Issue 5: October 2009

UIJ Volume 2 Issue 5 October 2009

Letter from the Editor - October 2009

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

Is Ureteral Stenting Necessary After Uncomplicated Ureteroscopy Lithotripsy for Small Middle and Distal Ureteral Stones?

ABSTRACT

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

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Laparoscopic-Guided Percutaneous Nephrolithotomy in a Reoperated Pelvic Kidney

ABSTRACT

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

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Mersilene Complication in Bladder Exstrophy Repair: Report of 3 Cases

ABSTRACT

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

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Post-Tubularized Incised Plate Urethroplasty Healing: An Experimental Randomized Study in 40 Dogs

ABSTRACT

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

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Modified N-Shaped Ileal Neobladder After Radical Cystectomy

ABSTRACT

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

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Simplified Approach for Correction of Congenital Penile Curvature

ABSTRACT

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

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A Practical Approach to Diagnosis and Treatment of Interstitial Cystitis

ABSTRACT

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

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Medical Treatment for Small Stones in the Lower Ureter

ABSTRACT

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

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Reoperative Hypospadias Repair Based on Urethral Plate Status

ABSTRACT

INTRODUCTION: The purpose of the study was to determine the suitable procedure for redo hypospadias repair based on the status of the urethral plate.

METHODS: Thirty-five patients with failed hypospadias repair were evaluated regarding the status of the urethral plate, the meatus, residual chordee, and the available surrounding tissues. The mean patient age was 5.8 years (range, 2-12 years). At presentation, 25 patients had the meatus at the distal shaft, 8 at the midshaft, and 2 had complete neourethral stricture. The urethral plate appeared healthy and wide in 30 patients and narrow in 3 patients. All patients had a straight penis with single previous repair. The initial procedure was unknown in 15 patients and was the tubularized incised plate (TIP) procedure in 20 patients. Thirty patients underwent reoperation with TIP procedure, 3 had a Mathieu technique, and 2 had onlay island flap. After repair, cosmetic and functional outcomes were evaluated.

RESULTS: Mean follow-up was 23.2 months (range, 12-36 months). Complete wound dehiscence occurred in 3 (8.6%) cases that had the TIP procedure; they are awaiting further repair. No fistulae occurred. Twenty-seven patients had a vertical slit meatus at the tip of the glans and 5 had a rounded meatus. Calibration was satisfactory in all cases using 8-10 Fr plastic catheters. Uroflowmetry was done in 15 (46.9%) patients and found to be within normal limits, with a Q mean of 9.53 mL/s (range, 5-16 mL/s).

CONCLUSIONS: Redo TIP urethroplasty is effective and safe when the urethral plate is healthy. When the urethral plate is narrow or the neourethra is stenosed, other alternatives should be considered for repair.

KEYWORDS: Hypospadias; Reoperation; Urethral plate

CORRESPONDENCE: Mohamed Mostafa Hussein, MD., Urology Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt ().

CITATION: UroToday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.08

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Safety and Efficacy of Ofloxacin on Bacillus Calmette-Guerin Induced Toxicity in Patients with Superficial Bladder Cancer

ABSTRACT

INTRODUCTION: The purposes of the present prospective study were: (1) to investigate the role of a fluoroquinolone (ofloxacin) in reducing the side effects of bacillus Calmette-Guerin (BCG) therapy in patients with nonmuscle invasive bladder cancer; (2) to determine if ofloxacin had any influence on the antitumor efficacy of the BCG therapy.

METHODS: From December 2006 to December 2007, 100 consecutive patients were enrolled in the study. Patients were randomly assigned to group 1 (n = 50) to receive ofloxacin or group 2 (n = 50) to receive a placebo. The groups were similar in patient age, sex, tumor stage, and tumor grade. Patients were followed for 12 months. The efficiency of the BCG therapy was determined clinically using an adverse event scale index. The patients were also evaluated endoscopically.

RESULTS: During the study period, there were 267 adverse events occurring after more than 850 BCG instillations. A significant decrease of burning with micturition was noted in group 1 (n = 41) when compared with group 2 (n = 19) (P = .03). Ofloxacin did not significantly reduce the occurrence of any other mild, moderate, or severe adverse events. After a follow-up of 12 months, results showed that ofloxacin did not affect the efficacy of BCG therapy. There were no significant differences between the 2 groups in disease recurrence or progression rates.

CONCLUSION: Instituting antibiotic prophylaxis with ofloxacin after each BCG instillation appears to be an efficient and safe method of improving treatment tolerability for burning with micturition. Ofloxacin reduced this adverse event without serious consequences. By decreasing the burning symptoms, patients may be more inclined to continue the BCG treatment.

KEYWORDS: Bladder; Transitional cell carcinoma; BCG therapy; Adverse events;

CORRESPONDENCE: Yassine Nouira, 5 Rue Ibn Messaoud El Menzah 6 – 2091, Ariana, Tunisia ().

CITATION: Urotoday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.13

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Percutaneous Nephrolithotomy Versus Open Surgery for Patients with Renal Staghorn Stones

ABSTRACT

INTRODUCTION: In 2005, the American Urological Association Nephrolithiasis Clinical Guidelines Panel recommended percutaneous stone removal as first-line treatment for the management of staghorn calculi. New endourological techniques have led to treating staghorn calculi with more effective and less invasive methods. The aim of the present study was to compare the results of percutaneous nephrolithotomy (PCNL) with open surgery for staghorn stones.

METHODS: METHODS: There were 120 participants with staghorn stones; 72 patients (60%) had PCNL and 48 patients (40%) had open surgery. Variables of age, sex, group, intraoperative and postoperative complications, operation time, and duration of hospitalization were examined. Complications were compared and the probability of group differences reported.

RESULTS: Intraoperative complications occurred in 9 patients (18.8%) during PCNL and 10 patients (13.9%) during open surgery, but the group difference was not statistically significant (P = .611). The most common intraoperative complication for both groups was bleeding that required blood transfusion. Patients treated with PCNL had a significantly shorter mean hospital stay of 3.93 days when compared with a hospital stay of 5.08 days following open surgery (P = .003). Postoperative complications occurred in 2 patients (4.2%) following PCNL and 9 patients (12.5%) following open surgery, but the group difference was not statistically significant (P = .05). The stone-free rate was 81.9% after PCNL and 91.6% after open surgery, a difference that was not statistically significant (P = .84).

CONCLUSION: PCNL is a valuable treatment option for staghorn stones, with complication and stone-free rates comparable to open surgery. Moreover, PCNL resulted in a significantly shorter hospital stay. Therefore, the results of the present study concur with prior literature stating that PCNL should be considered the first stage in treatment for most patients with staghorn stones.

KEYWORDS: Percutaneous nephrolithotomy; Open surgery; Staghorn; PCNL; Stone Free Rate

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.1944-5784.2009.10.09

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Kidney Hemorrhage After Renal Biopsy Treated by Percutaneous Superselective Segmental Renal Artery Embolization

ABSTRACT

INTRODUCTION: Renal biopsy-related vascular injuries are frequent but usually unimportant. However, they can lead to dramatic situations of hemodynamic instability and even death. Transcatheter embolization is a minimally invasive technique used to treat some forms of arterial bleeding.

CASE PRESENTATION: A 33-year-old woman with acute renal insufficiency requiring hemodialysis received an ultrasound-guided renal biopsy of the right kidney. She developed a perirenal hematoma (12 cm diameter) with active bleeding from the lower pole. Superselective embolization was performed with a 2.7F catheter and microcoils 0.018 inches in diameter. Her hemodynamic status was stabilized and there was no further decrease in the hematocrit level. The renal parenchyma remained well perfused except for the embolized segment. Imaging during the follow-up period showed no significant damage. The patient was discharged with a residual hematoma.

CONCLUSION: Superselective embolization therapy for renal trauma provides an effective and minimally invasive means to stop active bleeding. Immediate clinical success with minimal renal parenchyma loss can be obtained.

KEYWORDS: Therapeutic embolization; Hemorrhage; Renal Biopsy

CORRESPONDENCE: Francisco Botelho, MD, Servico de Urologia - Hospital S. João, Alameda Prof. Hernani Monteiro; 4200-319 Porto, Portugal ().

CITATION: UroToday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.10

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Ideopathic Scrotal Calcinosis (ISC): Etiology and Treatment

ABSTRACT

INTRODUCTION: Idiopathic scrotal calcinosis (ISC) is a rare benign disorder characterized by multiple asymptomatic nodules. The nodules occur on the scrotal skin wall. The purposes of the present study were to: (1) determine whether or not there is a defect in calcium and phosphorous metabolism among patients with ISC; (2) study the effect of treatment with topical steroid and topical vitamin A on nodule recurrence.

METHODS: There were 18 patients with a mean age of 20 years (range, 18-55 years). Six of the patients reported that the nodules were asymptomatic; 12 reported symptoms of itching, heaviness in the scrotum, secondary infection in the lesions, and discharge. Evaluation included patient history, physical examination, and serum levels of calcium, phosphorous, and alkaline phosphatase. Lesions were excised. Patients in group 1 (n = 10) were treated with a long-term topical steroid for 2 weeks, followed by topical vitamin A for 6 months. Patients in group 2 (n = 8) received no topical treatment. Patients were reevaluated every 6 months for 3 years.

RESULTS: Serum levels were within the normal range for calcium (mean = 9.5 mg/dL; SD = 3.5) and phosphorous (mean = 3.2 mg/dL; SD = 0.7), but higher than normal for alkaline phosphatase (mean = 135 U/L; SD = 35). No nodule recurrence was observed in patients receiving the topical treatments. There were 4 reports of recurrence among patients receiving no topical treatments, occurring after 8, 13, 16, and 24 months.

CONCLUSION: The pathogenicity of ISC is not clear. It might be idiopathic, caused by dystrophic calcification, the result of inflammation of epidermal cysts or minor trauma, or due to degeneration and necrosis of dartos muscle. Diagnosis is solely confirmed by surgical excision and histopathologic examination. In the present study, the authors found no anomalies of calcium and phosphorous metabolism except an increase in alkaline phosphatase level. Recurrence was only seen among patients who did not receive topical treatment after surgical excision. Therefore, the authors suggest the use of local treatment of steroids and vitamin A to prevent probable recurrences. However, further studies are needed to reach a more definitive conclusion.

KEYWORDS: Idiopathic scrotal calcinosis; Calcium and phosphorous metabolism anomalies; Alkaline phosphatase

CORRESPONDENCE: Dr. Mahmood Molaei, Department of Urology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran ().

CITATION: Urotoday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.04

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