Accuracy of Computed Tomography for Identifying Locally Advanced Disease in Patients with Muscle-Invasive Bladder Cancer


Introduction: To retrospectively evaluate the utility of computed tomography (CT) scanning in identifying patients with locally advanced bladder cancer.

Methods: We performed an Institutional Review Board-approved review of 858 patients that underwent radical cystectomy (RC) from 2000 to 2008 at our institution. We selected patients with muscle-invasive bladder cancer (MIBC) who underwent up-front RC without neoadjuvant chemotherapy and who were assessed by preoperative CT scan. We limited this analysis to 48 CT scans obtained prior to transurethral resection. All CT scans were blinded and retrospectively re-read by a dedicated genitourinary radiologist (CSN) to identify tumor location, the presence of wall thickening, and evidence of extravesical disease (stranding or nodularity) or lymph node metastases. These radiologic findings were compared with pathologic findings.

Results: Pretransurethral resection CT scans were able to accurately identify tumor location in 66.7% of patients (sensitivity = 88.9%, specificity = 33.3%) while lymph node assessment was accurate in 58.3% (sensitivity = 75%, specificity = 62.5%). However, only 16.7% of patients with pathologic T3b disease were actually identified on CT as having radiologic evidence of extravesical disease. Specific radiologic signs suggestive of local disease extension, such as wall thickening, stranding, and nodularity correlated poorly with true pathologic T3b disease.

Conclusion: CT scanning has limits in its ability to accurately identify extravesical disease and lymph node spread in patients with MIBC. Investigations into additional or alternative means of clinical staging for bladder cancer patients are incredibly crucial.

Rian J. Dickstein, Chaan S. Ng, Colin P. Dinney, Ashish M. Kamat,

Departments of Urology and Radiology, the University of Texas, M. D. Anderson Cancer Center, Houston, Texas, United States

Submitted May 29, 2013 - Accepted for Publication August 14, 2013

KEYWORDS: Urinary bladder neoplasms, X-ray computed tomography, neoplasm staging

CORRESPONDENCE: Ashish M. Kamat, Department of Urology, Unit 1373, the University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, United States ()

CITATION: UroToday Int J. 2013 October;6(5):art 55.


A Large Calculus in Crossed Renal Ectopia without Fusion: A Case Report


Crossed renal ectopia is a congenital malformation that occurs either in fused or non-fused form. Only 10% are of the non-fused variety. Most cases remain undiagnosed because they remain asymptomatic. We report a case of crossed left-to-right renal ectopia with stones and successful management.

Atul Kumar Khandelwal, Ahsan Ahmad, Mahendra Singh, Vijoy Kumar, Rajesh Tiwari, Shivani Khandelwal

Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India

Submitted June 1, 2013 - Accepted for Publication July 31, 2013

KEYWORDS: Crossed ectopia, kidney without fusion, calculus

CORRESPONDENCE: Atul Kumar Khandelwal, MBBS, MS, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India ()

CITATION: UroToday Int J. 2013 October;6(5):art 54.


Letter from the Editor - August 2013

Dear Colleagues,

At the height of the summer, we hope you all have a chance to enjoy some time off and recharge your batteries! We at UroToday International Journal are not slowing down much at any time of the year but are proud to continue bringing our readership an interesting and educational mix of articles and case-reports in the field of urology and urologic oncology.

We also would like to remind everyone to view UIJ on the social media outlets Facebook and Twitter, and follow us and the breaking news posted there.

In this issue, Pujari et al. analyzed the utility of tamsulosin in patients with pelvic floor urethral distraction injuries (PFUDD) undergoing voiding cystourethrograms to assess the posterior urethra for length of the distraction defect. They concluded that tamsulosin effectively relaxed the bladder neck and allowed the delineation of the posterior urethra in patients of PFUDD with a competent bladder neck. This prevented the patients from undergoing further invasive diagnostic techniques (bougiogram and antegrade cystourethroscopy).  

Sharma et al. prospectively evaluated the safety, feasibility, and efficacy of day care/ambulatory tubeless percutaneous nephrolithotomy. They conclude it is a feasible and effective option that can safely be offered to patients, providing uncomplicated surgery and favorable postoperative parameters.

A retrospective chart review was completed by Logan et al. to analyze their institutional renal cell carcinoma (RCC) database to determine how consistently aberrations in aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) values were present when metastatic RCC was present. They found that AST, ALT, and ALP are unreliable in suggesting the presence of metastatic RCC lesions in liver or bone, and underscore the importance of imaging.

Lodh et al. aimed to identify independent predictors of unsuccessful trial without catheter (TWOC) in men with acute urinary retention secondary to benign prostate hyperplasia. Their study suggested that age, intravesical prostatic protrusion, transition zone volume, transition zone index, and residual urine volume are significant risk factors for unsuccessful TWOC.

To reduce the OAB symptoms and to estimate safety and tolerability of non-invasive treatment, Kosilov et al. evaluated the use of combined antimuscarinics as the alternative to single agent treatment in elderly OAB patients. They found that the majority of elderly patients were treated successfully with combined high-dosage antimuscarinics. In addition, the quantity of side effects was comparable to that of normal-dosed antimuscarinics.

Pujari et al. performed a prospective study in an attempt to revise the serum PSA cut off level to suit the Asian population. The cut off level of serum PSA beyond which investigations are warranted in Asians is controversial at present and further multicenter trials involving a larger number of patients must be carried out to arrive at a consensus, since blindly following the current Western literature results in unnecessary interventions in this patient population.

A simple and safe technique of male urethral catheterization only requiring equipment readily available in every urology department is described by Gardi et al.

Finally, in a Letter to the Editor, McLean et al. discuss the parental attitudes toward fertility preservation in boys with cancer. Most parents of pediatric oncology patients are under-informed about fertility implications of cancer therapy, and most would want their son to undergo fertility preservation. Predictably, increased infertility risk and increased theoretical success rate both independently increase parents’ interest.

We also present a series of case studies that include various topics, including en-bloc kidney transplantation, isolated ano-vaginal fistula, renal pelvis squamous cell carcinoma, and giant leiomyoma of ureter.

It is our primary goal to publish original studies, and we encourage you to submit the results of clinical or basic science research in all areas of urology. I personally thank the authors and reviewers for their valuable contributions to this issue.

Warm Regards, 

Karl-Erik Andersson

The Challenge of Difficult Catheterization in Men: A Novel Technique and Review of the Literature



Male urethral catheterization can be difficult and is still a familiar problem for urologists. A laborious male urethral catheterization is often consequent to the presence of a bulky prostate due to benign prostatic enlargement, a condition intimately related to aging with an increasing prevalence in elderly people. The task of passing a urethral catheter in this atypical condition often leads to repeated and unsuccessful attempts, which can cause the patient distress, and are often related to a wide range of complications, sometimes leading to medico-legal lawsuits.

We describe a simple and safe technique only requiring equipment readily available in every urology department. It facilitates the chances of an atraumatic and successful catheter insertion in men suffering from different pathologic or anatomic conditions when a primary attempt of simple transurethral catheterization fails.

The performance of the technique was tested in 76 patients who required bladder catheterization by a urologic consultant because of failed primary attempts. Difficulties were attributable to past transurethral resection of the prostate in 10 patients, past open radical retropubic prostatectomy in 7, and benign prostate enlargement in 59. Successful catheterization was obtained in 65 patients, 5 patients were otherwise catheterized by a rigid catheter, and 6 required a suprapubic catheter or flexible cystoscopy. Complications comprised self-limiting urethral bleeding in 12 patients, urinary tract infection in 4, and false passage in 2.

The technique is well tolerated and increases the likelihood of successful primary urethral catheterization in this set of patients; moreover, a hospital admission that is needed in case of placing a suprapubic catheter is not required.

Mario Gardi, Giulio Massimo Balta, Marcello Repele, Nicola Zanovello, Giovanni Betto, Simonetta Fracalanza, Wanni Battanello, Bruno Santoni, Silvia Secco, Andrea Agostini, Massimo Dal Bianco

Submitted June 1, 2013 - Accepted for Publication July 31, 2013

KEYWORDS: Difficult catheterization, bulky prostate, prostate enlargement, complication, malpractice

CORRESPONDENCE: Mario Gardi, MD, PhD, Urology Unit, Department of Surgery, Ospedale Sant’Antonio, Building G, Via Facciolati, 71, Padova, Italy ()

CITATION: UroToday Int J. 2013 August;6(4):art 53.


Giant Leiomyoma of the Ureter Leading to a Loss of Renal Function: A Case Report



Leiomyoma of the ureter is a very rare benign tumor of mesenchymal origin, which may be very difficult to differentiate from malignant tumors before surgery. With the exception of the numerous fibrous polyps, only the occasional example of leiomyomas, neurofibromas, hemangioma, and fibrolipoma have been reported. To the best of our knowledge only 12 cases have been reported worldwide since 1955, with only 1 case of bilateral ureteric leiomyoma. The aim of this report is to highlight the rarity of this tumor and its impact on renal function.

Tanveer Iqbal Dar, Mohamad Sajid Bazaz, Nuzhat Tabasum, Mohammad Saleem Wani, Abdul Rouf Khawaja

Submitted March 21, 2013 - Accepted for Publication July 22, 2013

KEYWORDS: Ureteral tumors, leiomyoma, radical nephroureterectomy

CORRESPONDENCE: Dr. Tanveer Iqbal, Clinical Assistant, Department of Urology and Renal Transplant Surgery, Sir Ganga Ram Hospital, New Delhi, India, 110060 ()

CITATION: UroToday Int J. 2013 August;6(4):art 52.


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