The authors present the case of a 68-year-old male with mucinous adenocarcinoma of the ileal neobladder. The adenocarcinoma occurred 20 years after radical cystoprostatectomy for Stage pT2 transitional bladder cell cancer. An international literature search revealed 10 cases with a neoplasm in an ileocystoplasty, but this type of adenocarcinoma has not been reported previously. The present case supports the hypothesis that morphologic and molecular changes in an ileal neobladder may increase the risk of local malignancies. Patients with an ileal neobladder may develop glandular malignancy and should be closely followed.

KEYWORDS: Neoplasm; Bladder; Enterocystoplasty; Urinary diversion

CORRESPONDENCE: Dr. Satâa Sallami, Department of Urology, La Rabta Hospital-University, Tunis 1007, Tunisia ().

CITATION: Urotoday Int J. 2009 Dec;2(6). doi:10.3834/uij.1944-5784.2009.12.16

Urinary incontinence secondary to neurogenic detrusor overactivity (NDO) is a common problem in patients with neurologic pathology. Patients with NDO are at increased risk for recurrent urinary tract infection and renal damage, especially due to high intravesical pressures. They may also experience urinary urgency, frequency, and incontinence, which are all factors that negatively affect quality of life. Oral antimuscarinic agents are considered first-line pharmacologic therapy, but their use may be limited by adverse effects and result in poor compliance and adherence. Surgical augmentation of the bladder is a rare final alternative when other attempts to restore continence have failed. However, there are other less invasive treatment options that are currently available or undergoing research. These options include transdermal or intravesical administration of antimuscarinics, intravesical administration of other agents (including vanilloids and botulinum toxins A and B), and electrical stimulation. The available alternatives have demonstrated varying degrees of efficacy and are all minimally invasive, allowing surgery to be avoided where possible. However, neither vanilloid nor botulinum toxin therapy is approved by the United States Food and Drug Administration for treatment of detrusor overactivity. Treatment should always begin with the most reversible forms of therapy and progress to more complex options.

KEYWORDS: Antimuscarinics; Botulinum toxin; Neurogenic detrusor overactivity; Neuromodulation

CORRESPONDENCE: Karl-Erik Andersson, MD, PhD, Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157 ()

CITATION: UroToday Int J. 2009 Dec;2(6). doi:10.3834/uij.1944-5784.2009.12.10

ABSTRACT

Occurrence of prostatic abscess has become very rare since the advent of modern antibiotics. The authors report a case of a 51-year-old man with insulin-dependent diabetes mellitus and recurrent urinary tract infections who was diagnosed with prostatic abscess. He was treated successfully with transrectal ultrasound (TRUS) guided needle aspiration under local anesthetic. TRUS-guided drainage is a safe and effective therapeutic approach for the treatment of this disorder.

KEYWORDS: Prostatic abscess; Ultrasound guided needle aspiration

CORRESPONDENCE: Michael Nomikos MD, Consultant Urologist, Knossou Street 275, Heraklion, Crete, 71409, Greece ()

CITATION: UroToday Int J. 2009 Dec;2(6). doi:10.3834/uij.1944-5784.2009.12.11

Complete penile amputation is a rare condition that requires immediate and complex surgical treatment. There are few descriptions of successful operative techniques using microsurgical methods in the literature.

The authors present the rare case of 30-year-old man who amputated his penis at its base using an ax. Nine hours after the injury, the patient underwent microsurgical anastomosis of the arteries, veins, corpora cavernosa, and urethra. The authors describe the steps in their surgical procedure and provide illustrative figures. They also explain their perioperative and postoperative support therapy.

Approximately 20% of the distal spongy body and skin of the penis became necrotic beginning on the 6^th postoperative day. On the 18^th day, necrectomy of the penile skin flap was performed and the phallus was buried in the scrotum. Exteriorization of the penis that was partially covered by scrotal skin was completed 2 months after reanastomosis. The distal necrotic part of the urethra was reconstructed using buccal mucosa graft transplantation. A split-thickness skin graft from a lower limb was used to cover the rest of the phallus. The patient achieved return of physiologic micturition with no urethral structures. He also experienced incomplete erectile function.

KEYWORDS: Penile amputation; Penile replantation; Surgical techniques

CORRESPONDENCE: Marek Wyczółkowski MD, PhD, Department of Urology, Rydygier Memorial Hospital, Złotej Jesieni 1 Str., 31-826 Cracow, Poland ().

CITATION: Urotoday Int J. 2009 Dec;2(6). doi:10.3834/uij.1944-5784.2009.12.08

INTRODUCTION: The aim of the present study was to compare the safety and efficacy of transurethral electrovaporization of the prostate (TUVP) with conventional transurethral resection of the prostate (TURP) in the treatment of patients with moderate to severe bladder outlet obstruction due to benign prostatic hyperplasia (BPH).

METHODS: Between December 2001 and November 2003, 131 patients presented to the author's institution with moderate to severe bladder outflow symptoms due to BPH. The patients were randomly assigned to undergo TURP (n = 67) or TUVP (n = 64). Patients receiving TURP had a significantly larger mean prostate size (P = .01) but were similar in all other evaluated characteristics. Using the hospital database, the author reports the available follow-up results after 1, 2, 3, and 5 years. The International Prostate Symptom Score (IPSS), uroflowmetry (Q-max), and postvoid residual volume (PVR) were used for evaluation. Operative time, catheterization time, hospital stay, and blood tests were also compared.

RESULTS: Of the 131 total patients, 51 patients receiving TURP and 50 patients receiving TUVP completed 5 years of follow-up; 21 patients died and the remaining 9 could not be contacted. No deaths were associated with either resection or vaporization of the prostate. Patients receiving TURP had a significantly longer mean postoperative catheterization time (P < .001) and mean hospitalization time (P < .001). Patients had significantly lower mean serum hemoglobin and hematocrit 1 hour following TURP (P < .001). There were no significant group differences for any other measures.

CONCLUSIONS: To the author's knowledge, the present study is the largest reported comparison of TURP and TUVP over a 5-year follow-up period. The low intraoperative and perioperative morbidity, rapid convalescence time, short hospital stay, and simplicity of the procedure make TUVP a potentially suitable, safe alternative to TURP in the therapeutic armamentarium for BPH. Because of its unique electrosurgical properties, higher risk patients can be treated successfully with this technique. The main disadvantage of TUVP appears to be the unavailability of prostate tissue needed for pathologic examination. Additionally, although TURP and TUVP were found to be comparable for prostate sizes < 60 g for patients in the present study, TURP may be advantageous for patients with larger prostates.

KEYWORDS: Transurethral electrovaporization of the prostate (TUVP); Transurethral resection of the prostate (TURP).

CORRESPONDENCE: Ehab Rifat Tawfiek MD, Department of Urology, El Minia University Hospital, Elminia 16666, Egypt ().

CITATION: UroToday Int J. 2009 Dec;2(6). doi:10.3834/uij.1944-5784.2009.12.12

INTRODUCTION: The purpose of the study was to compare the ease of use, safety, and efficacy of direct trocar insertion (DTI) and open access (Hasson technique) in laparoscopic surgery. This is the first known report of DTI used in urolaparoscopy.

METHODS: The study was a retrospective evaluation of patients referred for laparoscopic procedures between December, 2005 and June, 2008. A total of 148 patients were studied; 62 patients (41.9%) received DTI and 86 patients (58.1%) received open laparoscopy. Patients were not randomly assigned to treatment groups. For the DTI, the abdominal wall was lifted and the trocar was pushed through the fascia and muscle layer. The surgeon felt when the trocar had pierced the peritoneum and entered the abdominal cavity. For the open technique, the peritoneal cavity was opened under direct vision and the trocar was inserted. The variables measured were access time, minor and major complications, visceral and vascular injury and bleeding, conversion to open surgery, length of hospitalization, failed entry, and abdominal pressure for creation of the pneumoperitoneum. Chi-square and t tests were used to compare categorical and continuous variables, respectively.

RESULTS: The mean length of hospitalization was 26.95 hours (SD = 7.78) for patients receiving DTI and 30.44 hours (SD = 13.98) for patients receiving open laparoscopy, but the difference was not statistically significant (P > .05). The mean access time for DTI was 91.75 seconds (SD = 79.77), which was significantly shorter than the mean access time of 263.97 seconds (SD = 119.28) for patients receiving open laparoscopy (P < .0001). The mean abdominal pressure for creation of the pneumoperitoneum with DTI was 16.17 mmHg (SD = 1.46), which was significantly higher than the mean abdominal pressure of 15 mmHg (SD = 0) with open laparoscopy (P < .0001). There were very few complications in either study group. Although 11 patients (17.74%) in the DTI group and 7 patients (8.14%) in the open laparoscopy group had previous open abdominal or groin surgery, the previous surgeries did not negatively impact the laparoscopic procedures (P = .01). There were no entry failures in either group.

CONCLUSION: DTI is faster and appears to be more efficacious for some aspects of surgery than the open laparoscopy technique, although the safety of the two techniques is equivalent. The authors suggest that direct trocar insertion can be used in urolaparoscopic surgeries. Future prospective studies with larger numbers of patients randomly assigned to treatment groups are needed to confirm the results.

KEYWORDS: Laparoscopic surgery; Direct trocar insertion; DTI; Laparoscopic access; Pneumoperitoneum; Emphysema; Urolaparoscopy; Endopth Xcel trocar

CORRESPONDENCE: Siavash Falahatkar M.D., Guilan University of Medical Sciences, Urology Research Center, Razi Hospital, Sardare Jangal Street, Rasht, Guilan 41448, Iran ( email address is being protected from spam bots, you need Javascript enabled to view it).

CITATION: UroToday Int J. 2009 Dec;2(6). doi:10.3834/uij.1944-5784.2009.12.03.

INTRODUCTION: Spontaneous rupture (SR) of the urinary collecting system with perirenal and retroperitoneal extravasation of the urine is an unusual condition that is typically caused by ureteral-obstructing calculi. The authors present a retrospective study of 10 cases. They report evaluation, endoscopic management, and follow-up assessments.

METHODS: Between 1998 and 2008, 10 patients were admitted for SR of the urinary collecting system proximal to a lithiasic obstruction. There were 6 males and 4 females. The mean patient age was 51.5 years. At presentation, all patients had sudden severe flank pain. There were no other urinary symptoms. All patients had a physical examination, laboratory blood and urine analyses, and radiography, ultrasonography, intravenous urography (IVU), and/or computed tomography (CT). Ureteroscopy was performed. Ureteral stones were fragmented with a pneumatic lithotripter.

RESULTS: Ultrasonography and IVU or CT showed a perinephric collection due to urine extravasation that was compatible with rupture of the renal collecting system. SR was secondary to an obstructing calculus in all cases. Patients were managed successfully by primary endoscopic treatment of ureteroscopic lithotripsy and stenting. Follow-up was unremarkable.

CONCLUSION: SR of the urinary collecting system is a very rare pathological condition. It should be considered in cases of unusual renal colics. Ureteroscopic lithotripsy followed by double-J stenting of the ureter appears to be a quick, safe, and effective management approach.

KEYWORDS: Pelvis rupture; Ureteral rupture; Ureteral calculus; Computed tomography; Ureterel stent; Endoscopic lithotripsy

CORRESPONDENCE: Dr. Sallami Satâa, Department of Urology, La Rabta Hospital-University, Tunis 1007, Tunisia ().

CITATION: UroToday Int J. 2009 Dec;2(6). doi:10.3834/uij.1944-5784.2009.12.07

A 47-year-old female presented with a history of hematuria and right loin pain 18 months after receiving chemoradiotherapy for advanced cervical carcinoma. A CT scan demonstrated a grossly abnormal right kidney suggestive of either inflammatory or malignant change. A percutaneous biopsy under CT guidance demonstrated squamous cell carcinoma in keeping with metastatic cervical carcinoma. Metastasis of cervical carcinoma to the kidney is extremely rare, with only 8 previous cases reported in the literature.

KEYWORDS: Cervical carcinoma; Renal metastasis; Biopsy; Caval thombus

CORRESPONDENCE: Dr. David C. Hutchings, Department of Urology, Churchill Hospital, Oxford, OX3 7LJ, UK ().

CITATION: Urotoday Int J. 2009 Dec;2(6). doi:10.3834/uij.1944-5784.2009.12.05

INTRODUCTION: Patients with pathologically confirmed upper tract transitional cell carcinoma (TCC) currently undergo surveillance according to well described protocols. The literature offers little guidance for monitoring patients with abnormal upper tract cytology without prior upper tract TCC. The purpose of the present study was to assess the risk of upper tract TCC based on cytology and determine a reasonable observation strategy for this abnormal finding.

METHODS: The authors performed a 10-year retrospective cohort study of 204 patients (366 renal units) within the New England Veterans Administration Healthcare System. Upper tract cytology was collected: (1) as a consequence of lateralizing hematuria during cystoscopy in 2 patients; (2) following abnormal upper tract imaging in 27 patients; (3) from the bladder in the presence of a suspected bladder tumor and/or carcinoma in-situ (CIS) in 16 patients; (4) from the bladder despite a negative workup for lower tract tumor in 159 patients. Cytology results reported as negative or atypical were categorized as normal; suspicious or positive results were categorized as abnormal. Odds ratios (OR) were calculated and hazard curves plotted to determine risk and time span of tumor development among the cohorts.

RESULTS: Twenty-six renal units had upper tract TCC over a median follow up of 38 months. The OR for development of upper tract TCC with abnormal upper tract cytology was 3.27 and did not change with a previous history of lower tract disease. The accumulation rate differed with normal and abnormal upper tract cytology among those who developed upper tract TCC.

CONCLUSION: Upper tract cytology has a poor sensitivity for tumors of the upper urinary tract. Patients with abnormal upper tract cytology are 3 times more likely to develop TCC than patients with normal upper tract cytology and should be carefully monitored for at least 6 years. However, the exact method and frequency of monitoring remains undetermined.

KEYWORDS: Transitional cell carcinoma; Urothelial carcinoma; Cytology; Upper tract; Renal pelvis; Ureter

CORRESPONDENCE: Rian Dickstein, MD, Department of Urology, 720 Harrison Avenue, Suite 606, Boston, MA 02118 ()

CITATION: UroToday Int J. 2009 Dec;2(6). doi:10.3834/uij.1944-5784.2009.12.01

A 39-year-old male presented with a tumor in the urethral orifice. A papillary tumor (1 cm × 1 cm) was found at the meatus of a distal hypospadia. The patient underwent tumor resection without urethroplasty. The pathological diagnosis was squamous cell carcinoma. No recurrence or metastasis was found during 2 years of follow-up. Squamous cell carcinoma in the urethral orifice of hypospadias is extremely rare. To the authors’ knowledge, this is only the second case reported in the literature.

KEYWORDS: Urethral cancer; Squamous cell carcinoma; Meatus; Hypospadia

CORRESPONDENCE: Yoshiyuki Kojima MD, Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan ().

CITATION: Urotoday Int J. 2009 Dec;2(6). doi:10.3834/uij.1944-5784.2009.12.13

Foreign bodies left inside the patient following surgical procedures are infrequently reported in the literature. Incidence figures might be underestimated because of medico-legal implications. A 56-year-old male had a right ureterolithotomy for a lumbar ureteral stone. He was asymtomatic for 3 years before presenting with intermittent right flank pain. Imaging showed a tumor-like mass in the right lumbar region. Surgical exploration revealed a textiloma.

KEYWORDS: Urinary surgery; Retroperitoneal space; Postoperative complication; Foreign body; Textiloma.

CORRESPONDENCE: Dr. Sallami Satâa, Department of Urology, La Rabta Hospital-University, Tunis 1007, Tunisia ().

CITATION: UroToday Int J. 2009 Dec;2(6). doi:10.3834/uij.1944-5784.2009.12.09

Dear Colleagues,


UroToday International Journal offers open access with the objective to accelerate the timely and widespread dissemination of new urological relevant research findings and, ultimately, to have a more immediate impact on clinical practice than traditional publishing methods. The editorial team is pleased to publish both clinical and basic research, in addition to review articles, case studies, and other articles representing clinical practice. This combination of clinical and basic research is reflected in the present issue.

The article by Hammouda et al in (Post-Tubularized Incised Plate Urethroplasty Healing: An Experimental Randomized Study in 40 Dogs) is an example of research in a dog model. The authors studied the mechanism of urethral healing after tubularized incised plate urethroplasty and describe some aspects of wound development following hypospadia repair. A clinical study on the same theme is found in the article by Hussein (Reoperative Hypospadias Repair According to Urethral Plate Status). He found the tubularized incised plate urethroplasty to be effective and safe when the urethral plate is healthy.

The topical review article in this issue, written by Evans et al, discusses the diagnosis and treatment of interstitial cystitis. The authors describe the etiology of the disorder, diagnostic tests, and pharmacologic and nonpharmacologic treatments presented in the literature to date.

In this issue, the focus on clinical practice includes an article by Salem (Medical Treatment for Small Stones in the Lower Ureter) comparing the efficacy of the α-adrenergic blocker tamsulosin and the calcium channel blocker nifedipine, two commonly prescribed drugs used in medical expulsive therapy for distal ureteric stones. Patients taking tamsulosin experienced significant benefits. Another study by Salem et al provides longitudinal results of a surgical approach for correction of penile curvature, including a tabled review of comparable literature. Falahatkar et al authored 3 articles in this issue. Perhaps the timeliest was a study comparing the use of stents with no stents after uncomplicated ureteroscopic lithotripsy for small (< 10 mm) middle and distal ureteral stones. Their results helped to build support for elimination of indwelling stents in these circumstances.

Readers will undoubtedly find several other articles of interest in this issue. Gamal et al report on the feasibility and outcomes of the N-shaped pouch with an afferent tubular isoperistaltic segment as a new technique for creating a capacious, low pressure bladder substitute following radical cystectomy; Ahmadnia et al discuss pathophysiology and treatment of the rare disorder, idiopathic scrotal calcinosis, and Fitouri et al report the safety and efficacy of ofloxacin on BCG-induced toxicity in patients with superficial bladder cancer. Finally, Banakhar and Mosli, and Botelho et al present interesting and relevant case reports.

We thank the authors for their submissions and the reviewers for providing timely responses in the peer review process for publication. We look forward to hearing your views on the articles that are presented here in post-publication discourse and we look forward to your future submissions.

Kind regards,

K-E Andersson
Editor-In-Chief
UIJ

INTRODUCTION: Previous studies have suggested that routine stenting can be avoided following ureteroscopy. A prospective investigation was performed to determine the outcome of stent or no-stent placement after uncomplicated ureteroscopic lithotripsy for small (< 10 mm) middle and distal ureteral stones.

METHODS: Fifty six patients meeting inclusion criteria underwent uncomplicated ureteroscopic intracorporeal lithotripsy using a pneumatic device. No patient required ureteral dilation. Patients were randomly assigned to nonstented (n = 28) and stented (n = 28) treatment groups. The stent was removed after 2 days. Patients were followed for 2 weeks postoperatively.

RESULTS: There were no significant between-group differences in patient age, sex, stone size, or stone location. There were no significant between-group differences in mean operation time and postoperative pain. The group receiving the stent had a significantly longer mean hospital stay (2.14 days vs 1.25 days) (P < .0001). The stone-free rate was exactly the same at 96.4% for each group; the procedure was not successful for 1 patient in each group. There were no significant between-group differences in flank pain, fever, and hematuria. However, dysuria was significantly more common in the group receiving a stent (P = .002).

CONCLUSIONS: Patients who did not receive a stent after ureteroscopic intracorporeal lithotripsy had the same success rates as those who received a stent, while needing a shorter hospital stay and having less dysuria. These findings suggest that ureteral stent placement following uncomplicated ureteroscopy may be avoided, thereby reducing patient morbidity and surgical costs.

KEYWORDS: Ureteral stone; Ureteroscopy; Ureteral stent

CORRESPONDENCE: Siavash Falahatkar M.D., Guilan University of Medical Sciences, Urology Research Center, Razi Hospital, Sardare Jangal Street, Rasht, Guilan 41448, Iran ().

CITATION: Urotoday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.12

The stone-retaining pelvic ectopic kidney of a 46-year-old female was treated with laparoscopically assisted complete supine percutaneous transperitoneal nephrolithotomy. She had a past history of previous open surgery for a left kidney stone about 7 years ago, left transurethral ureterolithotripsy (TUL) about 5 years ago, and an unsuccessful left extracorporeal shock wave lithotripsy (ESWL) recently. Ultrasound and intravenous pyelogram (IVP) imaging showed multiple calculi in a left ectopic pelvic kidney overlying on the sacrum. The burden of stone was 5 cm. With the patient in the supine position under laparoscopic control, the bowels were dislodged with forceps until the kidney became visible. Under laparoscopic control, the nephrostomy track was created on the antegrade route using a one shot dilator. Percutaneous nephrolithotomy was carried out in the usual manner with a rigid 26F nephroscope. Stones were fragmented and removed. No complications occurred. The operating time was 105 minutes; the hospital stay was 4 days. On the basis of the authors' experience, PNL with guided laparoscopy in pelvic kidneys is safe even in reoperative patients.

KEYWORDS: Reoperated pelvic kidney; Complete supine percutaneous transperitoneal nephrolithotomy (PNL); Urolithiasis; Laparoscopic guided PNL; Ectopic kidney

CORRESPONDENCE: Siavash Falahatkar M.D., Guilan University of Medical Sciences, Urology Research Center, Razi Hospital, Sardare Jangal Street, Rasht, Guilan 41448, Iran ( email address is being protected from spam bots, you need Javascript enabled to view it ).

CITATION: UroToday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.06

Bladder exstrophy is one of the rare bladder anomalies. It needs complex surgical management. The main surgical procedures include bladder closure, epispadias repair, and pelvic stability with innominate bone osteotomy and symphysis pubis repair. Mersilene is a synthetic material that can be used for symphysis repair. The authors report Mersilene sinus formation and infection in 3 cases of bladder exstrophy. The cases were managed by Mersilene removal without any further effect on pelvic stability.

KEYWORDS: Bladder exstrophy; Pelvic stability; Mersilene complication

CORRESPONDENCE: Mai Banakhar, Urology Department, King Abdul Aziz University Hospital, PO Box 80215, Jeddah 21589, Kingdom of Saudi Arabia (KSA) ().

CITATION: UroToday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.01

INTRODUCTION: The mechanism of urethral healing after tubularized incised plate urethroplasty (TIP) is still debatable. The purpose of the present study was to report post-TIP healing in a randomized-study hypospadias dog model.

METHODS: The hypospadias model was created in 40 male mongrel dogs that were randomly allocated into group 1 and group 2 with 20 dogs in each, and 4 subgroups (1a and 1b; 2a and 2b) with 10 dogs in each. The urethral plate width was reduced to 10 mm and 6 mm in group 1 and group 2, respectively. The urethral plate (UP) was tattooed and bisected by midline longitudinal incision. The length of UP and urethral incision (UI) was 2 cm in subgroups 1a and 2a and 4 cm in subgroups 1b and 2b. Tubularization of UP was done over an 8 Fr feeding tube. After 4 weeks, the phallus was harvested and transverse sections were obtained from the area of UI. They were stained by hematoxylin and eosin (H&E), Masson's trichrome, and fibronectin stains and pathologically examined.

RESULTS: Four cases of proximal urethral fistulae were reported in group 2 (1 in subgroup 2a; 3 in subgroup 2b). Gross inspection exhibited intervening tissues at the site of UI. The size of the intervening tissues between the healing edges of the UI was 0.8 mm (SD = 0.1) in group 1 and 2.5 mm (SD = 0.2) in group 2. Light microscopy revealed creeping of normal-appearing squamous surface epithelium in all specimens. Increased collagen fiber deposition was recorded in group 2 when compared with group 1. Fibronectin was expressed in the subepithelial locations of the urethra in all studied animals. However, dense signals were reported in group 2 in comparison to group 1.

CONCLUSIONS: Healing after TIP occurs by secondary intention with creeping of the surface epithelium. Collagen deposition was increased in cases of UP ≤ 6 mm in width. Post-TIP complications may increase in cases of narrow UP, especially with the neourethra and UI > 2 cm in length.

KEYWORDS: Urethra; Hypospadias; Dog; Healing.

CORRESPONDENCE: Dr. Hisham Hammouda, Director of the Pediatric Urology Unit, Urology Department, Faculty of Medicine, Assiut University Hospital, 71111, Assiut, Egypt ().

CITATION: UroToday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.07

INTRODUCTION: The authors report on the feasibility and outcomes of the N-shaped pouch with an afferent tubular isoperistaltic segment as a new technique for creating a capacious, low pressure bladder substitute following radical cystectomy.

METHODS: Between April 2000 and April 2006, 42 patients (36 male, 6 female) with invasive bladder cancer were considered good candidates for orthotopic urinary diversion. All had radical cystectomy with bilateral pelvic lymphadenectomy and orthotopic bladder substitution by an ileal low pressure reservoir (N-shaped) with an afferent isoperistaltic tubular segment. Of the 42 patients, 36 (86%) had squamous cell carcinoma; 6 had transitional cell carcinoma. None of the patients had positive lymph nodes after pathologic examination of the specimen. Thirty-two males and 4 females were available for a median follow-up period of 24.8 months. Follow-up included clinical and radiographic studies to determine functional and oncological outcomes.

RESULTS: : Eleven patients (25%) had early complications during the period ≤ 3 months following surgery. Seven of these patients had complications such as wound infection, prolonged ileus, persistent urinary leakage, and deep venous thrombosis that were treated conservatively. One female patient developed a pouch-vaginal fistula that required repair. The remaining 3 patients had oncological failures, 1 of which was isolated urethral recurrence. Late complications occurred in 15 patients (37.5%). These included pouch stones, outflow obstruction, mucus retention, and adhesive bowel obstruction. Daytime and nighttime continence was achieved in 92% and 80% of the patients, respectively, and ureteroileal stricture was observed in 5%. The upper tracts remained unchanged or improved in 95% of the patients.

CONCLUSIONS: Ileal orthotopic bladder substitution (N- shaped) with an afferent ileal tubular segment offers good functional results with good preservation of the renal units. It is considered a safe and technically feasible surgical procedure.

KEYWORDS: N-pouch; Cystectomy; Orthotopic diversion

CORRESPONDENCE: Wael M Gamal, MD, Department of Urology, Sohag University, 31 el nasr Street, Sohag, Egypt ().

CITATION: Urotoday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.02

INTRODUCTION: The purpose of the present study was to evaluate the long-term results of simplified tunica albuginea plication for correction of congenital penile curvature in adults.

METHODS: Twenty patients with congenital curvature of the penis had surgical correction. The mean age of the patients was 27 years (range, 16-48 years). Nineteen patients had a ventral penile curvature and 1 patient had a ventrolateral curvature. The mean angle of ventral bending was approximately 65° (range, 35°-90°). Detailed history was taken and physical examinations were conducted. Erection was induced by intracavernosal injection of 15 µg of prostaglandin E₁ to assess all directions of penile curvature and to determine the angle of deviation. The course of the neurovascular bundles was determined without dissection. Type 2/0 polypropylene plicating sutures were taken through the full thickness of the tunica albuginea. Two to 3 pairs of longitudinal plication sutures placed in both sides of the neurovascular bundles avoided injury of circumflex veins. Plication stitches were made parallel to assure symmetrical adjustment of the curvature. Patients were discharged after 16-24 hours. Follow-up evaluations were done weekly for 8 weeks and annually thereafter. Patients were followed for 2-5 years.

RESULTS: Operative time was 60 to 100 minutes. Successful outcome was achieved in 19 (95%) of the patients. The penis became straight during full and rigid erections and the patients were satisfied with the penile cosmetic feature and sexual intercourse. No patient complained of significant shortening of the erect penis. Recurrence of curvature occurred in 1 patient due to excessive and rigid erections early postoperatively. Three patients complained of uncomfortable sensation due to palpable knots from the polypropylene sutures. One patient had corrective surgery due to coital discomfort caused by the knots. The stitches were removed under local anesthesia with no recurrence of the curvature.

CONCLUSION: The present technique of tunica albuginea plication is simple and not time consuming. It prevents the complications of dissection and mobilization of the neurovascular bundles. Slight shortening of the penis is a disadvantage of the technique. However, it does not interfere with sexual satisfaction.

KEYWORDS: Penile curvature; Congenital; Chordee; Tunica albuginea

CORRESPONDENCE: Dr. Tarek Salem, Rehab City, Modern Cairo, Group 94, Building 4, Flat 11, Cairo, Egypt ().

CITATION: UroToday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.03

Interstitial cystitis/painful bladder syndrome (IC/PBS) is characterized by pelvic pain, urinary urgency and frequency, and nocturia. The etiology of IC/PBS is unknown but likely multifactorial. It can be difficult to diagnose IC/PBS because of variable presentation. No definitive diagnostic tests and no established guidelines for the treatment of this condition exist. It is possible to distinguish IC/PBS from other similar conditions through careful history taking and physical examination. A variety of treatment options are available; multimodal therapy may offer patients the best outcomes.

KEYWORDS: Interstitial cystitis; Pelvic pain; Chronic pelvic pain; Painful bladder syndrome

CORRESPONDENCE: Robert Evans, MD, Alliance Urology Specialists, 509 North Elam Ave., Greensboro, NC 27403 ().

CITATION: UroToday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.11

INTRODUCTION: There are a variety of treatment options available for management of lower ureteral stones. Recent studies have shown the efficacy of some types of drug therapy. The present investigation was a prospective study with randomized patient groups. The purpose was to compare the efficacy of tamsulosin and nifedipine, two commonly prescribed drugs used in medical expulsive therapy for distal ureteric stones.

METHODS: A total of 171 patients with distal ureteral stones < 1 cm in diameter were randomly divided into 3 groups and given medications for a period of 30 days. Patients in all 3 groups received: (1) prophylactic ciprofloxacin (500 mg) 2 times/day for 1 week; (2) Rowatinex capsules (100 mg) 3 times/day until the stone was expelled; (3) EPIMAG magnesium citrate effervescent sachets (2.125 g) dissolved in water 3 times/day until the stone was expelled; (4) diclofenac sodium tablets (50 mg) 2 times/day for 1 week. In addition to the fixed medications described above, patients in group 1 (n = 58) were treated with tamsulosin (0.4 mg) 1 time/day for a maximum of 30 days; patients in group 2 (n = 57) took slow-release nifedipine (30 mg) 1 time/day for a maximum of 30 days. Patients in group 3 (n = 56) were not given tamsulosin or nifedipine. The variables measured were stone expulsion rate, time of expulsion, and number and severity of pain attacks. ANOVA and chi-square tests were used for statistical analysis.

RESULTS: There were no statistically significant differences between the 3 groups on characteristics of sex, age, stone size, or stone laterality. Results showed that 89.6% of the patients taking tamsulosin (group 1) expelled their stones within 30 days, compared with 66.6% of the patients taking nifedipine (group 2) and 57.1% of patients taking only analgesics (group 3). The difference between group 1 and the other groups was statistically significant. Patients taking tamsulosin expelled the stones in a significantly shorter amount of time than patients in the other 2 groups. They also had significantly fewer pain attacks and needed fewer analgesics. Patients taking nifedipine did not have any significant benefits over patients in the other 2 groups.

CONCLUSION: Medical expulsion therapy for lower ureteric stones is a successful procedure. Adding an α-1 adrenergic blocker such as tamsulosin to the treatment regimen is recommended before undertaking any more invasive intervention.

KEYWORDS: Ureter; Stones; Tamsulosin; Nifedipine

CORRESPONDENCE: Dr. Tarek Salem, Rehab City, Modern Cairo, Group 94, Building 4, Flat 11, Cairo, Egypt ().

CITATION: UroToday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.05