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…

Simplified method using kidney / ureter / bladder x-ray to determine the appropriate length of ureteral stents

Vol. 44 (6): 1224-1233, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0620 ORIGINAL ARTICLE Makoto Taguchi 1, Kenji Yoshida 1, Motohiko Sugi 1, Hidefumi Kinoshita 1, Tadashi Matsuda 1 1 Department of Urology and Andrology, Kansai Medical University, Osaka, Japan ABSTRACT Purpose: To investigate a method to determine the appropriate length of ureteral stents, given that the stent length may lead to exacerbation of urinary symptoms if the stent crosses the bladder midline. Materials and Methods: We retrospectively reviewed the position of the distal curl of the ureteral stent using kidney/ureter/bladder (KUB) radiographs after ureteroscopic lithotripsy in 165 patients who underwent placement of 24- or 26-cm ureteral stents. According to the KUB findings, we categorized the position of the distal curl of the ureteral stent into two groups. In Group 1, the stents did not cross the midline (appropriate length); in Group 2, the stents crossed the midline (inappropriate length). We assessed several patient parameters (sex, height, body mass index, and stone side) and the index of ureteral length using KUB radiographs (“C-P”) and computed tomography (CT, “PV”). Multivariate analysis was performed to identify the most significant factors affecting the position of ureteral stents. We also calculated the cutoff points of the receiver operating characteristic (ROC) curve of C-P and P-V for the position of ureteral stents. Results: The multivariate analysis showed that C-P was the most significant factor affecting the position of ureteral stents (p < 0.001) in patients with 24- and 26-cm ureteral stents. Comparison of the ROC curves of C-P and P-V showed that C-P was superior to P-V (p < 0.01) in patients with 24- and 26-cm stents. Conclusion: The use of KUB radiographs was effective and simple in determining the appropriate length of ureteral stents. Keywords: Kidney; Ureter; Urinary Bladder [Full Text]...

read more

Vitamin C inhibits crystallization of struvite from artificial urine in the presence of Pseudomonas aeruginosa

Vol. 44 (6): 1234-1242, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0656 ORIGINAL ARTICLE Muhammed A. P. Manzoor 1, Surya Ram Duwal 2, M. Mujeeburahiman 3, Punchappady-Devasya Rekha 1 1 Yenepoya Research Centre, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India; 2 Department of Biochemistry, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India; 3 Department of Urology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India ABSTRACT   Background: Formation of struvite stones is associated with urinary tract infection by urease-producing bacteria. Biogenic crystal growth in natural and synthetic materials is regulated by the action of inhibitors, ranging from small ions, molecules to large macromolecules. Materials and Methods: We report the dynamics of in vitro crystallization of struvite in presence of vitamin C in synthetic urine using single diffusion gel growth technique. Sodium metasilicate gel of specific gravity 1.05 and the aqueous solution of ammo­nium dihydrogen phosphate were used as the medium for growing the struvite crystals. The crystallization process was induced by a urease positive struvite stone associated Pseudomonas aeruginosa to mimic the infection leading to stone formation. The grown crystals were characterized by ATR-FTIR and powder XRD. The surface morphology was analysed through FE-SEM for comparison between treatments. Results: We observed decrease in number, dimension, and growth rate of struvite crys­tals with the increasing concentrations of vitamin C. Crystals displayed well-defined faces and dendritic morphology of struvite in both control and biogenic systems. Conclusion: The results strongly suggest that, vitamin C can modulate the formation of struvite crystals in the presence of uropathogenic bacteria.   Keywords: Struvite; Pseudomonas aeruginosa; Ascorbic Acid [Full...

read more

Beneficial effects of oltipraz, nuclear factor – erythroid – 2 – related factor 2 (Nrf2), on renal damage in unilateral ureteral obstruction rat model

Vol. 44 (6): 1243-1251, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2018.0232 ORIGINAL ARTICLE Emre Can Polat 1, Huseyin Besiroglu 2, Levent Ozcan 3, Alper Otunctemur 1, Ahmet Tugrul Eruyar 4, Adnan Somay 5, Nurver Ozbay 5, Mustafa Cekmen 6, Ceyla Eraldemır 7, Emin Ozbek 8 1 Department of Urology, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey; 2 Department of Urology, Catalca Ilyas Cokay State Hospital, Istanbul, Turkey; 3 Department of Urology, Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey; 4 Department of Pathology, Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey; 5 Department of Pathology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey; 6 Department of Biochemistry, Istanbul Medeniyet University, Istanbul, Turkey; 7 Department of Biochemistry, Kocaeli University, Kocaeli, Turkey; 8 Department of Urology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey ABSTRACT Introduction: We investigated whether Oltipraz (OPZ) attenuated renal fibrosis in a unilateral ureteral obstruction (UUO) rat model. Materials and Methods: We randomly divided 32 rats into four groups, each consisting of eight animals as follows: Rats in group 1 underwent a sham operation and received no treatment. Rats in group 2 underwent a sham operation and received OPZ. Rats in group 3 underwent unilateral ureteral ligation and received no treatment. Group 4 rats were subjected to unilateral ureteral ligation plus OPZ administration. Transforming growth factor beta-1 (TGF-β1), E-cadherin, nitric oxide (NO) and hydroxyproline levels were measured. Histopathological and immunohistochemical examinations were carried out. Results: TGF-β1, NO and E-cadherin levels in the UUO group were significantly higher than the sham group and these values were significantly different in treated groups compared to the UUO group. In rats treated with UUO + OPZ, despite the presence of mild tubular degeneration and less severe tubular necrosis, glomeruli maintained a better morphology when compared to the UUO group. Expressions of α–SMA in immunohistochemistry showed that the staining positivity decreased in the tubules of the OPZ-treated group. Conclusions: While the precise mechanism of action remains unknown, our results demonstrated that OPZ exerted a protective role in the UUO-mediated renal fibrosis rat model highlighting a promising therapeutic potency of Nrf2-activators for alleviating the detrimental effects of unilateral obstruction in kidneys.   Keywords: Oltipraz [Supplementary Concept]; Renal Insufficiency; Ureter [Full Text]...

read more

Encrusted cystitis caused by corynebacterium urealyticum: a case report with novel treatment strategy of intravesical dimethyl sulfoxide

Vol. 44 (6): 1252-1255, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0588 CHALLENGING CLINICAL CASES Tayyar Alp Ozkan 1, Mustafa Savas Yalcin 2, Ozdal Dillioglugil 2, Ibrahim Cevik 3 1 Department of Urology, Kocaeli Derince Traning and Research Hospital, Kocaeli, Tukey; 2 Department of Urology, Kocaeli University, School of Medicine, Kocaeli, Tukey; 3 Department of Urology, Okan University, School of Medicine, Istanbul, Tukey ABSTRACT Encrusted cystitis (EC) was first described as chronic cystitis with mucosal calcification in 1914 (1). It is a very rare chronic inflammatory disease presenting with dysuria, pelvic pain and gross hematuria. Voided urine contains mucus or calcified mucopurulent stone like particles. Urinalysis always reveals alkaline pH. It may be present in healthy individuals with no predisposing etiological factors (2-4). Etiologically, previous urological diseases, immunosuppression, urinary infection with urea splitting bacteria, or urological interventions resulting in bladder mucosa trauma may also be present (5, 6). In the present case report, we describe a novel treatment for EC with intravesical dimethyl sulfoxide. Keywords: Corynebacterium; Cystitis; Dimethyl Sulfoxide [Full Text]...

read more

Neurofibromas of the bladder in a child with neurofibromatosis type 1

Vol. 44 (6): 1256-1257, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0199 RADIOLOGY PAGE Gulec Mert Dogan 1, Ahmet Siğirci 1, Leyla Karaca 1 1 Department of Radiology Pediatric, Inonu University Malatya, Turkey No abstract available [Full...

read more

Recto-urethral fistula presenting as fever of unknown origin: a rare complication of prostatic abscess

Vol. 44 (6): 1258-1260, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0468 RADIOLOGY PAGE Sun Hwa Lee 1, Seong Jong Yun 2, Seokyong Ryu 1 1 Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea; 2 Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea ABSTRACT Not available [Full...

read more

Robotic excision of complex adrenal mass with retrocaval extension and encasement of renal hilum with renal preservation

Vol. 44 (6): 1261-1261, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0384 VIDEO SECTION Vishnu Raveendran 1, Ramaprasad Manasseri Koduveli 1, Kishore Thekke Adiyat 1 1 Aster Medcity, Kochi, Kerala, India ABSTRACT Objective: The purpose of this video is to present robotic excision of a complex adrenal mass with retrocaval extension and encasement of renal hilum in a 16 year old boy. Biochemical screening was negative for metabolically active compo­nent. Computerized tomographic scan with contrast revealed a homogenous mass of approximately 10.8 cm x 6.2 cm x 4.2 cm in the suprarenal area on right side that was extend-ing behind inferior vena cava and encasing renal hilar vessels. Imaging findings were that of a classical ganglioneuroma. Material and methods: Robot assisted laparoscopic adrenalectomy with sparing of renal hilar vasculature was performed. With patient in lateral position, five ports were used, including one for liver retraction. Da Vinci® system with four arms was docked from over the right shoulder. The displaced renal hilar structures were identified by opening Gerota’s fascia. Mass was dissected completely and removed through Pfan-nensteil incision. Results: Duration of procedure was 345 minutes and console time was 290 minutes. Blood loss was 250 mL. Post-opera­tive renal doppler showed normal blood flow. He was discharged on post-operative day three. Histopathologic examina­tion of specimen revealed ganglioneuroma arising from adrenal gland. Conclusion: Ganglioneuroma is a rare adrenal tumor with good prognosis on surgical removal. The advent of robotic surgery has made complex surgical procedures involving vital structures like inferior vena cava be performed using minimally invasive techniques without compromising oncologic principles. ARTICLE INFO Available at: https://www.intbrazjurol.com.br/video-section/20170384_Raveendran_et_al Int Braz J Urol. 2018; 44 (Video #18): 1261-1 [Full...

read more

The Lithocatch (TM) by Boston Scientific: how to use it and how to solve a common problem

Vol. 44 (6): 1262-1262, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2018.0105 VIDEO SECTION Giuseppe Giusti 1, Marco Lucci Chiarissi 1, Antonello De Lisa 1 1 Department of Urology, University of Cagliari, Cagliari , Italy ABSTRACT Introduction: The LithocatchTM basket is a immobilization device commercialized by Boston Scientific. It allows to col­lect multiple stone fragments from the ureter. The ability of the basket to capture a large number of stone fragments, is however responsible for a problem connected to its usage: the entrapment of the basket inside the ureter. In this video we explain how to use it and how to solve this problem. Material and Methods: After positioning the LithocatchTM over the fragments, the basket is opened and it is rotated through a special handle to collect stones. One frequent problem occurs when too many fragments are collected at once, preventing the extraction of the device. We research our archives to extrapolate the total number of procedures carried out with the LithocatchTM in the last two years and the total number of complications occurred. Results: We experienced the above mentioned complication in 16 procedures (14% of the total) of 114 surgeries per­formed. The way described to solve this complication was efficient and did not produce any damage to the ureter or to the basket. Conclusion: The LithocatchTM has an excellent ability to capture small stones so it allows to reduce the length of the pro­cedure. Paying attention to limit the amount of fragments collected, it is possible to avoid the entrapment of the basket. If this complication occurs, the problem can be solved by reducing the size of the stone fragments. The preferable type of energy is the ballistic one.   ARTICLE INFO Available at: https://www.intbrazjurol.com.br/video-section/20180105_Giusti_et_al nt Braz J Urol. 2018; 44 (Video #19): 1262-2 [Full...

read more

Addressing the challenges of reoperative robotic-assisted sacrocolpopexy

Vol. 44 (6): 1263-1264, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2018.0037 VIDEO SECTION Wilson Lin 1, Nitya Abraham 2 1 Yeshiva University Albert Einstein College of Medicine, NY, USA ; 2 Department of Urology, Montefiore Medical Center, NY, USA ABSTRACT Sacrocolpopexy is the gold-standard repair for apical pelvic organ prolapse (POP). However, over half of women with POP who undergo the surgery experience recurrence, particularly those with higher preoperative stage, younger age, and greater body weight. We address the challenges of repairing recurrent POP in a patient with a prior transabdominal mesh sacrohysteropexy. ARTICLE INFO Available at: https://www.intbrazjurol.com.br/video-section/20180037_Lin_et_al Int Braz J Urol. 2018; 44 (Video #20): 1263-4 [Full Text]...

read more

A martius flap in the treatment of iatrogenic distal urogenital fistula

Vol. 44 (6): 1265-1265, November – December, 2018 doi: 10.1590/S1677-5538.IBJU.2017.0444 VIDEO SECTION Ivan Ignjatovic 1, 2, Dragoslav Basic 1, 2, Milan Potic 1, 2, Ljubomir Dinic 1, Aleksandar Skakic 1 1 Clinical Center Nis, Serbia; 2 University in Nis, Faculty of Medicine Nis, Serbia ABSTRACT Introduction: Distal urogenital fistulas (DUF) are usually iatrogenic and are uncommon in Europe. They occur in the ure­thra or near the bladder neck, and can be caused by vaginal hysterectomy, para-urethral cyst surgery, or erosion of the bladder or urethra from tension-free slings or meshes. The psychological and physical health consequences of DUF are devastating because most patients consider themselves “healthy” before surgery. Incontinence can appear after success­ful DUF closure due to previously occult incontinence or urethral incompetence. Additional surgery for incontinence is sometimes necessary to achieve satisfactory outcome. Materials and Methods: A Martius flap was used in 23 patients between 2000 and 2015. Patient age range was 38-75 years (mean, 58.7). DUF was due to gynecologic surgery for benign disease (15 / 23; 65.2%), mesh / sling erosion (2 / 23; 8.7%), and malignancy (6 / 23; 26.1%). The follow-up period was one year. Results: DUF was closed in 22 patients (95.6%). Satisfaction and complete dryness was achieved in 16 patients (69.6%) after the first procedure. Postoperative complications were: postoperative hematoma in 1 (4.4%), primary failure in 1 (4.4%), overactive bladder (OAB) syndrome in 3 (13.2%) and postoperative incontinence in 6 (26.4%) patients. A fascial sling was placed in patients with incontinence. All patients were dry after the secondary surgery. Anticholinergics were used for the treatment of OAB syndrome. Discomfort at the flap harvesting site was of minor importance. Finally, 22 out of 23 patients (95.6%) were satisfied. Conclusion: A Martius flap and additional fascial sling could be successfully used to optimize DUF treatment.  ARTICLE INFO Available at: https://www.intbrazjurol.com.br/video-section/20170444_Ignjatovic_et_al Int Braz J Urol. 2018; 44 (Video #21): 1265-5 [Full Text]...

read more