Vol. 44 n. 6 Nov . Dec, 2018

Volume 44 | number 6 | Nov . Dec, 2018 -The November-December 2018 issue of the International Braz J Urol presents original contributions with a lot of interesting papers…

Prospective Evaluation of Chondroitin Sulfate, Heparan Sulfate and Hyaluronic Acid in Prostate Cancer

Vol. 44 (6): 1139-1146, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0569 ORIGINAL ARTICLE Matheus Neves Ribeiro da Silva 1, 2, Aline Mendes 1, João Roberto Maciel Martins 2, Marcos Tobias Machado 2, Maria Aparecida da Silva Pinhal 1 1 Departamento de Bioquímica, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil; 2 Departmento de Urologia Faculdade de Medicina do ABC, Santo André, SP, Brasil ABSTRACT Purpose: The present study evaluates chondroitin sulfate (CS) and heparan sulfate (HS) in the urine and hyaluronic acid (HA) in the plasma of patients with prostate cancer before and after treatment compared to a control group. Materials and Methods: Plasma samples were used for HA dosage and urine for quantification of CS and HS from forty-four cancer patients and fourteen controls. Clinical, laboratory and radiological information were correlated with glycosaminoglycan quantification by statistical analysis. Results: Serum HA was significantly increased in cancer patients (39.68 ± 30.00 ng/ mL) compared to control group (15.04 ± 7.11 ng/mL; p=0.004) and was further increased in high-risk prostate cancer patients when compared to lower risk patients (p = 0.0214). Also, surgically treated individuals had a significant decrease in seric levels of heparan sulfate after surgical treatment, 31.05 ± 21.01 μg/mL (before surgery) and 23.14 ± 11.1 μg/mL (after surgery; p=0.029). There was no difference in the urinary CS and HS between prostate cancer patients and control group. Urinary CS in cancer patients was 27.32 ± 25.99 μg/mg creatinine while in the men unaffected by cancer it was 31.37 ± 28.37 μg/mg creatinine (p=0.4768). Urinary HS was 39.58 ± 32.81 μg/ mg creatinine and 35.29 ± 28.11 μg/mg creatinine, respectively, in cancer patients and control group (p=0.6252). Conclusions: Serum HA may be a useful biomarker for the diagnosis and prognosis of prostate cancer. However, urinary CS and HS did not altered in the present evaluation. Further studies are necessary to confirm these preliminary findings. Keywords: Biomarkers; Glycosaminoglycans; Prostatic Neoplasms [Full Text]...

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Prognostic significance of Body Mass Index in patients with localized renal cell carcinoma

Vol. 44 (6): 1147-1155, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0629 ORIGINAL ARTICLE Chengtao Wang 1, Zebin Chen 2, Jun Dong 1, Bixiu Wen 1, Yong Fang 2 1 Department of Radiation Oncology, First Affiliated Hospital of Sun Yat – Sen University, Guangzhou, China; 2 Department of Urology, First Affiliated Hospital of Sun Yat – Sen University, Guangzhou, China   ABSTRACT Objective: To investigate the relationship between the pretreatment body mass index (BMI) and the clinical outcomes in patients with localized stage I – III renal cell carcinoma (RCC) surgically treated. Materials and Methods: From January 2000 to December 2012, 798 patients with stage I – III RCC were recruited from First Affiliated Hospital and Cancer Center of Sun Yat – Sen University. Patients were divided into two groups of BMI < 25 kg / m2 or BMI ≥ 25 kg / m2 according to the World Health Organization classifications for Asian populations. The differences in the long-term survival of these two BMI groups were analyzed. Results: The 5 – year failure – free survival rates for BMI < 25 kg / m2 and BMI ≥ 25 kg / m2 groups were 81.3% and 93.3%, respectively (P = 0.002), and the 5 – year overall survival rates were 82.5% and 93.8%, respectively (P = 0.003). BMI was a favored prognostic factor of overall survival and failure – free survival in a Cox regression model. Conclusions: Pretreatment body mass index was an independent prognostic factor for Chinese patients surgically treated, localized stage I – III RCC. Keywords: Body Mass Index; Carcinoma, Renal Cell; Prognosis [Full Text]...

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Surgical techniques for facilitating laparoscopic intracorporeal orthotopic neobladder: initial experience

Vol. 44 (6): 1156-1165, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0505 ORIGINAL ARTICLE Lianchao Jin 1,2, Mingshuai Wang 1, Feiya Yang 1, Yinong Niu 1, Nianzeng Xing 1 1 Department of Urology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China; 2 Department of Urology, Peking University Shougang Hospital, Beijing, China ABSTRACT   Purpose: To describe our technique and outcomes for laparoscopic intracorporeal ileal neobladder (ICNB) reconstruction. Materials and Methods: From April 2014 to November 2016, 21 patients underwent laparoscopic ICNB at our tertiary referral centre. ICNB with bilateral isoperistaltic af­ferent limbs and several technique improvements were introduced. Demographics, clinical, and pathological data were collected. Perioperative, 1-year oncologic, 1-year Quality of life and 1-year functional outcomes were reported. Results: ICNB was successfully performed in all 21 patients without open conversion and transfusion. Mean operative time was 345.6±66.9 min, including 106±22 min for LRC and PLND and 204±46.4 min for ICNB, respectively. Mean established blood loss was 192±146 mL. The overall incidence of 90-d complication was 33.3%, while major complication occurred in 4.8%. One-year daytime and night-time continence rates were 85.7% and 57.1%, respectively. One patient died from myocardial infarction six months postoperatively, and two patients had lung metastasis five months and six months respectively. Conclusions: We described our experience of 3D LRC with a novel intracorporeal or­thotopic ileal neobladder, and the technique improvements facilitate the procedure. However, further studies are required to evaluate long-term outcomes of the intracor­poreal neobladder with bilateral isoperistaltic afferent limbs.  Keywords: Laparoscopy; Quality of Life; Cystectomy [Full Text]...

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Retroperitoneoscopic resection of retroperitoneal nonadrenal ganglioneuromas: our technique and clinical outcomes

Vol. 44 (6): 1166-1173, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0460 ORIGINAL ARTICLE Changjin Shi 1, Feng Li 1, Yanchao Wang 1, Long Pei 1, Tao Wang 2 1 Department of Urology, the Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China; 2 Department of Nephrology, Hebei Provincial General Hospital, Shijiazhuang, China ABSTRACT Objective: To report our experience of retroperitoneoscopic technique in semi-lateral decubitus position for the retroperitoneal nonadrenal ganglioneuromas in 18 patients, and to evaluate its clinical outcomes. Materials and Methods: From January 2012 to May 2016, 18 patients with retroperitoneal nonadrenal ganglioneuromas underwent retroperitoneoscopic resection. With the patients in semi-lateral decubitus position, a 4-port retroperitoneal approach was used. Data were collected on the tumor size, tumor location, perioperative outcomes, pathology, and lastknown disease status. We reviewed the operative videos to identify surgical tips and tricks. Results: All procedures were carried out successfully without converting to open surgery. The tumors had an average size of 5.2cm. The mean operative time was 86.5 min, with a mean estimated blood loss of 85.4mL. There were three patients suffering from intraoperative complications. Postoperatively, all patients achieved an uneventful recovery; the mean postoperative hospital stay was 5.5 days. The postoperative pathology revealed to be retroperitoneal ganglioneuromas. With a mean follow-up of 39.5 months, all patients were recurrence free. The review of the operative videos revealed several tips and tricks, including keeping peritoneum and posterior Gerota fascia intact to provide a favorable operative exposure of tumors, and placing the harmonic scalpel through different ports during tumor dissection. Conclusions: With the patient in semi-lateral decubitus position and a 4-port retroperitoneal approach, retroperitoneoscopic resection of retroperitoneal nonadrenal ganglioneuroma is a feasible, effective, and safe procedure. This approach has distinct advantages including direct access to the tumor, optimal exposure of tumor and less intraperitoneal interference. Keywords: Retroperitoneal Neoplasms; Ganglioneuroma; Pathology [Full...

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Retroperitoneal laparoscopic nephroureterectomy with distal and intramural ureter resection for a tuberculous non – functional kidney

Vol. 44 (6): 1174-1181, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0326 ORIGINAL ARTICLE Canqiang Li 1, Yi Yang 1, Le Xu 1, Minjie Qiu 1 1 Department of Urology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, Guangdong, China   ABSTRACT   Objective: To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection for a tuberculous non-functional kidney. Materials and Methods: A total of 27 individuals diagnosed with unilateral non-functional kidney secondary to tuberculosis were treated between June 2011 and June 2015. All patients had normal renal function on the contralateral side and underwent the standard four-drug anti-tuberculosis treatment for at least four weeks before surgery. Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients, and the urinary-bladder junction of distal ureter was managed using different auto-suture techniques. Results: Nineteen male and 8 female patients with an average age of 47.3 years (range, 36-64 years) underwent surgery. All the operations were successfully performed with­out conversion. The median operative time was 109.3 min (range, 75-138 min), the median blood loss was 157.5 mL (range, 70-250 mL), and the median hospitalization time was 3.7 days (range, 3-6 days). No serious perioperative complications occurred. Anti-tuberculosis chemotherapy was prescribed to all patients, with the entire course of treatment lasting six months. No recurrence of tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of 26.7 months (range, 6-54 months). Conclusion: Retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection is a safe and feasible approach for the treatment of tuberculous non-functional kidneys. Keywords: Tuberculosis, Renal; Nephroureterectomy; Nephrectomy [Full...

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Oxidative stress in the bladder of men with LUTS undergoing open prostatectomy: a pilot study

Vol. 44 (6): 1182-1193, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2018.0127 ORIGINAL ARTICLE Marcio Augusto Averbeck 1, 2, 3, Nelson Gianni de Lima 4, Gabriela Almeida Motta 1, Lauro Beltrão 2, Nury Jafar Abboud Filho 2, Clarice Pereira Rigotti 2, William Nascimento dos Santos 2, Steven Kitzberger Jaeger dos Santos 2, Luis Fernando Batista da Silva 2, Ernani Luis Rhoden 2, 3, 5 1 Departamento Pós-graduação em Ciências da Saúde da Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil; 2 Serviço de Urologia, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brasil; 3 Serviço de Urologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil; 4 Serviço de Urologia, Hospital de Nossa Senhora dos Navegantes, Torres, RS, Brasil; 5 Disciplina de Urologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil ABSTRACT Purpose: This study aims to evaluate the link between preoperative parameters and oxida­tive stress (OS) markers in the bladder wall of men undergoing open prostatectomy. Materials and Methods: From July 2014 to August 2016, men aged ≥ 50 years and presenting with LUTS were prospectively enrolled. Preoperative assessment included validated questionnaires (IPSS and OAB – V8), lower urinary tract ultrasound and uro­dynamics. Bladder biopsies were taken during open prostatectomy for determination of OS markers. Increased OS was defined by increased concentration of malondialdehyde (MDA) and / or decreased concentration of antioxidant enzymes (superoxide dismutase and / or catalase). P<0.05 was regarded as statistically significant. Results: Thirty – eight consecutive patients were included. Mean age was 66.36 ± 6.44 ye­ars, mean prostate volume was 77.7 ± 20.63 cm3, and mean IPSS was 11.05 ± 8.72 points. MDA concentration was increased in men with severe bladder outlet obstruction (BOO gra­de V – VI according to the Schaefer’s nomogram) in comparison with BOO grade III – IV (p = 0.022). Patients with severe LUTS also had higher MDA concentration when compared to those with mild LUTS (p = 0.031). There was a statistically significant association between increased post – void residual urine (cut off ≥ 50 mL) and not only higher levels of MDA, but also reduced activity of SOD and catalase (p < 0.05). Conclusions: This pilot study showed that severity of LUTS and BOO were associated with increased MDA concentration in the bladder wall of men undergoing open prosta­tectomy. Further studies are still needed to assess the role of non – invasive biomarkers of OS in predicting bladder dysfunction in men with LUTS. Keywords: Urinary Bladder; Lower Urinary Tract Symptoms; Urinary Bladder Neck Obstruction; Oxidative Stress [Full Text]...

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Changing bulking agent may require change in injection volume for endoscopic treatment of vesicoureteral reflux

Vol. 44 (6): 1194-1199, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2018.0033 ORIGINAL ARTICLE Ali Tekin 1,2, Ismail Yagmur 1,2, Sibel Tiryaki 1,2, Zafer Dokumcu 1, Ibrahim Ulman 1,2, Ali Avanoglu 1,2 1 Department of Pediatric Surgery, Ege University Faculty of Medicine, Izmir, Turkey; 2 Division of Pediatric Urology, Ege University Faculty of Medicine, Izmir, Turkey ABSTRACT Introduction: Various bulking agents were utilized for endoscopic correction of VUR. A study reviewing multi-institutional data showed that the amount of injection material has increased over time with the purpose of improving success rates, which also resul­ted in costs. We noticed an opposite trend in our center since we started using a new bulking agent. The aim of this study was to evaluate evolution of our practice with different bulking agents. Patients and Methods: Records of VUR patients who underwent subureteric injection with polyacrylate polyalcohol copolymer (PPC) and dextronomere hyaluronic aci­de (DxHA) between 2005 and 2014 were reviewed. Variation of different parameters throughout the study period was evaluated along with the success rate. Success was defined as complete resolution of reflux. Results: A total of 260 patients with 384 refluxing units were included. The success rate was higher in PPC group compared to DxHA group. There was no statistically significant difference between years regarding distribution of VUR grade, body weight, patient height, and age in PPC group. Despite significant reduction in injection volu­me, success rate did not decrease through the years with PPC. Conclusion: Different bulking agents may require different injection volumes to achieve the same success rate in endoscopic treatment of vesicoureteral reflux. Habits gained with previous experience using other materials should be revised while using a new agent. Keywords: Vesico-Ureteral Reflux; Endoscopy; Cakut [Supplementary Concept] [Full Text]...

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The learning curve of sting method for endoscopic injection treatment of vesicoureteral reflux

Vol. 44 (6): 1200-1206, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0465 ORIGINAL ARTICLE Ayhan Dalkiliç 1, Göksel Bayar 2, Hasan Demirkan 3, Kaya Horasanli 3 1 Department of Urology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey; 2 Department of Urology, Martyr Prof Dr. Ilhan Varank Sancaktepe Training and Research Hospital, Turkey; 3 Department of Pediatric Urology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey ABSTRACT Objective: To identify how many endoscopic injection (EI) procedures, STING method, must be performed before reaching an ideal success rate when simulation training has not been received. Materials and Methods: The EI procedures performed by two pediatric urology fellows were investigated. The study excluded patients without primary VUR and those with previous EI or ureteroneocystostomy, lower urinary tract dysfunction, and/or duplicate ureters. The EIs used dextranomer hyaluronate and the STING method, as described by O’Donnell and Puri. Groups number was determined by multiple statistical trials. Statistically significance differences were achieved with one combination that had 35 EI procedures each and with 3 different combination of patients, having 12, 24, and 36 patients, respectively. Therefore, groups were established 12 patients. The first fellow performed 54 EIs, and the second performed 51. Therefore, each of the first fellow’s three groups contained 18 EI procedures, and each of the second fellow’s 17. Results: The study included 72 patients and 105 ureter units. When the data from both fellows were combined, each of the three groups contained 35 procedures. For the first fellow, the success rates in the first, second, and third groups were 38.3%, 66.6%, and 83.3% (p = 0.02), respectively, and for the second fellow, the success rates were 41.2%, 64.7%, and 82.3% (p = 0.045), respectively. The increased success rates for both fellows were very similar. Conclusions: An acceptable rate of success for EI may be reached after about 20 pro­cedures and a high success rate after about 35-40 procedures. Keywords: Learning Curve; Endoscopy; Vesico-Ureteral Reflux [Full Text]...

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Pelvic floor electromyography and urine flow patterns in children with vesicoureteral reflux and lower urinary tract symptoms

Vol. 44 (6): 1207-1214, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2018.0401 ORIGINAL ARTICLE Lida Sharifi-Rad 1, 2, Seyedeh-Sanam Ladi-Seyedian 1, Hossein Amirzargar 1, Abdol-Mohammad Kajbafzadeh 1 1 Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran; 2 Department of Physical Therapy, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran ABSTRACT Objective: To determine the different urine flow patterns and active pelvic floor electromyography (EMG) during voiding in children with vesicoureteral reflux (VUR) as well as presenting the prevalence of lower urinary tract symptoms in these patients. Materials and Methods: We retrospectively reviewed the charts of children diagnosed with VUR after toilet training from Sep 2013 to Jan 2016. 225 anatomically and neurologically normal children were included. The reflux was diagnosed with voiding cystourethrography. The study was comprised an interview by means of a symptom questionnaire, a voiding diary, uroflowmetry with EMG and kidney and bladder ultrasounds. Urine flow patterns were classified as bell shape, staccato, interrupted, tower and plateau based on the current International Children’s Continence Society guidelines. Results: Of 225 children with VUR (175 girls, 50 boys), underwent uroflowmetry + EMG, 151 (67.1%) had an abnormal urine flow pattern. An active pelvic floor EMG during voiding was confirmed in 113 (50.2%) children. The flow patterns were staccato in 76 (33.7 %), interrupted in 41 (18.2%), Plateau in 26 (11.5%), tower in 12 (5.3%) and a bell shape or normal pattern in 70 (31.5%). Urinary tract infection, enuresis and constipation respectively, were more frequent symptoms in these patients. Conclusions: Bladder/bowel dysfunction is common in patients with VUR that increases the risk of breakthrough urinary tract infections in children receiving antibiotic prophylaxis and reduces the success rate for endoscopic injection therapy. Therefore investigation of voiding dysfunction with primary assessment tools can be used prior to treating VUR. Keywords: Vesico-Ureteral Reflux; Lower Urinary Tract Symptoms; Urinary Bladder [Full Text]...

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Artificial sphincter “BR – SL – AS 904” in the treatment of urinary incontinence after radical prostatectomy: efficacy, practicality and safety in a prospective and multicenter study

Vol. 44 (6): 1215-1223, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2018.0128 ORIGINAL ARTICLE Salvador Vilar Correia Lima 1, 2, Evandilson Guenes Campos de Barros 1, Fabio de Oliveira Vilar 1, Flavia Cristina Morone Pinto 2, Thomé Décio Pinheiro Barros 1, 2, José Carlos Truzzi 3, Luiz Gustavo M. de Toledo 4, Francisco Kanasiro 5, João Luiz Amaro 6 1 Serviço de Urologia, Hospital das Clínicas, Universidade Federal de Pernambuco, UFPE, Recife, PE, Brasil; 2 Departamento de Cirurgia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, UFPE, Recife, PE, Brasil; 3 Departamento de Urologia, Instituto do Câncer Dr. Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil; 4 Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil; 5 Serviço de Urologia, Hospital Santa Marcelina, Porto Velho, RO, Brasil; 6 Disciplina de Urologia, Unesp – Universidade Estadual Paulista, São Paulo, SP, Brasil ABSTRACT Purpose: The objective of the present study is to test the efficiency and practicality of a new artificial sphincter “BR – SL – AS – 904” in the control of urinary incontinence in post – PR patients and to evaluate their complications. Patients and Methods: Fifteen patients with incontinence after one year of radical prostatectomy were included prospectively. All patients underwent artificial urethral sphincter (AUS) implant “BR – SL – AS – 904” according to established technique. Inde­pendent variables such as free urinary flow, PAD weight test, ICIQ – SF score and uri­nary symptoms through the IPSS score were compared in different follow-up moments. Results: Patients submitted to AUS implantation did not present trans – operative or post – operative complications related to the surgical act such as: infection, hematoma, erosion or urinary retention. Device was inert to the body during the follow-up, sho­wing an excellent adaptation of the patients, besides the easy handling. The mean age was 68.20 years 40% of the patients had systemic arterial hypertension, 6.7% diabetes mellitus, 6.7% were hypertensive and diabetic, 13.4% were hypertensive, had diabetes and hypercholesterolemia and 26.7% patients had no comorbidities. It was evidenced that the urinary flow peak during the follow-up remained stable. Decreased averages and median PAD weight test were 135.19 to 75.72 and 106.00 to 23.50, respectively. The IPSS score decreased and the quality of life increased (12.33 to 3.40 and 2.50 to 3.20 respectively). The ICQF – SF questionnaire score also showed a decrease, ranging from 16, 71 to 7.33. Conclusion: The artificial sphincter implant “BR – SL – AS 904” was reproducible, safe and effective in the control of urinary incontinence in post – PR patients. Keywords: Urinary Incontinence; Urinary Sphincter, Artificial; Prostatic Neoplasms [Full Text]...

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