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Letter from the Editor - June 2013

Dear Colleagues,

Like the spring weather, Urotoday International Journal boasts its own mix of interesting and unpredictable articles of note that are sure to engage and interest our readers. We are proud of the encouraging variety of submissions and the discussion they will create in the days, weeks, and months ahead.

Singh et al. assessed the effectiveness of using intravesical prostatic protrusion (IPP) in correctly predicting bladder outlet obstruction (BOO) in symptomatic patients with BPH. In these patients, they compared IPP with other parameters of BOO like prostate volume, bladder wall thickness, PVR, and uroflowmetry. They conclude that bladder wall thickness and post-void residue in conjunction with IPP are good predictors of clinically significant BOO due to BPH.

Khan and colleagues discuss the incidence of immediate graft function (IGF), identify events causing delayed graft function (DGF), slow graft function, and factors that promote IGF in our living donor transplant recipients using kidneys recovered exclusively by open donor nephrectomy (ODN). They conclude that ODN is associated with excellent IGF and recommend it.

Nath et al. aim at determining the role of testosterone as a lithogenic factor and its relation to urinary and stone components. They found higher serum-free and total testosterone, and 24 hours of urinary oxalate  in male stone formers compared to non-stone formers. A larger prospective study is necessary to establish testosterone as a lithogenic factor in male former-stone patients.

The team of Falahatkar et al. compares complications and outcomes of totally ultrasonic versus fluoroscopically guided complete supine percutaneous nephrolithotomy (csPCNL). Through their findings, they demonstrate that totally ultrasonic had similar outcomes to fluoroscopic csPCNL in selected cases and conclude that ultrasonography can be an alternative to fluoroscopy in csPCNL.

Al-Asali and team assess if the AJUST® SIS would be an effective alternative to the TOT in a cohort of patients who have urodynamic stress incontinence with concomitant detrusor overactivity, voiding difficulty, high BMI, or those with previous retropubic surgery. Mean postoperative pain scores were low with no de novo groin pain. All women had satisfactory postoperative voiding and a negative cough stress test at 6 weeks of follow-up. At the 2-year follow-up, 89% had still improved.

Finally, Draga et al. present a study that investigates the accuracy of reproducing bladder coordinates during transurethral resection using an optical navigation system, as a first step to assess the feasibility of accurate navigation-assisted resection of bladder tumors. They show that navigation-assisted mapping of the bladder is accurate with constant bladder volumes.

We also present a series of case studies on several topics, including idiopathic urethral strictures, late bladder erosion complications, and primary vulval tuberculosis.  

As always, we are grateful to our sustained readership, our devoted authors, and our hard-working editorial board that continues to work tirelessly to make UIJ a distinguished journal in the field. 

Sincerely,

Karl-Erik Andersson

Late Bladder Erosion Complications and Vesical Stone Formations of Synthetic Graft Materials Used in Mid-Urethral Sling Procedures

ABSTRACT

We present a case of 2 patients with late bladder erosion and vesical stone formation due to mesh erosion from mid-urethral polypropylene slings and their management. Patients presented 18 and 22 months after surgery with hematuria, recurrent urinary tract infections, and lower urinary tract symptoms. Stone fragmentation was done by pneumatic lithotripsy, and transurethral resection of the mesh was performed using a 26 Fr resectoscope. Postoperative control cystoscopy demonstrated complete healing of bladder mucosa after 3 months. The patients were satisfied with this result, and the patients reported significant improvement of symptoms. The patients remained completely continent at the follow-up period. The endoscopic management of the eroded mesh should be the first choice of bladder erosion therapy. Careful and comprehensive urethrocystoscopy is mandatory during a mid-urethral sling procedure. There is a need for long-term follow-up of patients with mid-urethral slings. We present a case of 2 patients with late bladder erosion and vesical stone formation due to mesh erosion from mid-urethral polypropylene slings and their management. Patients presented 18 and 22 months after surgery with hematuria, recurrent urinary tract infections, and lower urinary tract symptoms. Stone fragmentation was done by pneumatic lithotripsy, and transurethral resection of the mesh was performed using a 26 Fr resectoscope. Postoperative control cystoscopy demonstrated complete healing of bladder mucosa after 3 months. The patients were satisfied with this result, and the patients reported significant improvement of symptoms. The patients remained completely continent at the follow-up period. The endoscopic management of the eroded mesh should be the first choice of bladder erosion therapy. Careful and comprehensive urethrocystoscopy is mandatory during a mid-urethral sling procedure. There is a need for long-term follow-up of patients with mid-urethral slings. 


Emrah Okulu, Kemal Ener, Mustafa Aldemir, Onder Kayigil

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


KEYWORDS: Bladder erosion, incontinence surgery, vesical stone

CORRESPONDENCE: Emrah Okulu, M.D., Umit Mh. Meksika Cd. 2463. sk. 4/32, Umitköy, Yenimahalle, Ankara, Turkey ()

CITATION: UroToday Int J. 2013 June;6(3):art 41. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.15

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The Role of Serum Testosterone as a Lithogenic Factor and Its Correlation with Stone and Urine Composition Amongst Male Stone Formers

ABSTRACT

Introduction: Urolithiasis typically affects adult men more commonly than women with a two- to threefold higher incidence. Stone disease has been found to have an inverse relationship as one ages. This gender and age differentiation invites the role of testosterone as a possible lithogenic factor. Our study aims at determining the role of testosterone as lithogenic factor and its relation to urinary and stone components.

Methods: A total of 87 men older than 18 years were enrolled in our study. Early morning free and total testosterone, serum level of the parathyroid hormone, calcium acid, and uric acid were estimated between the 2 groups. Twenty-four hours of urinary oxalate, uric acid, and calcium were estimated in all patients and the control. Stone analysis was done to determine stone composition for stones in the former group.

Results: Of the 87 patients, 48 patients had a history of urolithiasis and 39 patients had no history of urolithiasis. In comparison to non-stone formers, stone formers have higher serum-free and total testosterone, and 24-hour urinary oxalate. A positive and weak-positive correlation was found in relation to 24 hours of urinary oxalate for free and total testosterone, respectively. Calcium oxalate stones were found in 40 patients. Other differences between the 2 groups were not statistically significant.

Conclusions: A higher serum-free and total testosterone, and 24 hours of urinary oxalate were found in male stone formers compared to non-stone formers. Serum testosterone had a positive correlation to urinary oxalate. These findings have a similarity with animal and human studies. A larger prospective study is necessary to establish testosterone as a lithogenic factor in male former-stone patients.


Simanta Jyoti Nath, Debanga Sarma, Puskal K. Bagchi, Sasanka K. Baruah, Rajeev T. Puthenveetil, Saumar J. Baruah

Submitted February 25, 2013 - Accepted for Publication May 12, 2013


KEYWORDS: Serum testosterone, urinary oxalate, calcium oxalate stones

CORRESPONDENCE: Dr. Simanta Jyoti Nath, Department of Urology, Gauhati Medical College & Hospital, Bhangagarh, Guwahati, PIN-78100, Assam, India, ()

CITATION: UroToday Int J. 2013 June;6(3):art 37. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.11

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Primary Vulval Tuberculosis Presenting As Multiple Vulval Ulcers: A Rare Case Report

ABSTRACT

Primary tuberculosis (TB) of the vulva is very rare. Here we report a case of primary ulcerative vulvar TB. The diagnosis was made on the histopathological finding along with demonstration of acid-fast bacilli on tissue biopsy and managed with anti-tubercular drugs. So, tuberculosis should be suspected in cases of non-healing vulvar ulcers, particularly in developing countries.


Krishnendu Maiti, Shwetank Mishra, Malay Bera, Dilip Pal, Moumita Maiti, Partha Pratim Mondal

Submitted February 27, 2013 - Accepted for Publication May 10, 2013


KEYWORDS: Vulva, tuberculosis, non-healing, ulcers

CORRESPONDENCE: Shwetank Mishra, Department of Urology, Institute of Postgraduate Medical Education & Research, Kolkata, India ()

CITATION: UroToday Int J. 2013 June;6(3):art 39. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.13

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Does Intravesical Prostatic Protrusion Predict Bladder Outlet Obstruction in Patients with Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia?

ABSTRACT

Aim: To prospectively detect clinically significant bladder outlet obstruction (BOO) in all symptomatic patients presenting with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) by studying select parameters like prostate volume, bladder wall thickness (BWT), intravesical prostatic protrusion (IPP), post-void residue (PVR), and uroflowmetry. Our aim is also to determine the effectiveness of using IPP in correctly predicting BOO in symptomatic patients with BPH, and to compare IPP with other parameters of BOO like prostate volume, bladder wall thickness, PVR, and uroflowmetry in patients with symptomatic BPH.

Methods: After obtaining institutional ethical clearance for this study and administering an informed consent, history, focused urological examination, and International Prostate Symptom Score (IPSS), select ultrasonographic and uroflowmetry parameters were recorded and analyzed in 48 selected patients, as per our protocol.

Results: The mean BWT, PVR, and IPP were 6.26 mm, 91.27 cc, and 8.2 mm, respectively, and their mean maximal flow rate (MFR), average flow rate (AVR), voiding duration, acceleration, and hesitancy time in 44/48 evaluable patients (4 patients had AUR) were 13.68 (3 to 49) mL/min, 7.17 (2 to 25) mL/min, 49.12 (15 to 115) secs, 3.82 (0 to 70) secs, and 13.9 (1 to 242) secs, respectively. The paired sample test (2-tailed) analysis demonstrated that the relationship between BWT vs MFR, IPP (mm) vs MFR, PVR vs MFR, and AFR was highly significant (P < 0.001).

Conclusion: With increasing life expectancy, more men are destined to develop bothersome symptoms due to BPH. Bladder wall thickness and post-void residue in conjunction with intravesical prostatic protrusion are good predictors of clinically significant bladder outlet obstruction due to BPH. A search for more reliable, accurate, and non-invasive methods could substitute present methods of evaluating symptomatic BOO due to BPH.


Iqbal Singh, Shankar Kumar

Submitted February 27, 2013 - Accepted for Publication May 10, 2013


KEYWORDS: BPH, bladder outlet obstruction, bladder wall thickness, post-void residue, intravesical prostatic protrusion

CORRESPONDENCE: Dr. Iqbal Singh, MCh (Urology), DNB (GU Surgery), MS, DNB (Surgery), Professor & Senior Consultant Urologist, Department of Surgery (Urology), University College of Medical Sciences, New Delhi, India ()

CITATION: UroToday Int J. 2013 June;6(3):art 40. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.14

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