Commentary on “Parental Attitudes Toward Fertility Preservation in Boys with Cancer: Context of Different Risk Levels of Infertility and Success Rates of Fertility Restoration,” Sadri-Ardekani et al. (2013). Fertil Steril 99: 796-802


Cancer survival rates have increased dramatically in recent decades. Until better cancer therapies emerge, infertility will remain a common side effect of cancer therapy. Infertility therapies have likewise flourished in recent decades, but unfortunately the science of infertility has been relatively slow to infiltrate the oncology world. Parents of children with cancer are interested in preventing and/or preserving their children’s fertility. But do they know what their options are? Do they even know infertility is a risk? The answer to both, sadly, is often no. However, now that we know the majority of parents would agree to fertility preservation techniques, we may confidently proceed with appropriate clinical trials.

Thomas W. McLean, Hooman Sadri-Ardekani, Anthony Atala

Submitted June 16, 2013 - Accepted for Publication July 21, 2013

KEYWORDS: Cancer survival, fertility preservation, pediatric cancer

CORRESPONDENCE: Thomas W. McLean, Department of Pediatrics, division of Hematology/Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA ()

CITATION: UroToday Int J. 2013 August;6(4):art 50.


Prevalence of Prostate Carcinoma in the Indian Population: The Need to Revise Serum Prostate Specific Antigen (PSA)


Introduction: This prospective study is an attempt to revise the serum prostate specific antigen (PSA) cutoff level to suit the Asian population.

Materials and Methods: A prospective study was carried out on 172 male patients who underwent transrectal ultrasound (TRUS) prostate biopsies. Only those patients with a serum PSA level within the range of 4 to 10 mg/mL were included in this study. The decision to perform the biopsy was undertaken only after further evaluation using free:total PSA ratio.

Results: Of the 172 patients, 9 (5.23%) patients had adenocarcinoma prostate with a Gleason's score ranging from 4 to 7. In total, 163 (94.7%) patients had benign pathology. Serum PSA ranged from 4.2 to 9.8 ng/mL.

Conclusion: The cutoff level of serum PSA beyond which investigations are warranted in Asians is controversial at present, and further multicentric trials involving a larger number of patients must be carried out to arrive at a consensus.

Nandan R. Pujari

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

KEYWORDS: Prostate carcinoma, serum PSA, Asian population, adenocarcinoma

CORRESPONDENCE: Nandan R. Pujari, MS, DNB (Urology), MGM Medical College, Mumbai, Maharashtra, India ()

CITATION: UroToday Int J. 2013 August;6(4):art 51.


Squamous Cell Carcinoma Arising in Keratinizing Desquamative Squamous Metaplasia (KDSM) of the Renal Pelvis


Keratinizing desquamative squamous metaplasia (KDSM) of the upper urinary tract is a rare condition. We present a case of a 45-year-old male smoker of more than 20 years presenting with a 1-month history of recurrent, intermittent left flank pain of moderate intensity associated with dysuria and nausea. In this case the differential diagnosis included renal cell carcinoma, tuberculosis of the kidney, and KDSM. However, the pathological findings showed squamous cell carcinoma arising in KDSM. Hence we report this rare association of a squamous cell carcinoma of the renal pelvis arising in KDSM.

Mohammed S. Al-Marhoon, P. A. M. Saparamadu, Krishna P. Venkiteswaran, Omar Shareef, Joseph Mathewkunju

Submitted June 7, 2013 - Accepted for Publication July 17, 2013

KEYWORDS: Squamous cell carcinoma, metaplasia, kidney

CORRESPONDENCE: Mohammed S. Al-Marhoon, PhD, MD, MRCSEd, BSc, Sultan Qaboos University, Al-Khould, Muscat, Oman ()

CITATION: UroToday Int J. 2013 August;6(4):art 49.


Isolated Ano-vaginal Fistulae without Associated Vesicovaginal Fistulae Following Prolonged Labor: A Rare Entity


Isolated ano-vaginal fistulae without associated vesicovaginal fistulae following prolonged labor have not been reported. They present with fecal discharge per vaginum. A two-layered fistulae closure with interposition flap is the treatment of choice. Herein, we report such a rare entity that deserves mention.

Vishwajeet Singh, Dheeraj Kumar Gupta, Rahul Janak Sinha

Submitted May 15, 2013 - Accepted for Publication June 30, 2013

KEYWORDS: Ano-vaginal fistulae, vesicovaginal fistulae, obstetric delivery, interposition flap

CORRESPONDENCE: Vishwajeet Singh, M.S.,M.Ch (Urology), Chhatrapati Sahuji Maharaj Medical University (Formerly KGMC), Lucknow, Uttar Pradesh, India

CITATION: UroToday Int J. 2013 August;6(4):art 48.


Management of Overactive Bladder (OAB) in Elderly Men and Women with Combined, High-Dosed Antimuscarinics without Increased Side Effects


Objectives: Numerous elderly patients with overactive bladder (OAB) demonstrate insufficient treatment results under antimuscarinic monotherapy with dose increase. To reduce the OAB symptoms and to estimate safety and tolerability of non-invasive treatment, we evaluated the use of combined antimuscarinics as the alternatives.

Methods: Eighty-one patients older than 65 years, both male and female, who earlier received (for 6 months or more before our study) double-dose antimuscarinic monotherapy (trospium), whose initial symptoms did not resolve (or the improvement was short lived), and who experienced mild or no side effects, were included in this study. The patients demonstrated urodynamic-proven overactive bladder with daily incontinence, increased intravesical pressure, and reduced bladder capacity. Taking into account the strength of the initial study treatment, they were distributed into 3 groups and treated with 2 antimuscarinics. The patients underwent urodynamic examination before enrollment in the sixth week and in the fourth month. During the whole treatment period, they kept special bladder diaries where they, among other issues, described side effects during treatment.

Results: Significant changes were noted at the 6-week follow-up in all 3 groups. The average number of daily incontinence events decreased from 6 to 2 events. The average maximum bladder capacity (177 to 356 mL) and reflex volume (149 to 284 mL) increased; detrusor compliance also improved (average, 16 to 37 mL/cm H2O). Twenty-four patients reported side effects; 3 of them discontinued the successful treatment due to this reason. Seven other patients did not receive any noticeable improvement of detrusor dysfunction, although they did not report any side effects.

Conclusion: The majority of elderly patients, who previously demonstrated unsatisfactory results under dose-escalated monotherapy, were treated successfully with combined high-dosage antimuscarinics (87.6 %). The quantity of side effects was comparable to that of normal-dosed antimuscarinics.

Take-Home Message: The majority of elderly patients, who continued to suffer from symptoms of overactive bladder after dose-escalated antimuscarinic monotherapy, showed subjective and objective treatment success. The therapy used the combination of high-dosed antimuscarinics (87.6%). Obtained side effects were comparable to (did not exceed) the single-drug treatment.

Kirill Kosilov, Sergey Loparev, Marina Ivanovskaya, Lily Kosilova

Submitted April 16, 2013 - Accepted for Publication July 14, 2013

KEYWORDS: Overactive bladder, aging population, pharmacologic treatments, muscarinic antagonists, side effects, tolterodine, trospium, oxybutynin, solifenacin, combination antimuscarinics, urodynamic monitoring

CORRESPONDENCE: Kirill Kosilov, Far Eastern Federal University, Department of Neurourology-Urodynamics, Primorsky Regional Diagnostic Center, Vladivostok, Russian Federation ()

CITATION: UroToday Int J. 2013 August;6(4):art 47.


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