 – 10.0 ng/mL. Total prostate and transition zone volumes were measured by transrectal ultrasound using the prolate ellipsoid method. The clinical values of PSA, free-to-total (F/T) ratio, PSA density (PSAD) and PSATZ for the detection of prostate cancer were calculated and statistical comparisons between biopsy-positive (cancer) and biopsy-negative (benign) were conducted. Results: Cancer was detected in 172 patients (26.2%). Mean PSA, PSATZ, PSAD and F/T ratio were 7.5 ng/mL, 0.68 ng/mL/cc. 0.25 ng/mL/cc and 0.14 in patients with prostate cancer and 6.29 ng/mL, 0.30 ng/mL/cc, 0.16 ng/mL/cc and 0.22 in patients with benign biopsies, respectively. ROC curves analysis demonstrated that PSATZ had a higher area under curve (0.838) than F/T ratio (0.806) (P<0.001) and PSAD (0.806) (P<0.001). With a cut-off value of 0.22 ng/mL/cc, PSATZ had 100% of sensitivity and could have prevented 24% of unnecessary biopsies. Conclusions: PSATZ may be useful in enhancing the specificity of serum PSA. Compared to other PSA related parameters, it was better in differentiating between prostate cancer and benign prostatic enlargement. Also, PSATZ could reduce a significant number of unnecessary biopsies. Keywords: Prostate; Biopsy; Diagnosis [Full text] Related Post Attenuation of partial unilateral ureteral obstruction -induced renal ... views 192 The association between the outcomes of extraperitoneal laparoscopic r... views 177 OAB score: a clinical model that predicts the probability of presentin... views 166 Can neutrophil to lymphocyte ratio predict lamina propria invasion in ... views...

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Comparing the short – term outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors in patients with coronary artery disese: a prospective, randomized, controlled study

Vol. 44 (4): 717-725, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0309 ORIGINAL ARTICLE Deniz Bolat 1, Bulent Gunlusoy 1, Ozgu Aydogdu 1, Mehmet Erhan Aydin 1, Cetin Dincel 1 1 Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey ABSTRACT   Introduction: To compare the perioperative outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors (TURBT) in patients with coronary artery disease (CAD). Materials and Methods: A total of 90 CAD patients with newly diagnosed bladder cancer who underwent TURBT were randomized into monopolar TURBT (M-TURBT) and bipolar TURBT (B-TURBT) groups. Primary outcome was safety of the procedures including obturator jerk, bladder perforation, clot retention, febrile urinary tract infection and TUR syndrome. The secondary outcome was the efficacy of TURBT procedures, including complete tumor resection, sampling of the deep muscle tissue and sampling of the qualified tissues without any thermal damage. Results: Mean ages of the patients in M-TURBT and B-TURBT groups were 71.36±7.49 and 73.71±8.15 years, respectively (p=0.157). No significant differences were found between M-TURBT and B-TURBT groups regarding complete tumor resection (76.2% vs. 87.5%, p=0.162) and muscle tissue sampling rates (71.4% vs. 64.6%,p=0.252). Obturator jerk was detected in 16.7% of the patients in M-TURBT group and 2.1% in B-TURBT group (p=0.007). No statistically significant differences were found between the groups regarding intraoperative and postoperative complications. Conclusions: Both monopolar and bipolar systems can be used safely and effectively during TURBT procedure in CAD patients. Due to the more frequently seen obturator jerk in M-TURBT than B-TURBT, careful surgical approach is needed during M-TURBT.   Keywords: Urinary Bladder Neoplasms; Prostatectomy; Coronary Artery Disease [Full text] Related Post Testicular versus ejaculated sperm should be used for intracytoplasmic... views 214 Current practice of antibiotic utilization for renal colic in the emer... views 180 Comparison between multiparametric MRI with and without post – c... views 195 Can preoperative neutrophil lymphocyte ratio predict malignancy in pat... views...

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