Issue 5: December 2008

UIJ Volume 1 Issue 5 December 2008

Late-Presentation Cross-Ectopia Testes in an Infertile Man 31-Years Old


We present a 31-year-old man with transverse testicular ectopia of the left testis. He presented to our surgical outpatient department with right scrotal swelling, originally diagnosed as an obstructed hernia, and an impalpable testis in the left scrotum. We performed a right herniotomy on the patient and found a large lobulated left testis and normal right testis in the right scrotum. Diagnosis of transverse testicular ectopia was made on the operation table, as the man originally came for repair of obstructed right inguinal hernia. This is the first case of transverse testicular ectopia we have come across since 1966.

Keywords: Transverse testicular ectopia, Inguinal hernia, Urogenital anomalies

Correspondence: Abdulqadir Maghded Zangana, Erbil Teaching Hospital, PO Box 178, Erbil, Iraq,



Utilization of the NMP22 BladderChek Urine Test as an Adjunct to Atypical Cytology in the Detection of Bladder Cancer Recurrence


Objective: To assess the performance of the NMP22® BladderChek® (NMP22-BC) urine test compared with cytological and histological findings for detecting bladder cancer recurrence in patients with a prior history of bladder cancer.

Methods: A prospective study was performed, evaluating a total of 112 urine samples from 67 patients. These samples were obtained prior to cystoscopy and were analyzed with the NMP22-BC. The results were compared against those of voided urine cytology (VUC) and cystoscopy.

Results: Of the 112 samples, there was a total of 27 recurrences (24.1%). The overall sensitivity of NMP22-BC alone was 33%, VUC with malignant or suspicious specimens alone was 37%, and the two methods combined was 46%. The specificity of NMP22-BC alone was 92%, VUC alone was 99%, and both methods combined was 92%. The detection rate of bladder cancer recurrence in high-grade tumors increased from 50% for NMP22-BC alone and 43% for VUC alone, to 64% when both tests were used in combination. The detection rate of recurrence for stages Ta, T2, and CIS was also significantly increased when NMP22-BC and VUC were used in combination. The overall positive and negative predictive values were 68% and 84% respectively. Inclusion of atypia as positive for recurrence (VUC+A) increased the overall sensitivity of cytology to 72% but decreased the specificity to 64%. However, in cases where atypical cytology was confirmed with positive NMP22-BC, the sensitivity of the combination was 46% and specificity was 100%.

Conclusion: NMP22® BladderChek® is a valuable addition to voided urine cytology for detection of high-risk lesions. Our study shows that once atypical cytology is confirmed by NMP22-BC, the specificity is 100%. Furthermore, the sensitivity of this combination is superior to that of malignant or suspicious cytology alone.

Keywords: Bladder cancer, NMP-22, Cytology, Urinary markers

Correspondence: Ravi Munver, Department of Urology, Hackensack University Medical Center, 360 Essex Street, Suite 403, Hackensack, NJ, 07601,



Perforating Intravesical Intrauterine Devices: Diagnosis and Treatment


Background: Intravesical foreign bodies are a reported problem with variable natures. Rarely, it is reported to be an intrauterine device (IUD) that perforates through both the uterine and the vesical walls to lie within the urinary bladder.

Objective: We report our experience with 6 cases of IUDs perforating into the urinary bladder.

Methods: Over 5 years, a total of 6 patients with IUDs perforating to the bladder presented to our facility complaining of LUTS and positive for microscopic hematuria of variable duration. Large, 4- to 5-cm stones were found in 2 patients and were removed via cystolithotomy. IUDs were removed from 3 patients via cystolitholapaxy and endoscopic extraction, and 1 partially perforating IUD with no stone formation was treated via extraction of the device per vagina.

Results: All procedures went well with no complications. Patients received urinary drainage for 1 week postoperatively.

Conclusion: IUD perforation to the bladder, with or without stone formation, is a rare event that can be diagnosed and treated easily with minor procedures and minimal complications, provided that the urologist kept the condition in mind.

Keywords: IUD, Bladder stone

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



Nocturia: Pathogenesis and Diagnosis From a New Viewpoint


Nocturia, which affects general health and quality of life, is a symptom often observed not only in patients with benign prostatic hyperplasia, but in the elderly of both genders as well. There are 5 causes of nocturia: (1) nocturnal polyuria, (2) reduction of nocturnal bladder capacity, (3) a combination of 1 and 2, (4) global polyuria, and (5) sleep disorders. To understand the pathogenesis of nocturia, it is important to investigate different factors for each cause. For nocturnal polyuria (1), it is important to investigate excessive fluid intake, hypertension, circadian rhythm of arginine vasopressin (AVP), and cardiovascular conditions based on brain natriuretic peptide (BNP) levels in plasma. For reduction of nocturnal bladder capacity (2), blood pressure and plasma concentrations of melatonin and glycine must be measured. Complicating systemic diseases such as diabetes mellitus, diabetes insipidus and polydipsia can lead to global polyuria (4), and sleep disorders (5) are defined by the quality of sleep, including conditions of arousal and hypnagogic disorders. The purpose of this article is to review the pathogenesis and diagnosis of nocturia, particularly by focusing on other causes than urological fields, which might lead to a better understanding of nocturia. To diagnose and make a therapeutic plan for nocturia, a modified bladder diary, International Prostate Symptom Score (IPSS), King’s Health Questionnaire (KHQ), Pittsburgh Sleep Quality Index (PSQI), and a sleeping diary are useful and should be combined with an interview and urological examination.

Keywords: Nocturia, Pathogenesis, Diagnosis

Correspondence: Hitoshi Oh-oka, Department of Urology, Independent Administrative Institution National Hospital Organization Kobe Medical Center 3-1-1, Nishi-Ochiai, Suma-ku, Kobe, Hyogo 654-0155, Japan,


Renal Cell Carcinoma with Synchronous Gallbladder Metastasis Treated with Laparoscopic Radical Nephrectomy and Cholecystectomy in the Same Setting


Renal cell carcinoma (RCC) with gallbladder metastasis is a very rare entity, whether as a synchronous or metachronous lesion. Additional ancillary immunohistochemical tests may be required to make the diagnosis. We report the case of a 66-year-old woman with primary RCC and a synchronous gallbladder metastasis, who underwent laparoscopic radical nephrectomy and cholecystectomy in the same setting. Gallbladder histopathology revealed clear cell RCC, similar to the primary tumor. With positive immunostaining of the tumor for CA-IX, she has responded well to interleukin-2 immunotherapy.

Keywords: Kidney neoplasm, Gallbladder, Metastasis

Correspondence: J. Stuart Wolf, Jr., University of Michigan, Department of Urology, 1500 East Medical Center Drive, TC 3875, Ann Arbor, MI, 48109,



Early and Late Complications in Living Donor Nephrectomies


Between May 2000 and May 2003, 300 living donor nephrectomies were performed through an extraperitoneal flank approach. The majority of complications were minor, easily diagnosed, and managed during hospital stay. Early postoperative complications were reported in 22 (7.33%) cases. Of these, wound complications were the most common, accounting for 10 (3.33%) complications, followed by 8 (2.67%) pulmonary complications. The most serious postoperative complication was frank wound bleeding necessitating wound exploration in 2 (0.67%) patients. Postoperative urinary retention was reported in 3 (1%) patients, and deep venous thrombosis was reported in 1 (0.33%). Urinary tract infections were diagnosed in 15 (5%) patients, and there was a stricture of the urethra in 1 (0.33%) patient. All cases were diagnosed and managed carefully. Follow-up lasted for 18-36 months. Late postoperative complications were reported in 28 (9.33%) patients, and urinary calculi were found in 12 (4%) donors.

We proved that retroperitoneal flank nephrectomy is a safe approach for the donor, with acceptable early and late surgical complications. It provides optimal allografts for transplantation, and there were no complications related to non-drain fixation.

Keywords: Living donors, Nephrectomy, Surgical complications

Correspondence: Ahmed Shelbaia, Department of Urology, Cairo University, Borg El Atbaa, Faisal Street, Giza, Egypt,



Treatment of Symptomatic Simple Renal Cysts by Percutaneous Aspiration and Ethanol Sclerotherapy


Introduction: Although simple renal cysts are usually asymptomatic and discovered incidentally, treatment is undoubtedly still indicated in symptomatic patients. Significant pain, compression of the pelvicalyceal system, and possibly related hypertension or hematuria are indications for intervention.

Patients and Methods: Our study included 17 patients (11 men and 6 women, mean age of 46 years) with symptomatic simple renal cysts. The main presentation was renal pain in 9 patients, followed by hypertension in 5 and hematuria in 3. The patients were treated by ultrasonography (US)-guided percutaneous aspiration and with an injection of 95% ethanol. Patients were evaluated one month postoperatively and every six months thereafter by clinical assessment, US, and intravenous urography. Success was defined as complete when there was total ablation of the cyst and partial when there was a recurrence of less than half the original cyst volume and a resolution of symptoms. Failure was defined as the recurrence of more than half of cyst volume or persistent symptoms.

Results: After aspiration and ethanol sclerotherapy, there was microscopic hematuria in 2 patients and low-grade fever (< 38.3°C) in another 2, but no major complications. During a mean follow-up of 19 months (range 14–40), there was complete cyst ablation in 15 (88%) patients and partial resolution in 2 (12%). Pain disappeared or was much improved in all patients. Hypertension was well controlled with no medication in 4 previously hypertensive patients, and hematuria disappeared in all 3 affected patients.

Conclusion: Ethanol sclerotherapy for symptomatic simple renal cysts is simple, minimally invasive, and highly effective. We recommend it as the first therapeutic option in these patients.

Keywords: Simple renal cyst, Percutaneous aspiration, Sclerotherapy

Correspondence: Mohamed Awny Labib, Senior Lecturer, School of Medicine, University of Zambia,