ABSTRACT

Background: Lower urinary tract symptoms (LUTS) have been described in patients with bladder dysfunction due to prolapsed lumbar disks. Progressive compression caused by lumbar disk herniation leads to loss of bladder sensation and voiding difficulty due to an acontractile detrusor.

Objective: Our objective in this study was to determine the cystometric findings in patients with lumbar intervertebral disk protrusion (LDP).

Methods: 80 patients with lumbar disk protrusion were included in this study. Their mean age was 39.9 years (26-64), 58 patients (72.5%) were males, and 22 (27.5%) were females. They were divided into two groups according to their urodynamic results: patients in Group I had normal detrusor function (52 patients), and patients in Group II had abnormal detrusor activity (28 patients). Thorough histories and clinical examinations, including general examinations, urological examinations, and neurological examinations, were done for each patient. Uroflowmetry and cystometry were done for the evaluation.

Results: 18 out of 28 patients in Group II had acontractile detrusor, 7 patients had detrusor underactivity, and 3 patients had neurogenic detrusor overactivity. 35 patients (43.75%, 12 from Group I, 23 from Group II) presented with urological symptoms, and all had more than one symptom. Of the 28 patients in Group II, 23 reported LUTS suggestive of bladder outlet obstruction, and only 5 patients in Group II showed no urological symptoms (P<0.05). There was a statistically significant difference between the two groups regarding multiple LDP affections (P<0.05). There was a high percentage of non-contained LDP in Group II with a statistically significant difference (P<0.05).

Conclusion: Acontractile detrusor represents the most common cystometric finding in patients with LDP. Neurogenic detrusor overactivity may occur in the initial stage of the disease. Patients with multiple, diffuse, and non-contained LDP are more liable to have abnormal detrusor activity.

Keywords: Lumbar intervertebral disk protrusion, urodynamics, acontractile detrusor

Correspondence: Mohamed Hassan, Urology Department, Suez Canal University, Ismailia, Egypt,

ABSTRACT

Introduction: Complete duplication of the collecting system is one of the most common congenital urologic anomalies that should be oriented with nephroureterectomy when symptomatic with urinary tract infection or flank pain. Until recently, nephroureterectomy involved a flank incision with significant morbidity and prolonged recovery time. In the last few years, there have been a few reports of partial nephroureterectomy, particularly in the pediatric population.

Case Presentation: A 25-year-old woman presented to our consult with a history of recurrent right pyelonephritis and a right duplicated kidney and ureter associated with atrophy of the hydronephrotic upper-pole and dilation of the entire respective ureter. Voiding Cystourethrography showed no vesicoureteral reflux. She elected to undergo laparoscopic transperitoneal upper-pole nephroureterectomy. There were no postoperative complications, and the cosmetic result was excellent.

Conclusion: To our knowledge this is one of the few reports of laparoscopic partial nephroureterectomy done in adults. This seems to be a safe and effective technique to be performed in adults, with admirable cosmetic and functional results.

Keywords: Laparoscopic, Partial nephroureterectomy, Duplex kidney, Megaureter

Correspondence: Francisco Botelho, Department of Urology, Hospital S. João, R. Igreja da Areosa nº34 4ºDto, 4200-323, Porto, Portugal,

ABSTRACT

Introduction: Diabetes mellitus is a common public health problem due to the seriousness of its complications. Because of the potential harm to the kidneys of diabetic patients, preventive and therapeutic measures should be taken against the various types of lithiasis.

Materials and Methods: This survey included 116 type 1 diabetics. First morning urine samples were examined with a polarized light microscope for qualitative and quantitative analysis of crystalluria.

Results: The calcium oxalates were more abundant in both genders compared to the other crystalline species, with a frequency of 76.7% at direct examination and 82.4% at +4°C. The total frequency of purine crystalluria was 22.0% at direct examination.

Conclusion:The crystalluria observed in type 1 diabetics showed the predominate prevalence of the oxalocalcic type (Weddellite) crystals with a frequency of 64.5%, followed by Whewellite with a frequency of 15.0%. The high percentage of the purine crystalluria in diabetics gives information about dangers to clinicians and experts.

Keywords: Diabetics, Lithiasics, Crystalluria, Uric acid, Purine, Calcium oxalate

Correspondence: Brahim Kacem, Department of Biology, Faculty of Sciences, University of Mostaganem, City 152 logts Bloc B 16, Mostaganem 27000, Algeria,

ABSTRACT

Background: The use of minimally invasive techniques in the treatment of staghorn and multiple renal stones has overshadowed the open techniques in the past two to three decades. In this study, we reevaluate the role of open techniques in the management of these conditions.

Objective: To compare the role of open techniques versus combined percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) in the management of staghorn and multiple renal stones.

Methods: Between 1999 and early 2005, a total of 208 patients were operated upon: 111 patients with 118 renal units underwent open-technique surgery, and 97 patients with 106 renal units underwent combined PCNL and ESWL. Operative time, operative cost, blood loss, stone-free rate, use of single or multiple sessions, hospital stay, complications, total cost, and time to return to ordinary activities were calculated and plotted in a database, analyzed, and compared for the two groups of patients.

Results: Operative time for the open group was significantly less than the PCNL group, as most of the latter needed multiple sessions of PCNL and ESWL, raising the hospital stay, the operative cost, and the total hospital cost. In the open group, 106 (89.8%) patients were stone free in a single session, and only 12 (10.2%) needed ESWL sessions. In the PCNL group, 88 (83%) patients were stone free after the first session, a statistically significant difference. However, the time needed for convalescence was significantly less for the PCNL group.

Comparing the complication rate for both groups, we found that the open group had less incidence of colonic injury, AV fistula, and urinary leakage, which reflected on the length of hospital stay and cost. However, the open group had more incidence of blood loss and pneumothorax, comparable incidence of sepsis, and needed more time to return to ordinary activity compared to the PCNL group.

Conclusion: Open techniques are still a viable option that should be considered when treating patients with complex multiple and staghorn renal stones, especially regarding their cost-effectiveness in the face of limited resources in developing countries.

Keywords: Stone, Renal, Staghorn, PCNL, Open

Correspondence: Mohamed Ali A Ismail, Urology Department, Theodore Bilharz Research Institute, Giza, Egypt,

ABSTRACT

Objective: A randomized prospective comparison of two synthetic mid-urethral tension-free slings was undertaken at a university hospital to evaluate clinical efficacy, complication rates, and ease of procedure and training residents.

Methods: Between January 2004 and September 2005, 96 women with stress urinary incontinence were consecutively assigned to Gynecare TVT^® or Boston Scientific Lynx^® mid-urethral slings (n=48 in each group) at the University of Nebraska Medical Center. Both groups were similar in mean age, parity, weight, preoperative post-void residual, cystometric capacity, flow rate, and urethral closure pressures. Postmenopausal status and previous incontinence surgery rates were also comparable. Intraoperative complications, ease of trocar placement, postoperative voiding difficulties, subjective and objective cure rates, and postoperative interventions were assessed. During statistical analysis, p<0.05 was used as cut-off for significance.

Results: Half of the patients in both groups underwent multiple procedures. There were two (4%) trocar injuries with the TVT and three (6%) with the Lynx (p=.21). Early postoperative voiding dysfunction was 21% (10 patients) for the TVT group versus 15% (7 patients) for the Lynx (p<0.001), whereas prolonged catheterization for two weeks was similar at 4% (2 patients) for both. UTI rate for the TVT was 10% (5 patients) and 13% (6 patients) for Lynx (p=0.02). Subjective cure rates were 94% (45 patients) and 92% (44 patients), respectively (p=.08). Urethral closure pressure <14 cm H₂O was the identifiable risk for objective failure. Objective cure rates were 96% (46 patients) for the TVT and 94% (45 patients) for the Lynx (p=.12), suggesting that some subjective failure was likely due to de novo bladder overactivity. One sling in the Lynx group was removed for skin cellulites, and one sling slit in TVT group was removed for voiding dysfunction due to duplicated ureter on the left side.

Conclusion: Despite similar efficacy, complication rates, and failure rates, the incidence of postoperative voiding difficulties was better with Lynx, due likely to the mid-urethral seal. However, it was difficult to place the Lynx trocar in patients with prior surgeries, probably due to the blunt needle and notch. An increased rate of vaginal graft exposure was seen with the Lynx. Residents favored the Lynx trocar because of its light weight and greater stability.

Keywords: TVT, Lynx, Synthetic mid-urethral tension-free slings

Correspondence: Neena Agarwala, University of Nebraska Medical Center, Omaha, NE 68198,

No abstract available.

Correspondence:

Dear Colleagues,

The 4th International Consultation on Incontinence (ICI) will be held in Paris July 5-8, 2008. The organizers of this workshop have summoned the world´s leading experts in urology, gynecology and urodynamics to present and discuss the most recent advances in the field, including epidemiology, basic science, and treatment. However, the purpose is not only to review the current state of knowledge on incontinence, but also to propose strategies for the practical diagnostic and therapeutic management of the disorders following the evidence based medicine principles. Additionally the purpose is to propose validated standard international instruments to evaluate incontinence, and to help standardize response criteria and recommendations for clinical research on incontinence.

This broad scope of the workshop is reflected in the abstracts of the posters that will be presented at the meeting and which this first issue of Urotoday International Journal (UIJ) is proud to publish with exclusivity. The abstracts comprise not only different aspects of the overactive bladder such as treatment, epidemiology, basic science, but also summarize recent advances in the areas of stress incontinence, pelvic floor disorders and prolapse. Methods, technical and diagnostic aspects of incontinence, as well as of treatment, are also covered. The aim of UIJ is to elevate the access to relevant urology science to professionals around the world and to make this scientific information available to a wide audience. We believe that there is a good chance that this aim will be fulfilled for these abstracts, since UIJ currently reaches over 60,000 professionals in urological diseases.

It is our hope that all professionals in the fields of incontinence research and management, both experienced and newcomers, will benefit from these abstracts, and become inspired towards further efforts.

Kind regards,
Karl-Erik Andersson
Editor-in-Chief

ABSTRACT

Foreign objects in the urinary bladder may result from urethral passage by the patient, extraneous trauma or ballistic injury, or even more rarely as a result of spontaneous migration of retained metal fragments from prior trauma. In the former acute trauma settings, the patient usually presents for prompt evaluation and treatment. In the latter setting, the patient may present in a delayed fashion with nonspecific urologic complaints. We present an unusual case report involving the extremely delayed migration of a retained piece of shrapnel into the urinary bladder.

Keywords: Bladder, Extravesical, Trauma, Shrapnel

Correspondence: Amir Arsanjani, Department of Urology, New York Medical College, Munger Pavilion, Room 457, Valhalla, NY, 10595,

ABSTRACT

Since the pathophysiology of Lower Urinary Tract Symptoms/Overactive Bladder (LUTS/OAB) is multifactorial, there are many potential targets for future drugs, as identified in preclinical investigations. However, it is difficult to predict what principles can be applied clinically. The mere finding that a drug affects the LUT in a desirable direction seldom motivates speculations like “this may be a new way of treating LUTS/OAB”. For several of the potentially useful drugs, published clinical studies have demonstrated the proof of principle. This review will discuss the pharmacology of and clinical experiences with some of these drugs.

Correspondence: K-E Andersson, Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC, 27157, USA,

ABSTRACT

Background: The development of computer-based equipment for diagnostic and therapeutic purposes has evolved considerably in the past few decades. The ability to remotely operate various devices has led physicians to provide off-site assistance in different areas of medicine.

Objectives: The aim of this paper is to share the authors’ initial experience with remote-access urodynamic telementoring. The main focus is in the possibility of using this method for teaching purposes.

Methods: A combination of software installed in both the equipment and the remote computer allowed mentors to participate in the test both peri- and post-procedurally. The use of a webcam allowed visualization and dialog with the patient, and more than one observer could monitor technicians performing the test. Password-protected access warranted patient privacy.

Results: The authors remotely monitored over one hundred urodynamic studies performed in two centers during the past 6 months. The results were satisfactory concerning remote visualization and reporting of tests. The use of this technology adds very little cost in terms of both equipment and operating procedures.

Conclusions: Telementoring in urodynamics may open new possibilities for the teaching and spreading of this important urologic diagnostic tool.

KEYWORDS: Telementoring, Urodynamics, Diagnostic, Urinary incontinence

CORRESPONDENCE: Salvador Vilar Correia Lima, Department of Urology, Federal University of Pernambuco, Av. Parnamirim, 95, Recife, Brazil,

ABSTRACT

Background: Of adults 50 to 80 years old, 29% of men in Europe and 34% of men in the United States have moderate to severe lower urinary tract symptoms. Alpha-blocker medications are the first line of therapy for men with these urinary symptoms. Among this population, cataracts are similarly common. The “intra-operative floppy iris syndrome” cataract surgery complication has been reported in men using alpha-blockers.

Objective: To assess the frequency of cataract surgery complications arising from alpha-blocker therapy in a large patient population.

Design, Setting, and Participants: We retrospectively reviewed the outcomes of 2666 consecutive adults who underwent elective unilateral cataract surgery. The surgeries took place between 2000 and 2005 at both a large university hospital system and a Veteran’s Association medical center. Medical records were assessed for medication use, and operative records were reviewed for evidence of difficult procedures.

Results: The risk of complicated cataract surgery was 14.9% in patients using alpha-blockers, approximately 50% higher than those not receiving this medication (9.5%) (p=0.003). The increased rate of complicated surgeries was restricted primarily to patients over 65 years of age, as 15.6% of surgeries performed on these patients resulted in complicated surgery (p=0.03). There was no statistically significant increase in the rate of complicated surgeries in patients under age 65 who were using alpha-blockers (p>0.05).

Conclusions: If possible, alpha blocker medications should be discontinued prior to eye surgery in older patients.

Keywords: Alpha-Blocker Medications, Lower Urinary Tract Symptoms, Intra-Operative Floppy Iris Syndrome, Cataract Surgery

Correspondence: Thomas A. Rozanski, Department of Urology, MC 7845, UTHSCSA, 7703 Floyd Curl Drive, San Antonio, Texas, USA, 78229,

ABSTRACT

Background: Atypical adenomatous hyperplasia (AAH) is a small, glandular proliferation that has histological similarities to Gleason grade 1 and 2 prostatic adenocarcinoma (PACG 1, 2). There are no distinct histomorphological criteria distinguishing these two lesions from each other and other small glandular proliferations. It is necessary to define histological criteria, as treatment approaches are different for these lesions.

Objectives: This study’s aim was to evaluate the differences in the secretory properties of AAH and PACG 1, 2. We searched for intraluminal crystalloids, corpora amylacea, mucin, and eosinophilic material.

Subjects and Methods: 105 totally embedded radical prostatectomy specimens containing 11 AAH (22 foci) and 15 PACG 1, 2 (22 foci) lesions were evaluated. Basal cell specific antikeratin was applied. We accepted that PACG 1, 2 lesions do not contain basal cells, and we grouped lesions as AAH and PACG 1, 2 based on this opinion. The luminal contents were evaluated by PASAB2, 5 and PTAH.

Results: We found differences between the AAH and PACG 1, 2 lesions for some parameters, including crystalloids, corpora amylacea, and mucin. We found similar properties between the two lesions for eosinophilic material.

Conclusion: In a difficult case, evaluation of the luminal content features may be helpful, but the diagnosis must be supported by immunohistochemistry.

Key Words: Adenosis, Small Glandular Proliferations, Low-Grade Cancer, Prostate, Crystalloids

Correspondence: Ahmet Midi, Pathology Laboratory, Maltepe University, Atatürk cad. Çam sok. No 3, Maltepe, Istanbul, 34882,

ABSTRACT

Intractable dysuria several months after Greenlight™ laser transurethral resection of prostate (PVP) is a well-known occurrence that may affect some men. We present a patient who suffered dysuria for four months after Greenlight™ vaporization but had prompt resolution after undergoing holmium laser ablation of the prostatic fossa. A possible explanation is discussed.

KEYWORDS: Benign Prostatic Hyperplasia, Laser, Dysuria

CORRESPONDENCE: Steve Y Chung, 3068 E. 1825th Road, Ottawa, IL, 61350,

Dear Colleagues,

I would like to announce the launch of the UroToday International Journal® (UIJ) (http://www.urotodayinternationaljournal.com), a new online, peer-reviewed, fast-tracked urology and urologic oncology publication. UIJ focuses specifically on the professional global urology and urologic oncology community. It will elevate the access to relevant urology and oncology science to professionals around the world. UIJ will make the scientific information available to a much wider audience than that reached by other journals, including potential readers who do not have access to a research library that can afford to pay for journal subscriptions. There is no charge to register, submit or publish an article in the UIJ. Additionally there are no charges for color figures. There is no other urology journal offering this unique approach to achieve peer-review publication.

UIJ reaches currently over 55,000 professionals in urology. UIJ will open for general submission of manuscripts on May 31st, 2008 for the July issue.

All manuscripts will be subject to rigorous peer-review. All accepted articles will be given Digital Object Identifier (DOI) numbers so that they can be retrieved and indexed by Pubmed as soon as the pending application from UroToday International Journal has been accepted.

The UroToday International Journal® has an international editorial board headed by myself, Professor at the Institute for Regenerative Medicine at Wake Forest University. The Section/Associate Editors are; Christopher P. Evans, Christian Gratzke and Yasuhiko Igawa. Christopher P. Evans MD, FACS is the Chair of the Department of Urology and Professor & Chairman of Urologic Surgical Oncology University of California, Davis, School of Medicine. Christian Gratzke is an Urologist in the Department of Urology, at the University of Munich in Germany and Yasuhiko Igawa, MD, PhD, is Professor in the Department of Urology at Shinshu University School of Medicine, Japan.Gina B. Carithers is the Publisher of both the UroToday International Journal® and www.urotoday.com. The Managing Editor is Tracy Ireland.

Kind regards,
Karl-Erik Andersson, MD, PhD

Editor-In-Chief

ABSTRACT

Introduction: Stress urinary incontinence (SUI) is the involuntary leakage of urine during periods of increased abdominal pressure (e.g., coughing, running or lifting). It is caused by an incompetent urethral sphincter which may arise as a consequence of damage to the pelvic floor muscles sustained during pregnancy and childbirth. Pharmacological therapy includes the off-label use of sympathomimetic medication (alpha-adrenergic agonists), to enhance urethral tone and alleviate symptoms, however their associated cardiovascular side effects (e.g. hypertension) limits their utility. PSD503 (Plethora Solutions Ltd, London, UK) is a controlled dose topical gel, which contains the alpha-adrenergic agonist phenylephrine (20% w/w). It has been developed as a locally administered treatment for SUI, to increase urethral tone and provide symptomatic relief, in the absence of systemic side effects.

Background

Obesity is an established and modifiable risk factor for urinary incontinence (UI) but conclusive evidence for a beneficial effect of weight loss on UI is lacking.

Introduction: We present a retrospective study involving 48 patients, who underwent transurethral resection of the prostate (TURP) for bladder outflow obstruction due to prostatic enlargement [4]. The aim of the study was to compare the safety of 2-way catheters post-TURP in relation to the 3-way catheter.

ABSTRACT

Introduction: Lower urinary tract dysfunction (LUTD) following neurological illness depends upon the level of lesion in the nervous system, causing a characteristic pattern of lower urinary tract symptoms (LUTS). However, a subset of patients may have symptoms that are at variance from the expected pattern.

Background

Obesity is an established risk factor for urinary incontinence (UI).

ABSTRACT

Introduction and Objectives: Faecal incontinence is a devastating social and physical handicap affecting 2% of the general population. It is 8 times more common in females than males, largely due to the adverse effects of childbirth on vulnerable pudendal nerves. Our laboratory created 2 rat models simulating faecal incontinence in which the inferior rectal nerve (a terminal branch of the pudendal nerve that supplies the external anal sphincter) is either crushed or compressed. We aimed to determine the effects of these injuries on inferior rectal-nerve axonal counts and cross-sectional areas in our rat models, and to correlate these findings with somatosensory evoked potentials (SSEPs) from the same animals.