Issue 3: June 2009

UIJ Volume 2 Issue 3 June 2009

Letter from the Editor - June 2009

Dear Colleagues,

This issue marks the one-year anniversary of the founding of UroToday International Journal. When the editorial team drafted our primary goal of “elevating access to relevant urology science to professionals around the world,” we had no idea that the journal would grow so quickly.

We are excited that our dream of becoming an international journal is being realized. Over the past year, we published articles from authors in 22 countries from 4 continents. These submissions reflect the world-wide distribution of our readership.

We could not achieve this success without the dedicated work of our reviewers, who continue to provide thorough and rapid feedback to our authors. We are grateful for their professional support. Because of their efforts, manuscripts received as recently as 7 weeks ago are appearing in this issue. We continue to strive for rapid turnaround of submissions so that we can share recent developments with our readers.

We have taken advantage of the fact that we are an electronic publication by adding other forms of media to the text of some articles. We hope to expand these multimedia educational tools and encourage authors to notify us if you have podcasts, video clips, Microsoft PowerPoint presentations, or audio commentary that may enhance your manuscript content. For examples, visit the audio recording of the basic science lecture in October, 2008 or the PowerPoint presentation accompanying the letter to the editor in April, 2009.

The current issue contains a wide variety of articles. Some highlights include: (1) a retrospective analysis on the effects of two dosage levels of darifenacin on 1053 patients with mild/moderate and severe urinary incontinence, written by Dr. Dmochowski and his colleagues; (2) a thorough discussion about different types of slings for correction of stress urinary incontinence, written by Dr. Farahat and his colleagues; (3) new surgical techniques for acute dilatation of the intramural ureter during ureteroscopy and for repair of distal and midpenile hypospadias, both provided by Dr. Gamal and his colleagues; (4) case reports on prostate leiomyosarcoma following radiation therapy to the prostate (Yee et al); an adenoid cystic variant of basal cell carcinoma following transurethral resection (Soloway et al); an appendicular vesical fistula (Labib and Mapulanga); a left-sided inferior vena cava in a patient with renal cell carcinoma of the right kidney (Katkoori et al); and surgical procedures to manage uterine prolapse associated with bladder exstrophy and to alleviate intractable groin pain following suburethral sling placement (Palma et al). Other articles on topics of interest to the practicing urologist and associated professionals are included.

Our heartfelt thanks go to the authors who have shared their work with us during the past year. We look forward to your future submissions as we continue to grow.

Kind regards,

K-E Andersson
Editor-In-Chief
UIJ

Peripheral Zone Sonographic Changes of the Prostate

ABSTRACT

INTRODUCTION: The aim of the investigation was to identify the diagnostic importance of peripheral zone sonographic findings in correlation with total prostatic specific antigen (tPSA) and pathological findings.

METHODS: Between January 2005 and January 2007, the transrectal biopsy records of 407 patients were reviewed for different prostatic indications. Echogenicity, calcific, and cystic changes of the peripheral zone were correlated with tPSA, total volume of the gland, digital rectal exam (DRE), and pathological findings.

RESULTS: The patients were divided into 3 groups (A, B, and C) according to tPSA: <4 ng="" ml="" n="159)," 4-10="" and="">10 ng/mL (n = 229), respectively. Heterogenicity was detected in 59.9% of cases and was higher when tPSA increased. Heterogenicity was found in the malignant biopsies of 78.7% of the patients (sensitivity = 78.78%; specificity = 44.6%). Calcific changes were found in 52% (n = 90) of group C (P < .05). Calcification was demonstrated in 41.4% (n=41) of malignant findings, but group comparisons were not statistically significant (sensitivity = 41.4%; specificity = 55.5%). Cystic changes were detected in 7.1% (n = 7) of malignant findings, but group comparisons were not statistically significant (sensitivity = 7.1%; specificity = 9.1%). However, 10.3% (n = 23) of patients with cystic peripheral zonal changes had high but not statistically significant PSA.

CONCLUSION: Heterogenicity of the peripheral zone is correlated with malignant pathology (positive predictor value = 31.9%) and high tPSA. Whenever a peripheral zone calcific change in prostatic sonography occurs, the urologist should suspect an increase of tPSA but without characteristic indicator of malignant anticipations (positive predictor value = 23.03%). Cystic changes in the peripheral zone are not specific findings and do not reflect any changes in tPSA or prostatic pathology.

KEYWORDS: Transrectal ultrasound; Echogenicity; Prostate calcification; Prostate cystic changes.

CORRESPONDENCE: El-Housseiny Ismail Ibrahiem (El- Zalouey) MD, Urology Department, Urology and Nephrology Center, Mansoura, Egypt. E-mail:

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Comparison of Ultrasonographic and Operative Findings in Undescended Testes

ABSTRACT

INTRODUCTION: A patient with a nonpalpable testis (NPT) is a diagnostic challenge. Use of ultrasonography (US) for the diagnosis of NPT is controversial. The purpose of the present study was to compare US with surgical findings.

METHODS: Between January 2000 and January 2007, 65 patients with a diagnosis of undescended testis (UDT) were evaluated. The 65 patients had 77 UDT. The patients had a physical examination that was followed by US and then surgery. All patients had a second physical examination in the operating room while under anesthesia

RESULTS: US localized 57 (74%) nonpalpable testes. Of these, 50 were in the inguinal region and 7 were in the abdomen. The sensitivity of US was 100% for the inguinal canal and 39% for intraabdominal viable testes.Enter text

CONCLUSION: All patients with presumed nonpalpable, undescended testes should be referred to a urologist for physical examination before receiving US. The authors recommend US as a first instrumental test for all patients with NPT. When US is negative, they advise laparoscopy.

KEYWORDS: Undescended testes; Ultrasonography; Cryptorchidism; Operative Finding

CORRESPONDENCE: Dr. Ahmed Al-ahnoumi, PO Box 16913, Sana’a Yemen ().

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Urodynamic Evaluation of Patients With Chronic Pelvic Pain Syndrome

ABSTRACT

INTRODUCTION: The purpose of the investigation was to conduct urodynamic evaluation on patients with chronic pelvic pain syndrome (CPPS) and thus define a specific urodynamic profile that might add to the pathophysiology of the syndrome. This profile may also aid definitive treatment.

METHODS: Participants were 34 men with mean age 34.2 (SD = 8.5; range, 24-45 years). All patients presented with symptoms of chronic prostatitis (eg, dysuria, frequency of micturition, burning perineal sensation, lower abdominal discomfort and/or suprapubic pain). They were classified as having CPPS after excluding prostatic infection by standard bacteriological methods. The patients were then evaluated with urodynamic measures including free-flow rate, filling (water) cystometry, a pressure -flow study of micturition, and electromyography of the external urethral sphincter.

RESULTS: Of the 34 total patients, 22 (64.7%) had a low mean Qmax of 10.4 ± 1.6 mL/s (range, 4-14 mL/s); 25 (73.5%) had a first sensation of filling and 27 (79.4%) a first desire to void at low volumes (<150 and="" 250="" respectively="" nine="" patients="" 26="" 5="" 7="" obstructed="" 2="" unobstructed="" had="" idiopathic="" detrusor="" overactivity="" regarding="" pressure-flow="" measures="" 25="" 73="" an="" obstructive="" pattern="" of="" micturition="" as="" defined="" by="" a="" low="" qmax="" 9="" 1="" 44="" ml="" s="" high="" intravesical="" pressure="" at="" maximum="" flow="" 87="" 4="" cmh2o="" increased="" opening="" 76="" the="" emg="" external="" sphincter="" was="" normal="" in="" all="" p="">

CONCLUSION: A significant proportion of the patients with CPPS had a particular urodynamic pattern of functional infravesical obstruction and sensory bladder deficit.

KEYWORDS: Urodynamic; Chronic pelvic pain syndrome

CORRESPONDENCE: Hashem Hafez, M.D., Department of Urology, Faculty of Medicine, Suez Canal University, Ring Road, Ismailia 41105, Egypt ()

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Post Radiotherapy Leiomyosarcoma of the Prostate: Can Radiation Therapy Induce a Secondary Cancer? A Case Report

ABSTRACT

Sarcoma of the prostate is a rare neoplasm, accounting for less than 0.1% of prostate malignancies. There are only a few cases reported in the literature. The prognosis for this cancer is poor and the average survival is variable. The authors present a case report on a patient diagnosed with prostate sarcoma following initial diagnosis and treatment for adenocarcinoma of the prostate. What makes this case interesting is that the patient had a history of failed treatment for prostate adenocarcinoma that consisted of external beam therapy and palladium seed implants. Eight years later, the patient was diagnosed with leiomyosarcoma of the prostate. There may be a causal relationship between radiation therapy to the prostate and the development of the leiomyosarcoma.

KEYWORDS: Prostate cancer; Prostate leiomyosarcoma; Sarcoma; Radiation induced sarcoma; Prostate adenocarcinoma; Secondary prostate cancer; Secondary prostate leiomyosarcoma

CORRESPONDENCE: Ihor S. Sawczuk MD, John Theuer Cancer Center, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601, USA ().

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Left-Sided Inferior Vena Cava with Renal Carcinoma: A Case Report

ABSTRACT

The authors present a rare case of left-sided inferior vena cava (IVC) in a patient with renal cell carcinoma of the right kidney. The anomalous IVC poses significant challenge to the surgeon. Preoperative identification of this congenital anomaly prevents complications during the surgical procedure. In this patient, the suprarenal portion of the IVC is on the right side and the infrarenal portion is on the left side, with the cava taking a left to right turn at the level of the renal veins anterior to the aorta.

KEYWORDS: Left Inferior vena cava; Nephrectomy; Renal cell carcinoma

CORRESPONDENCE: M. Manoharan, M.D. Associate Professor, Department of Urology, University of Miami Miller School of Medicine, P.O. Box 016960 (M814), Miami, Fl 33101, USA ().

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Artisanal Transobturator Sling Removal for Intractable Groin Pain

ABSTRACT

INTRODUCTION: The transobturator approach was first described by Delorme in 2001. It has become the preferred approach for suburethral sling placement in many centers due to its efficacy and low morbidity. Nevertheless, complications have been associated with it.

METHODS: The authors describe management of a female subject with intractable groin pain after the insertion of an artisanal transobturator sling. The right side of the sling was removed.

RESULTS: The patient described significant but incomplete pain improvement at the time of hospital discharge. After one week, she had no pain but moderate stress urinary incontinence recurred.

CONCLUSION: The present case illustrates that a partial removal is not indicated for complete treatment. Time-related intractable groin pain may completely subside after sling tape removal. However, possible recurrence of urinary incontinence following intervention must be reinforced during patient counseling.

KEYWORDS: Synthetic slings; Transobturator; Groin pain

CORRESPONDENCE: Paulo Palma, MD, PhD, Division of Urology, Department of Surgery, Rua Jose Pugliesi Filho 265, Campinas, Sao Paulo, Brazil 13085-415 ()

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