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…

Acute kidney injury following radical cystectomy and urinary diversion: predictors and associated morbidity

Vol. 44 (4): 726-733, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0283 ORIGINAL ARTICLE Yasser Osman 1, Ahmed M. Harraz 1, Samer El-Halwagy 1, Mahmoud Laymon 1, Ahmed Mosbah 1, Hassan Abol-Enein 1, Atalla A. Shaaban 1 1 Urology and Nephrology Center, Mansoura University, Egypt ABSTRACT Introduction: Acute kidney injury (AKI) after major surgeries is associated with significant morbidity and mortality. We aim to report incidence, predictors and associated comorbidities of AKI after radical cystectomy in a large cohort of patients. Materials and Methods: We conducted a retrospective analysis of 1000 patients who underwent open radical cystectomy in a tertiary referral center. Perioperative serum creatinine measurements were used to define AKI according to the RIFLE criteria (as Risk, Injury and Failure). The predictors of AKI after surgery were determined using univariate and multivariate analyses. Results: Out of 988 evaluable patients, AKI developed in 46 (4.7%). According to RIFLE criteria; AKI-Risk, AKI-Injury and AKI-Failure occurred in 26 (2.6%), 9 (0.9%) and 11 (1.1%) patients, respectively. Multivariate analysis showed that performing nephroureterectomy with cystectomy (Odds ratio [OR]: 4.3; 95% Confidence interval [CI]: 1.3-13.6; p=0.01) and the development of high grade complications (OR: 3.8; 95% CI 1.9-7.2; p<0.0001) were independently associated with AKI. Conclusions: AKI is a significant morbidity after radical cystectomy and the term should be included during routine cystectomy morbidity assessment. Keywords: Acute Kidney Injury; Cystectomy; Urinary Diversion [Full text]...

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The diagnostic value of FNDC5/Irisin in Renal Cell Cancer

Vol. 44 (4): 734-739, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0404 ORIGINAL ARTICLE Diler Us Altay 1, Esref Edip Keha 2, Ersagun Karagüzel 3, Ahmet Menteşe 2, Serap Ozer Yaman 2, Ahmet Alver 2 1 Department of Chemistry and Chemical Processing Technology, Ulubey Vocational School, Laboratory Technology Program, Ordu University, Ordu, Turkey; 2 Department of Medical Biochemistry, Faculty of Medicine, Karadeniz Technical University Trabzon, Turkey; 3 Department of Urology, Faculty of Medicine, Karadeniz Technical University Trabzon, Turkey ABSTRACT Purposes: The aim of this study was to determine the diagnostic significance of fibro­nectin type III domain containing protein 5 (FNDC5)/Irisin levels in the sera of patients with renal cell cancer. Materials and Methods: In the study, 48 individuals were evaluated. The patient group included 23 subjects diagnosed with renal tumor, and the control group of 25 healthy individuals. Patients diagnosed with renal tumor received surgical treatment consisting of radical or partial nephrectomy. Blood specimens were collected and serum FNDC5/ Irisin and carcinoembryonic antigen (CEA) levels were determined using enzyme-linked immunosorbent assay (ELISA). Results: FNDC5/irisin and CEA levels in renal cancer patients were significantly higher compared with the control group (p=0.0001, p=0.009, respectively). Also, FNDC5 levels was more sensitive and specific than CEA levels. The best cut-off points for FNDC5/ irisin were >105pg/mL and CEA were >2.67ng/mL for renal cancer. Conclusions: FNDC5/Irisin may be used as a diagnostic biomarker for renal cancer. Keywords: Carcinoma, Renal Cell; FNDC5 protein, rat [Supplementary Concept]; Urologic Neoplasms [Full text]...

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The preoperative stratification of patients based on renal scan data is unable to predict the functional outcome after partial nephrectomy

Vol. 44 (4): 740-749, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0636 ORIGINAL ARTICLE Riccardo Bertolo 1, 2 Cristian Fiori 1, 2 Federico Piramide 1, 2 Daniele Amparore 1, 2 Francesco Porpiglia 1, 2 1 Division of Urology, 2 Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy ABSTRACT Introduction: eGFR-categories are used to predict functional outcome after partial nephrectomy (PN); no study categorized patients according to preoperative renal scan (RS) data. Aim of the study was to evaluate if stratification of patients according to RS is a reliable method to predict minor/major loss of renal function after PN. Materials and Methods: We considered patients who underwent PN and RS pre-/post-PN for T1 tumor in our Institution (2007-2017). Demographics, perioperative and specifically functional data were analysed. On the basis of the baseline Split Renal Function (SRF), patients were stratified into risk-categories: 1) baseline operated-kidney SRF range 45-55%; 2) baseline operated-kidney SRF <45%. Risk categories were analysed with postoperative functional outcome: postoperative operated-kidney SRF decrease below 90% of baseline was considered significant loss of function. Contingency tables and univariate/multivariate regression were analysed looking for independent factors of postoperative functional impairment. Results: 224 patients were analysed, 125 (55.8%) maintained >90% of their baseline function. Worse probability of maintaining ≥90 baseline renal function was found in patients with Charlson’s Comorbidity Index (CCI≥3) (p=0.004) and patients with PADUA score ≥8 (p=0.023). After stratification by baseline renal function, ischemia was the only independent factor: no effect on patients with poorer baseline renal function. Patients with baseline SRF 45-55% who did not experience ischemia had the highest probability to maintain ≥90% baseline SRF (p=0.028). Ischemia >25 minutes was detrimental (p=0.017). Conclusions: Stratification of patients by SRF before PN is not a reliable predictor of renal functional outcome. Ischemia seems to scarcely influence patients with poorer renal function. Keywords: Acute Kidney Injury; Nephrectomy; Carcinoma, Renal Cell [Full text]...

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Ureteroscopy and stone treatment in the elderly (≥70 years): prospective outcomes over 5- years with a review of literature

Vol. 44 (4): 750-757, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0516 ORIGINAL ARTICLE Sarah Prattley 1, James Voss 1, Stephanie Cheung 1, Robert Geraghty 1, Patrick Jones 1, Bhaskar K. Somani 1  1 University Hospital Southampton, NHS Trust, United Kingdom, UK ABSTRACT   Objective: To assess outcomes of ureteroscopy for treatment of stone disease in the elderly. Ureteroscopy (URS) is an increasingly popular treatment modality for urolithiasis and its applications are ever expanding with the development of newer technologies. Its feasibi­lity and outcomes within the elderly population to our knowledge remain under-reported. Materials and Methods: We examined the patient demographics and surgical outcomes from our prospective database for patients ≥70 years who underwent URS for urolithiasis, in a 5-year period between March 2012 and December 2016. Results: A total of 110 consecutive patients underwent 121 procedures (1.1 procedure/ patient) with a mean age of 77.2 years (range: 70-91 years). Stone location was in the kid­ney/ pelviureteric junction (PUJ) in 29%, ureter in 37% and in multiple locations in 34%. The initial and final stone free rate (SFR) was 88% and 97% respectively. While 73% were done as true day case procedures, 89% patients were discharged within 24 hours. Eleven patients (9%) underwent complications of which 10 were Clavien I/II including acute urinary retention, urinary tract infection, stent symptoms and pneumonia. One patient underwent Clavien IV complication where they needed intensive care unit admission for urosepsis but fully recovered and were discharged home subsequently. Conclusion: Ureteroscopy is a safe and effective method of managing urolithiasis in elder­ly patients. Although most patients are discharged within 24-hours, consideration needs to be made for patients where social circumstances can impact their discharge planning. Keywords: Ureteroscopy; Calculi; Therapeutics [Full text]...

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Effect of phyllanthus niruri on metabolic parameters of patients with kidney stone: a perspective for disease prevention

Vol. 44 (4): 758-764, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0521 ORIGINAL ARTICLE Nidia D. Pucci 1, Giovanni S. Marchini 2, Eduardo Mazzucchi 2, Sabrina T. Reis 3, Miguel Srougi 2, Denise Evazian 1, William C. Nahas 2 1 Divisão de Nutrição e Dietética, Instituto Central, Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina. São Paulo, Brasil; 2 Divisão de Urologia, Hospital das Clínicas, Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brasil; 3 Laboratório de Investigação Médica, Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brasil ABSTRACT     Phyllanthus niruri (P.niruri) or stone breaker is a plant commonly used to reduce stone risk, however, clinical studies on this issue are lacking. Objective: to prospectively evaluate the effect of P. niruri on the urinary metabolic param­eters of patients with urinary lithiasis. Materials and Methods: We studied 56 patients with kidney stones <10mm. Clinical, meta­bolic, and ultrasonography assessment was conducted before (baseline) the use of P. niruri infusion for 12-weeks (P. niruri) and after a 12-week (wash out) Statistical analysis includ­ed ANOVA for repeated measures and Tukey’s/McNemar´s test for categorical variables. Significance was set at 5%. Results: Mean age was 44±9.2 and BMI was 27.2±4.4kg/m2. Thirty-six patients (64%) were women. There were no significant changes in all periods for anthropometric and several serum measurements, including total blood count, creatinine, uric acid, sodium, potassium, calcium, urine volume and pH; a significant increase in urinary potassium from 50.5±20.4 to 56.2±21.8 mg/24-hour (p=0.017); magnesium/creatinine ratio 58±22.5 to 69.1±28.6mg/ gCr24-hour (p=0.013) and potassium/creatinine ratio 39.3±15.1 to 51.3±34.7mg/gCr24- hour (p=0.008) from baseline to wash out. The kidney stones decreased from 3.2±2 to 2.0±2per patient (p<0.001). In hyperoxaluria patients, urinary oxalate reduced from 59.0±11.7 to 28.8±16.0mg/24-hour (p=0.0002), and in hyperuricosuria there was a de­crease in urinary uric acid from 0.77±0.22 to 0.54±0.07mg/24-hour (p=0.0057). Conclusions: P.niruri intake is safe and does not cause significant adverse effects on serum metabolic parameters. It increases urinary excretion of magnesium and potassium caused a significant decrease in urinary oxalate and uric acid in patients with hyperoxaluria and hyperuricosuria. The consumption of P.niruri contributed to the elimination of urinary calculi. Keywords: Kidney Calculi; Disease; Urolithiasis [Full...

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The role of bladder diverticula in the prevalence of acute urinary retention in patients with BPH who are candidates to surgery

Vol. 44 (4): 765-770, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0605 ORIGINAL ARTICLE Alexandre Iscaife 1, Gabriel dos Anjos 1, Cristovão Barbosa Neto 1, Willian Carlos Nahas 1, Miguel Srougi 1, Alberto Azoubel Antunes 1 1 Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo – FMUSP, SP, Brasil   ABSTRACT Introduction: The urinary bladder diverticula (BD) secondary to benign prostatic hyperplasia (BPH) is a complication that can lead to urinary stasis, stone, urinary tract infection (UTI) and tumors. It’s role in acute urinary retention (AUR) is not totally understood. Objectives: To determine the effect of BD size on AUR rates in patients with BPH candidates to surgery. Subjects and Methods: We performed a retrospective cohort study of 47 patients with BPH and BD who underwent BPH surgery associated to complete bladder diverticulectomy from 2006 to 2016. We analyzed risk factors for AUR in patients with BD using univariate, multivariate and correlation analysis. Results: There was a difference in the size of the diverticula, with 6.8 cm vs. 4.5 cm among patients with and without AUR respectively (p=0.005). The ROC curve showed a correlation between the size of BD and the risk of AUR. The value of 5.15 cm presented a sensitivity of 73% and a specificity of 72%. The area under the curve was 0.75 (p=0.01). Comparing groups with BD >5.0 cm vs. ≤5.0 cm, the AUR incidence was 74% and 27.8% respectively with an OR of 2.65 (1.20-5.85) (p=0.005). In the multivariate analysis, only the size of the diverticula reached statistical significance (p=0.012). Conclusions: The diameter of BD is an independent risk factor for AUR in patients with BPH and BD who are candidates to surgery. A diameter greater than 5.15 cm increases the risk of AUR. Keywords: Bladder Diverticulum [Supplementary Concept]; Prostatic Hyperplasia; Urinary Retention [Full...

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Comparison of inflammatory markers between brucella and non-brucella epididymo-orchitis

Vol. 44 (4): 771-778, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2018.0004.0 ORIGINAL ARTICLE Ali Cift 1, Mehmet Ozgur Yucel 1 1 Department of Urology, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey ABSTRACT Objectives: Brucellosis is a multi-system infectious disease that is associated with inflammation, which causes an increase in acute phase reactants. Hematological inflammatory markers of brucellosis include mean platelet volume (MPV), red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR). In this study, we aimed to evaluate the diagnostic value of hematological inflammatory markers in Brucella epididymo-orchitis (BEO), and to investigate the utility of these markers for differential diagnosis from non-Brucella epididymo-orchitis (non-BEO). Materials and Methods: We retrospectively reviewed the records of 22 BEO and 50 non-BEO patients. Hematological parameters were recorded and compared between the two groups. The main diagnostic criteria for BEO were positive clinical findings (i.e., testicular pain, tenderness and scrotal swelling), a positive Rose Bengal test result, standard tube agglutination (STA) titer ≥ 1/160, and/or a positive blood culture. Results: The most decisive factors in discriminating between BEO and non-BEO were NLR, RDW, and MPV, in decreasing order of their strength. Regardless of other factors, NLR values < 2.3 significantly increased the odds of BEO (OR=8.080, 95% CI: 1.929-33.843, p=0.004). After adjusting for other factors, RDW values >14.45% significantly increased the odds of BEO (OR=7.020, 95% CI: 1.749-28.176, p=0.006). Independent of the other factors, patients with MPV < 7.65 fL had a 6.336 times higher risk for BEO (95% CI: 1.393 – 28.822, p=0.017). Conclusion: Hematological inflammatory markers such as NLR, RDW, and MPV can aid in the differential diagnosis of BEO and non-BEO. Keywords: Brucella; Infectious Disease Medicine; Hematologic Neoplasms [Full text]...

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Comparison of the Kelly’s plication and TOT simultaneously with vaginal hysterectomy, on the incontinence, and sexual functions

Vol. 44 (4): 779-784, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2018.0019 ORIGINAL ARTICLE Neslihan Bayramoglu Tepe 1, Omer Bayrak 2, Huseyin Caglayan Ozcan 1, Mete Gurol Ugur 1, Ilker Seckiner 2 1 Department of Obstetrics and Gynecology, University of Gaziantep, Gaziantep, Turkey; 2 Department of Urology, University of Gaziantep, Gaziantep, Turkey ABSTRACT Purpose: To compare the effect of vaginal hysterectomy-anterior/posterior colporrhaphy with Kelly’s plication(VH-KP), versus vaginal hysterectomy-anterior/posterior colporrhaphy-transobturator tape(VH-TOT) surgeries on incontinence, quality of life, and sexual functions in patients with pelvic organ prolapse(POP), and concurrent obvious stress urinary incontinence(SUI). Materials and Methods: Between 2013 and 2017, fifty patients treated with VH-KP(n = 25), and VH-TOT(n = 25) due to POP and SUI, were evaluated prospective consecutively. Age, parity, duration of urinary incontinence,and the daily pad use were recorded. Patients were filled “rinary Distress Inventory-6(UDI-6)”, “Incontinence Impact Questionnaire 7(IIQ-7)” and “Index of Female Sexual Function(IFSI)” questionnaire forms at preoperatively,and postoperative 6th month. No usage of pads was accepted as subjective cure rate.Intraoperative,and postoperative complications were noted. Results: There was no statistically significant difference between two groups, for the mean age of the patients, parity, duration of SUI, and the daily pad use, preoperatively (p > 0.05). Decreased UDI-6 scores, IIQ-7 scores and daily pad usage, and increased IFSF scores were found statistical significantly in each group, at the postoperative 6 th month (p < 0.05). However, VH-TOT group had higher improvement rates, on UDI-6 scores (69.5% vs 63.0%, p = 0.04). In addition, it was notable that the the rates of the patients had IFSF scores ≥ 25 was higher in VH-KP group (p = 0.05). Four (16%) patients had recurrent SUI in the VH-KP group (p = 0.039) and vaginal extrusion occurred in 2 (8%) patients in the VH-TOT group (p = 0.153), postoperatively. Conclusions: Although the effects of VH-TOT surgery are superior to conventional methods for incontinence and quality of life; negative effects on sexual functions are notable. In addition, although recurrence rates of TOT are low, complications such as vaginal extrusion are accompanied by drawbacks of mesh usage. Keywords: Pelvic Organ Prolapse; Urinary Incontinence; Quality of Life [Full text]...

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Clinical features of carriers of reciprocal chromosomal translocations involving chromosome 2: report of nine cases and review of the literature

Vol. 44 (4): 785-793, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0233 ORIGINAL ARTICLE Xinyue Zhang 1, Hongguo Zhang 1, Cong Hu 1, Ruixue Wang 1, Qi Xi 1, Ruizhi Liu 1 1 Center for Reproductive Medicine and Center for Prenatal Diagnosis, First Hospital, Jilin University, Changchun, China ABSTRACT Objective: To explore the clinical features of carriers of chromosome 2 translocations, enabling informed genetic counseling of these patients. Materials and Methods: Eighty-two male carriers of a translocation who were infertile or receiving fertility counseling were recruited. Cytogenetic analyses were performed using G-banding. A search of PubMed was performed to determine whether the identi­fied translocations on chromosome 2 are involved in male infertility. The relationships of translocation breakpoints with male infertility and recurrent pregnancy loss were analyzed. Results: Of the 82 translocation carriers, 9 (11%) were carriers of a chromosome 2 translocation. Four cases had oligozoospermia or infertility, while five had normal se­men. In an analysis of the literature, 55 patients who were carriers of chromosome 2 translocations were also reviewed. Breakpoints at 2p13 and 2q31 were observed in six patients each, and were the most common. Breakpoints at 2p23, 2p13, 2p11.2, 2q31, and 2q37 were associated to both pre-gestational and gestational infertility, while other breakpoints were associated with gestational infertility. Conclusions: All breakpoints at chromosome 2 were correlated with gestational infer­tility. Carriers of chromosome 2 translocations should therefore receive counseling to continue with natural conception and use of different technologies available via as­sisted reproductive technology, such as preimplantation genetic diagnosis. Keywords:  Infertility, Male; Chromosomes, Human, Pair 2; Genetic Counseling [Full...

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Low serum melatonin levels are associated with erectile dysfunction

Vol. 44 (4): 794-799, July – August, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0663 ORIGINAL ARTICLE Aliseydi Bozkurt 1, Mehmet Karabakan 2, Binhan Kagan Aktas 3, Murat Gunay 4, Ercüment Keskin 1, Erkan Hirik 1 1 Department of Urology, Erzincan University Mengucek Gazi Research and Training Hospital, Erzincan, Turkey; 2 Department of Urology, Mersin Toros State Hospital, Mersin, Turkey; 3 Department of Urology, Ankara Numune Research and Training Hospital, Ankara, Turkey; 4 Department of Clinical Biochemistry, Erzincan University Mengucek Gazi Research and Training Hospital, Erzincan, Turkey ABSTRACT   Objective: Melatonin is a hormone secreted from the pineal gland and has anti-oxidative and anti-inflammatory effects. Oxidative stress is considered as an important factor in the etiology of erectile dysfunction (ED), and in many experimental models, positive re­sults have been obtained with melatonin treatment. This study aimed to measure serum melatonin levels in ED patients and to investigate the possible relationship between ED and melatonin levels. Materials and Methods: Sixty-two patients diagnosed with mild, moderate or severe ED according to the five-item International Erectile Function Index (IIEF-5) and 22 healthy individuals were included in the study. The serum melatonin levels, anthropometric data, and other biochemical and hormonal parameters of all the subjects were recorded. De­tailed anamnesis was also obtained in terms of diabetes, hypertension, cardiovascular diseases, smoking status, and alcohol use. Results: The serum melatonin level was found 34.2±13.3 ng/dL in the mild ED group, 33.3±14.7 ng/dL in the moderate ED group, 34.8±17.2 ng/dL in the severe ED group, and 44.6±16.5 ng/dL in the control group. The serum melatonin levels were significantly lower in all ED groups compared to the control group (p=0.019). There was no signifi­cant difference in the serum melatonin levels between the three ED groups. Diabetes, hypertension, cardiovascular diseases, smoking and alcohol use were not significantly different between the ED groups (p>0.05). Conclusion: We consider that if our findings are supported by further studies with larger populations, the measurement of the serum melatonin level may have a future role in the diagnosis and treatment of ED. Keywords: Erectile Dysfunction; etiology [Subheading]; Melatonin; Oxidative Stress [Full text]...

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