Volume 3

UIJ Volume 3 2010

Scrotal Schwannoma: A Case Report


INTRODUCTION: Schwannoma is a benign, encapsulated neoplasm with an overall low incidence. It typically occurs in the head and neck regions and seldom develops in the scrotum. Histology shows 2 distinctive patterns (Antoni type A or type B) and several variants including cellular, ancient, glandular, and epithelioid. A 45-year-old male presented with a 1-year history of a painless, slowly growing, left-sided scrotal mass. Ultrasonography revealed an intrascrotal, extratesticular, soft-tissue mass without local invasion. The mass was successfully and totally excised without opening it and without remnant. Histopathology revealed an Antoni type A, cellular variant schwannoma of the scrotum.

Tarek A Salem

Urology Department, Suez Canal University, Ismailia, Egypt

Submitted July 20, 2010 - Accepted for Publication July 30, 2010

KEYWORDS: Schwann cell; Schwannoma; Neurolemmal sheath.

CORRESPONDENCE: Dr. Tarek Salem, Department of Urology, Suez Canal University, Faculty of Medicine, Ismailia 31911, Egypt ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.02




Fournier's Gangrene in a Man Who Was HIV-Positive With a High CD4 Count: An Unusual Presentation of a Complex Rectoscrotal Fistula


Fournier's gangrene is a potentially life-threatening, necrotising fasciitis of the perineal and/or genital region. Known risk factors include diabetes, alcoholism, and immunosuppression. Often described as idiopathic, a cause can usually be found such as trauma, catheterization, or anorectal fistula. We report a case of Fournier's gangrene in a 52-year-old man who was HIV-positive but had an underlying complex fistula that was discovered during the course of his treatment. He was successfully treated with surgical intervention and antibiotics. This patient was not typical of most previously described cases because: (1) he had a low viral load and previously high CD4 count; (2) there was no initial evidence of traditional portals of entry for organisms; (3) there was no evidence of sexually-transmitted infection found in surgical specimens; and (4) the complex fistula was the likely nidus of infection.

Sandra Chika Ndirika,1 Rex Melville,2 James Green1

1 Department of Urology, Whipps Cross University Hospital, London

2 Department of Sexual Health, Whipps Cross University Hospital, London

Submitted July 22, 2010 - Accepted for Publication September 16, 2010

KEYWORDS: Fournier's gangrene; Necrotising fasciitis; HIV/AIDS infection

CORRESPONDENCE: Miss S. C. Ndirika, Department of Urology, Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London, E11 9LR; ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.12

ABBREVIATIONS AND ACRONYMS: AIDS, acquired immune deficiency syndrome; CD4, cluster of differentiation 4; FG, Fournier's gangrene; HIV, human immunodeficiency virus.



Tension-Free Vaginal Tape Versus Transobturator Tape for Treatment of Female Stress Urinary Incontinence: A 2-Year Follow-Up Investigation


INTRODUCTION: The purpose of the study was to compare intraoperative, perioperative, and long-term (2-year) safety and efficacy of procedures using tension-free vaginal tape (TVT) versus transobturator tape (TOT) for the treatment of female stress urinary incontinence (SUI).

METHODS: Participants were 120 female patients with SUI. They were randomly assigned to 2 equal groups, receiving either TVT or TOT. All patients were evaluated by history, physical examination, urine culture, pelviabdominal ultrasound, and urodynamics; they also completed the International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF). Patients were followed for 2 years. The groups were compared for operative outcomes, complications, maximum flow rates (Qmax) before surgery and at 3-month follow-up intervals, cure rates, and ICIQ-SF scores.

RESULTS: Patients receiving TVT had significantly higher intraoperative blood loss (P < .001) and longer operative times (P < .001). There was no significant group difference in length of hospital stay. Qmax levels decreased after surgery, with no group differences at any follow-up evaluation. Minor complications occurred in < 10% of all patients, with no significant group differences. The success rate was 93.3 % (cure 83.3%; improved 10%) following use of TVT and 96.6% (cure 86.6%; improved 10%) following use of TOT; group differences were not significant. All patients with failed procedures had VLPP < 60 cmH20 and grade III SUI. Mean preoperative ICIQ-SF scores, a quality of life measure, were significantly lowered for all patients following surgery with no significant group differences.

CONCLUSION: Use of TVT and TOT in surgery result in similar outcomes, including cure rates. Based on the results of this 2-year study, both procedures have similar morbidity and should be considered safe and effective.

Osama Abdelwahab, Hammouda Sherif

Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt

Submitted August 18, 2010 - Accepted for Publication September 24, 2010

KEYWORDS: Stress urinary incontinence; Transobturator tape (TOT); Tension-free vaginal tape (TVT).

CORRESPONDENCE: Osama Abdelwahab, MD, 1st Gameel Street, Makkah Tower, 11513, Benha, Egypt ().

CITATION: Urotoday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.13

ABBREVIATIONS AND ACRONYMS: ICIQ-SF, International Consultation of Incontinence Questionnaire-Short Form; ISD, intrinsic sphincteric dysfunction; PVR, postvoid residual; Qmax, maximum flow rate; SUI, stress urinary incontinence; TOT, transobturator tape; TVT, tension-free vaginal tape; VLPP, Valsalva leak point pressure.



Five-Year Survival After Multimodal Approach in a Patient With Muscle-Invasive Transitional Cell Carcinoma of the Bladder and Adrenal Metastasis


A 59-year-old male presented with painless hematuria. Cystoscopy revealed a 6 cm solid lesion on the bladder wall. Transurethral resection of the mass showed a pT2 G3 transitional cell carcinoma (TCC). Staging computed tomography demonstrated a solitary left adrenal metastasis that was confirmed on fine-needle aspiration. He then underwent 6 cycles of gemcitabine and cisplatin. Postchemotherapy positron emission tomography demonstrated no glucose-avid areas. Left adrenalectomy and radical cystectomy were performed. There is no evidence of disease recurrence 62 months after the procedure. In metastatic TCC, postchemotherapy surgery is controversial but may provide significant survival benefit to patients with limited systemic disease that responds well to chemotherapy. This report adds to the growing body of evidence that supports a more aggressive multimodal approach to metastatic TCC in select patients. Other patient selection criteria are discussed.

Shuo Liu,1 Vincent Tse,1 Martin Stockler,2 Betty Lin3

1 Department of Urology, Concord Repatriation General Hospital, Sydney, Australia

2 Department of Medical Oncology, Concord Repatriation General Hospital, Sydney, Australia

3 Department of Anatomical Pathology, Concord Repatriation General Hospital, Sydney, Australia

Submitted August 17, 2010 - Accepted for Publication September 10, 2010

KEYWORDS: Adrenal; Bladder cancer; Metastasis; Survival

CORRESPONDENCE: Dr. Shuo Liu, Department of Urology, Concord Repatriation General Hospital, Hospital Road, Concord, Sydney NSW 2139, Australia ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.09

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; GC, gemcitabine and cisplatin; PET, positron emission tomography; TCC, transitional cell carcinoma.



Spontaneous Intraperitoneal Perforation of the Bladder Secondary to Tuberculosis


Spontaneous perforation of the bladder is a rare clinical condition that should be suspected in patients with acute abdomen and a history of tuberculosis. The present case is a 43-year-old male with a history of pulmonary tuberculosis and repeated urinary infections. Based on his presenting symptoms, perforation of the appendix was suspected. Laparotomy revealed several hundred milliliters of urine in the peritoneal cavity. There was also a marked inflammatory response with exudate throughout the peritoneum. A 3 cm defect was found in the posterior wall of the bladder. The bladder was retracted, with very thick and fibrous walls. Laborious radical peritoneal debridement was performed, followed by peritoneal lavage and bladder repair. Postoperatively, the patient was treated with antibiotics. Despite the clinical measures taken, the patient progressed with continuing sepsis and poor clinical course. Rupture of the urinary bladder must be included in the differential diagnosis of an acute abdomen. This is a rare but potentially fatal condition with a high mortality rate if not treated early.

Sataa Sallami,1 Mohamed M Gargouri,1 Mourad Tayeb,1 Mohamed Ben Slima,2 Mounir Makhlouf2

1 Department of Urology, La Rabta Hospital-University, Tunis, Tunisia

2 Department of Surgery, La Rabta Hospital-University, Tunis, Tunisia

Submitted May 17, 2010 - Accepted for Publication June 1, 2010

KEYWORDS: Urinary bladder; Perforation; Spontaneous; Abdomen; Acute; Tuberculosis.

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

CITATION: Urotoday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.06

ABBREVIATIONS AND ACRONYMS: MRI, magnetic resonance image; TB, tuberculosis.



Perioperative and 5-Year Oncological Outcomes Following Open Radical Cystectomy for 200 Patients: A Single Center Experience


INTRODUCTION: Contemporary benchmarks of the short-term and long-term outcomes of open radical cystectomy (ORC) that can be used for future comparison of minimally invasive techniques are incomplete. The purpose of this prospective study was to evaluate the perioperative and 5-year oncological results of ORC with urinary diversion.

METHODS: Between 2004 and 2009, 200 patients undergoing ORC with urinary diversion were prospectively enrolled. Indications for ORC included: (1) muscle-invasive bladder cancer detected by transurethral resection, or (2) high-grade stage Ta, T1, or carcinoma in situ that was refractory to repeated transurethral resection and intravesical immunotherapy or chemotherapy. Patients with metastatic disease were excluded. Mean patient age was 65.1 years. Perioperative, histopathologic, and postoperative follow-up data were recorded and analyzed statistically.

RESULTS: Ileal conduits were constructed in 159 (79.5%) patients; an ileal orthotopic neobladder (Studerâ's procedure) was constructed in 41 (20.5%) patients. Mean operating time was 275 minutes. Mean estimated blood loss was 690 mL. Blood transfusion was required in 37 (18.5%) patients. Mean hospital stay was 6.1 days. Major and minor complications were recorded in 16 (8%) and 31 (15.5%) of the patients, respectively. Perioperative mortality was recorded in 2 (1.5%) patients. Pathologically organ-confined and nonorgan-confined cancer was found in 135 (67.5%) and 65 (32.5%) patients, respectively; 33 (16.5%) patients had pathologically confirmed lymph nodes. Median follow-up was 60.1 months. Local recurrence and distant metastases were recorded in 16 (8%) and 9 (4.5%) patients, respectively. The 5-year disease-free survival, cancer-specific survival, and overall survival rates were 75.5%, 71.5%, and 63.5%, respectively. Survival rates were significantly higher for patients with organ-confined cancers and negative lymph nodes.

CONCLUSIONS: Open radical cystectomy has an acceptable perioperative morbidity and mortality, along with a favorable 5-year oncological efficacy. Minimally invasive techniques need long-term prospective comparison with this approach before they can be accepted as a standard treatment for urinary bladder malignancy.

Nayan K Mohanty, Anup Kumar, Pawan Vasudeva, Manoj Jain, Sanjay Prakash, Rajender P Arora

Department of Urology, V.M. Medical College & Safdarjang Hospital, New Delhi, India

Submitted July 22, 2010 - Accepted for Publication September 6, 2010

KEYWORDS: Urinary bladder; Carcinoma; Radical cystectomy

CORRESPONDENCE: Professor Nayan K Mohanty, C-II/124, Moti Bagh-I New Delhi, 110 029, India ().

CITATION: Urotoday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.08

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; LRC, laparoscopic radical cystectomy; ORC, open radical cystectomy; RRC, robotic radical cystectomy; TCC, transitional cell carcinoma.



Gonadotropin-Releasing Hormone Antagonists: From Basic Science to the Clinic in Patients With Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms


Gonadotropin-releasing hormone (GnRH) antagonists represent a new pharmacological class with several potential clinical indications. Although some of these indications (eg, prostate cancer) are clearly established, others are still in an exploratory phase and await confirmatory clinical trials to prove their clinical value in the treatment of target patients. Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are still investigational indications for GnRH antagonists. Although there have been several successful and hence promising proof-of-concept clinical trials, the conflicting confirmatory data on cetrorelix and lack of clarity on the putative mechanism of action leaves us with work to do before this indication can be declared established. In this short review article, we outline the rationale for the use of GnRH antagonists in LUTS associated with BPH, summarize briefly the available clinical data (phase II and III trials) with the different compounds, touch upon the proposed mechanisms of action, and try to set perspectives for this field of research.

Enrico Colli, László B. Tankó

Global Clinical Research and Development, Urology, Ferring Pharmaceuticals, Copenhagen, Denmark

Submitted September 13, 2010 - Accepted for Publication September 27, 2010

KEYWORDS: GnRH antagonists; Benign prostatic hyperplasia; Mechanisms of action; Clinical trials.

CORRESPONDENCE: Enrico Colli, MD, Head of Urology, Global Clinical R&D, Ferring Pharmaceuticals, Kay Fiskers Plads 11, 2300 Copenhagen S, Denmark ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.14

ABBREVIATIONS AND ACRONYMS: BPH, benign prostatic hyperplasia; GnRH, gonadotropin-releasing hormone; IPSS, International Prostate Symptom Score; LUTS, lower urinary tract symptoms, Qmax, maximum urinary flow rate.



Retroperitoneal Ganglioneuroma Presenting as a Right Renal Mass in an Adult Patient: A Case Report and Literature Review


Ganglioneuromas are benign tumors arising from the neural crest. The reported case is a 47-year-old female who presented with right lumbar pain that increased progressively in intensity over the last 3 years. Computed tomography revealed a homogeneous mass located just above and behind the right kidney. The patient underwent a tumorectomy through a lumbar approach. Histology revealed a primary extra-adrenal retroperitoneal ganglioneuroma. Related literature is reviewed.

KEYWORDS: Retroperitoneum; Sympathetic nervous system, Ganglioneuroma; Surgery.

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

CITATION: Urotoday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.03

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; GN, ganglioneuroma; MRI, magnetic resonance imaging.



The Effects of Ureterorenoscopy on Renal Function


INTRODUCTION: The effects of dilatation and increased pressure in the ureter and renal pelvis following ureterorenoscopy (URS) are not well documented. The purpose of the prospective study was to evaluate renal function in patients undergoing URS for treatment of ureteral calculi.

METHODS: URS was performed on 30 patients between March and June, 2009. The mean (SD) patient age was 38.8 (12.2) years. There were 23 males and 7 females. Biochemical tests of renal function in the serum and urine were performed before the URS and on the 7th postoperative day. Outcome measures were compared before and after URS for all patients, and separately for patients with or without a double-J stent, using paired t tests. Probability < .003 indicated significant differences, following a Bonferroni adjustment.

RESULTS: Out of 17 measures of renal function, there was a significant postsurgery increase in the amount of proteinuria excreted in the 24-hour urine (P = .001). Ureteral stents were inserted in 19 (63%) patients. Patients with and without DJ stents had a significant increase in proteinuria in 24-hour urine (P = .001 for both patient groups). There were no other significant differences. The mean URS duration was 40 minutes. The mean amount of serum physiological fluid consumed was 1860 mL (SD, 1474.2; range, 250-7500 mL). A pneumatic lithotripter was used in 27 (90%) of the cases to shatter the calculi. There were no surgical complications or significant changes in arterial blood pressure.

CONCLUSIONS: The URS procedure did not significantly alter any measure of renal function except for urine proteinuria in 24 hours, which increased following surgery for patients with or without DJ stents.

Mustafa Aldemir, Efe Önen, Önder Kayıgil

Department of 2nd Urology, Ankara Atatürk Teaching and Research Hospital, Ankara, Turkey

Submitted August 7, 2010 - Accepted for Publication September 3, 2010

KEYWORDS: Ureterorenoscopy; Renal functions; Ureteral stent

CORRESPONDENCE: Mustafa Aldemir, MD, Aydinlikevler Mahallesi Arilik Sokak No: 5/5, P.O. Box 06130, Ankara, Turkey ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.07 ABBREVIATIONS AND ACRONYMS: CRP, c-reactive protein; DJ, double J; URS, ureterorenoscopy.



En Bloc Bilateral Kidney, Aorta, and Vena Cava Transplantation From a Deceased Pediatric Donor to an Adult Recipient: A Case Report


Kidney transplantation is the treatment of choice for end-stage renal disease. There has been reluctance to transplant small pediatric deceased donor kidneys into adults because of possible vascular and urinary complications and insufficient nephron mass. The present case is a successful renal transplantation from a pediatric cadaver donor to an adult recipient. Both kidneys and a segment of inferior vena cava (IVC) and aorta were resected en bloc. One end of both the aorta and IVC was completely closed; the other ends were anastomosed to the internal iliac artery and the external iliac vein of the recipient, respectively. Renal DTPA scan of the transplanted kidney showed good perfusion and function. Recipient BUN, creatinine, urinary output, and blood pressure were acceptable. There have been no complications or signs of rejection 20 months later. The use of the en bloc technique may obviate the otherwise adverse effect of very small donor size on transplantation outcome.

Gholamreza Mokhtari, Farshid Pourreza, Seyed Alaeddin Asgari, Hossein Hemmati, Ahmad Enshaei, Seyedeh Atefeh Emadi, Amin Afsharimoghaddam

Urology Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran

Submitted July 6, 2010 - Accepted for Publication August 23, 2010

KEYWORDS:En bloc; Kidney transplant; End-stage renal disease.

CORRESPONDENCE: Ahmad Enshaei, MD, Urology Research Center, Guilan University of Medical Sciences, Razi Hospital, Sardar Jangal Street, Rasht, Guilan, Iran ()

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.04

ABBREVIATIONS AND ACRONYMS: ESRD, end-stage renal disease; IVC, inferior vena cava.



Electron Microscopic Evaluation of the Urethroileal Junction and Proximal Urethra in Females With Hypercontinence Following Orthotopic Ileal Neobladder Diversion


INTRODUCTION: Hypercontinence following orthotopic bladder diversion occurs in up to 40% of female patients. Its cause is still debated. The purpose of the study was to compare the histological makeup of specimens biopsied from the urethroileal junction and proximal urethra in female patients with normal voiding patterns and hypercontinence following orthotopic diversion.

METHODS: The participants were 11 females who had received orthotopic diversion after radical cystectomy with a Hautmann small intestinal neobladder. One year after the surgery, 5 patients were normally voiding without significant residual and 6 patients were hypercontinent (defined as voiding with > 150 mL residual urine or inability to void). All patients had cystoscopy and biopsy from the urethroileal junction and proximal urethra. A specially configured transurethral resection loop with a very small V-shaped tip was used to minimize the biopsy. The specimens were subjected to hematoxylin and eosin stain for light microscopy and processed for electron microscopy examination. Specimens from the 2 groups were compared for: (1) presence or absence of smooth muscle fibers, their number, and their orientation; (2) presence or absence of nerve fibers and their number.

RESULTS: Examination of the specimens from both groups showed only areas of connective tissue with scattered myelinated nerve fibers and smooth muscle fibrils. No obvious difference was found between patients with normal voiding characteristics and patients with hypercontinence regarding the number or orientation of smooth muscle fibers or nerve fibers.

CONCLUSION: The high incidence of hypercontinence in females undergoing cystectomy and orthotopic diversion could not be attributed to a difference in histological architecture in the area of the urethroileal anastomosis and the proximal urethra in this small sample. The level of urethral resection appears to be the primary evidence-supported cause of this condition.

Mohamed Ismail,1 Mohamed Wishahi,1 Takek Swellam,1 Soheir Mansy,2 Hoda Yehia2

1 Department of Urology, Theodore Bilharz Research Institute, Giza, Egypt

2 Department of Electron Microscopy, Theodore Bilharz Research Institute, Giza, Egypt

Submitted August 16, 2010 - Accepted for Publication September 15, 2010

KEYWORDS: Hypercontinence; Females; Orthotopic diversion

CORRESPONDENCE: Dr. Mohamed Ismail, Department of Urology, Theodore Bilharz Research Institute, 12311 Giza, PO Box 30, Giza, Egypt ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.10



Success of Extracorporeal Shockwave Lithotripsy for Distal Ureteric Stones in Patients With and Without Hydronephrosis


INTRODUCTION: The purpose of the present study was to verify whether ureteral obstruction due to solitary distal ureteric stones affects the outcome of extracorporeal shock wave lithotripsy (ESWL).

METHODS: The prospective study included 120 patients with solitary distal ureteral stones that were 6-15 mm in length and located below the lower border of the sacroiliac joint. Patients were assigned to one of 4 groups according to the degree of dilatation of the urinary system. Group 1 (n = 51; 42.5%) had no dilatation; group 2 (n = 41; 34.2%) had mild dilatation; group 3 (n = 20; 16.6%) had moderate dilatation; group 4 (n = 8; 6.7%) had severe dilatation. All patients underwent ESWL using the Siemens Lithostar Plus lithotripter (Siemens Corp; New York, NY, USA). Outcome measures were stone-free rates, number of treatment sessions, stone clearance time, and number and power of the shock waves used. Groups were compared using t and chi-square tests.

RESULTS: Three months after the last ESWL session, 95 patients (79.2%) were stone free, 6 patients (5%) had insignificant residual stones, and 19 patients (15.8%) had treatment failure. There was no significant difference in the ESWL outcomes across groups (P = .41). Patients with hydronephrosis required significantly more treatments than patients without obstruction (P < .002). The mean number of days needed to clear the stones progressively increased as hydronephrosis severity increased (P = .007). The groups with hydronephrosis required a significantly larger mean number of shock waves (P < .001). There was no significant group difference in the mean shock wave power used (P = .39).

CONCLUSIONS: The presence or degree of hydronephrosis did not significantly affect the overall success of ESWL in treating single distal ureteral stones measuring ≤ 15 mm. However, the presence of hydronephrosis significantly increased the retreatment rate and number of shock waves needed to clear the stone. Hydronephrosis also increased the interval to stone clearance.

Hashem Hafez, Mohamed Hassan Ali, Tarek Salem

Department of Urology, Faculty of Medicine, Suez canal University, Ismailia, Egypt

Submitted July 22, 2010 - Accepted for Publication August 23, 2010

KEYWORDS: Stones; Lower ureter; Extracorporeal shock wave lithotripsy.

CORRESPONDENCE: Dr. Tarek Salem, Department of Urology, Suez Canal University, Faculty of Medicine, Ismailia 31911, Egypt ().

CITATION: Urotoday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.05

ABBREVIATIONS AND ACRONYMS: ESWL, extracorporeal shock wave lithotripsy



Letter from the Editor - August 2010

Dear Colleagues,

The first annual reception hosted by the UroToday International Journal® was held during the 2010 AUA annual conference in San Francisco. The reception took place at the City Club of San Francisco where authors, reviewers, members of the Editorial Board, and industry mingled amongst beautiful artwork and views of the San Francisco skyline. The event was a welcomed reprieve from the hectic pace of the conference and provided the opportunity to honor the seven award-winning authors whose articles were deemed highly relevant to the scientific community and whose findings have strong implications for clinicians and patients. I enjoyed the privilege of presenting the awards to those authors able to attend the reception. I appreciate the support of our reviewers and Editorial Board for their dedication to the ongoing publication of the UroToday International Journal.

The rate of article submissions remains on the rise and the number of individual subscribers continues to grow to near 22,000 representative of all continents. Page views for the journal have more than doubled since the same time last year, reaching over 90,000 per year. We look forward to ongoing growth and to continuing to communicate relevant science throughout 2010.

This issue offers publication of a number of original research articles. Valentini and colleagues extended their previously published mathematical micturition model for analysis of urodynamic traces to include additional findings about nervous system control.

Two clinical investigations provide insight into treatment outcomes. First, Dash et al compared the effects of tamsulosin plus flavoxate with tamsulosin plus a placebo for treatment of lower urinary tract symptoms in 120 patients with benign prostatic hyperplasia. Although both treatment groups responded to therapy, the group taking the two active drugs had significant improvement in symptom scores and quality of life measures. Second, there is currently no universal agreement about choosing flexible ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) for management of kidney stones after extracorporeal shock wave lithotripsy has failed. The investigation by ElShebiny provides some insight. He studied 66 patients and discovered that the stone-free rate was similar following either procedure. Although PCNL surgery was shorter in duration and may be the best choice for removal of lower calyx stones, the advantages of significantly shorter hospital stay and less patient discomfort following URS may make it a preferred choice for other cases.

Xin-min et al measured 5-hydroxytryptamine (5-HT) plasma levels of the internal spermatic vein and peripheral vein in 30 patients with varicocele and infertility, and compared the results with 30 fertile patients needing other types of scrotal surgery. The authors found that patients with varicocele had significantly elevated 5-HT plasma levels in the spermatic vein.

Finally, this issue contains a number of case reports. Logan et al present a 58-year-old male with liposarcoma of the spermatic cord. The authors provide an extensive literature review on diagnosis and management of this disorder and recommend long-term surveillance for recurrence. Habibi et al describe a rare case of basal cell carcinoma that metastasized to the kidney of a 61-year-old female. Advanced imaging techniques are improving earlier detection of renal metastasis and this case provides a reminder that metastatic disease should be considered when evaluating renal masses.

Thank you for your continued support of the journal. I welcome your comments and look forward to including those that I receive in future issues.


Kind regards,

K-E Andersson

Basal Cell Carcinoma Metastatic to the Kidney: A Case Report


Metastases to the kidney are uncommon and usually seen in the setting of widespread disease. Furthermore, these metastases are usually clinically silent and therefore often detected only on autopsy. The most common primary sites are, in descending order, the lung, breast, and gastrointestinal tract. Basal cell carcinoma (BCC) rarely metastasizes; however when BCC does metastasize, the lung and bone are the most likely sites of involvement. BCC metastatic to the kidney is an extremely rare occurrence, with only several cases reported in the literature. The present case is a 61-year-old female with past medical history of BCC, who presented with a right gluteal mass and had an irregular hypodensity in the left kidney. Biopsy of the renal lesion showed tumor cells morphologically identical to the patient’s prior BCC, and subsequent immunohistochemical findings were consistent with BCC.

KEYWORDS: Kidney; Metastases; Basal cell carcinoma.

CORRESPONDENCE: Joseph Habibi, MD, VCU Medical Center, PO Box 980118, Richmond, VA 23298, USA ().

CITATION: Urotoday Int J. 2010 Aug;3(4). doi:10.3834/uij.1944-5784.2010.08.14

ABBREVIATIONS AND ACRONYMS: BCC, basal cell carcinoma; CT, computed tomography.



Laparoscopic Management of Suprarenal Leiomyosarcoma: A Case Report


The present report is a case of successful resection of a retroperitoneal leiomyosarcoma using laparoscopic surgery. There are few cases of this kind reported in the literature. The vast majority of patients have open surgery when the tumors are at an advanced stage. The patient is a 36-year-old man who presented with right upper abdominal pain. Evaluation by imaging studies led to the diagnosis of a retroperitoneal tumor (7.5 cm in diameter) above the right kidney. Laparoscopic surgery was performed. Histopathologic examination of the resected specimen showed a totally excised leiomyosarcoma. At a 10-month follow-up, the patient was disease-free and doing well. The results show that laparoscopic excision of a retroperitoneal leiomyosarcoma tumor can be applied safely and successfully as a minimally invasive procedure.

KEYWORDS: Leiomyosarcoma; Laparoscopy; Retroperitoneal tumor; Laparoscopic surgery.

CORRESPONDENCE: Masashi Matsushima, PhD, Department of Urology, Saitama Medical School, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan ().

CITATION: Urotoday Int J. 2010 Aug;3(4). doi:10.3834/uij.1944-5784.2010.08.15

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; MRI, magnetic resonance image; PK, PlasmaKinetic.



Pseudotumoral Eosinophilic Cystitis in 2 Children From India


Eosinophilic cystitis is a rare form of bladder inflammation. Fewer than 30 pediatric cases have been described in the literature. The current report is about 2 children, ages 11 years and 4 years. Both patients presented with irritative voiding disturbances and a bladder mass lesion that was seen on imaging. The diagnosis of eosinophilic cystitis was confirmed by cystoscopic biopsy. The children were treated with antihistamines, which resulted in complete clinical and radiological resolution of the lesion.

KEYWORDS: Bladder; Cystitis; Eosinophilic inflammation; Pseudotumor.

CORRESPONDENCE: Dr. Siddalingeshwar Neeli, Associate Professor & Consultant Urologist, Department of Urology, KLE University, J. N. Medical College and KLES Dr. Prabhakar Kore Hospital & MRC, Nehrunagar, Belgaum 590010, INDIA ().

CITATION: Urotoday Int J. 2010 Aug;3(4). doi:10.3834/uij.1944-5784.2010.08.07

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; EC, eosinophilic cystitis; IgE, immunoglobulin E.



Liposarcoma of the Spermatic Cord: A Case Report and Review of Management


Malignant lesions of the spermatic cord are rare; among them, sarcomas are the most frequent. The present article is a case report of a well-differentiated liposarcoma of the spermatic cord involving a 58 year-old male who presented with a painless scrotal mass. The mainstay of management is excision with radical orchiectomy. The most important factors for prognosis are the histologic subtype and surgical margin status. Adjuvant treatment may include radiation, depending on the presence of poor prognostic indicators. The role of chemotherapy is not clearly defined, and experience is limited to cases where recurrence has occurred. Patients with a well-differentiated liposarcoma of the spermatic cord have a good prognosis if surgical margins are negative and do not routinely require adjuvant therapy. Long-term surveillance is critical, because reports in the literature have demonstrated recurrences after 20 years.

KEYWORDS: Liposarcoma; Spermatic cord; Paratesticular tumor

CORRESPONDENCE: Joshua E. Logan, M.D., 6333 Center Drive, Building 16, Interstate Corporate Center, Norfolk, VA 23502, USA ().

CITATION: UroToday Int J. 2010 Aug;3(4). doi:10.3834/uij.1944-5784.2010.08.08

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; FNCLCC, Fédération Nationale des Centres de Lutte Contre le Cancer; MRI, magnetic resonance image; NCI, National Cancer Institute.



Antegrade Scrotal Sclerotherapy With and Without Tamoxifen for Treatment of Infertile Men Due to Variocele


INTRODUCTION: The objective was to compare the semen quality and hormonal levels of patients with variocele receiving antegrade scrotal sclerotherapy (ASS) alone versus a combination of ASS and tamoxifen.

METHODS: The design was a cross-sectional investigation of 72 patients with varicocele that were surgically managed with ASS. The patients were admitted to the hospital urology department from January to June 2009 with different grades of varicocele and infertility. They were randomly divided into 2 groups: 37 patients underwent ASS only; 35 patients underwent ASS and received tamoxifen citrate 10 mg twice daily, starting immediately after ASS and continuing for 6 months. All patients were evaluated preoperatively and postoperatively by history, clinical examination, semen analysis, and Doppler ultrasound. Hormonal assay was indicated in cases of severe oligospermia. Outcome measures were semen parameters and hormonal levels. Operative time, length of hospital stay, length of time before return to normal activity, recurrence rate, and cost of each procedure were also recorded.

RESULTS: The mean (SD) ASS operative time was 20 (6.4) minutes for patients with unilateral varicocele and 28 (10.8) minutes for patients with bilateral varicocele. The hospital stay for patients with unilateral and bilateral surgery was < 24 hours and < 30 hours, respectively. Patients in both groups showed statistically significant improvement in semen count, motility, and abnormal forms 6 months after surgery (P < .001). Over 70% of the patients in both groups had improvement in all 3 measures and there were no significant group differences (P > .05). Eleven out of 35 patients in group 2 required hormonal assessment because they had severe oligozoospermia. There was a significant improvement in hormonal levels following treatment (P < .01). Over 80% of the patients in both groups had no recurrence. Persistent varicocele occurred in 10 patients (13.9%), scrotal hematoma in 5 patients, and postoperative scrotal pain in 1 patient.

CONCLUSION: ASS for varicocele in male infertility due to varicocele significantly improves semen parameters with or without tamoxifen. ASS is a rapid, effective, and low-cost procedure.

KEYWORDS: Infertility; Scrotal sclerotherapy; Varicocele

CORRESPONDENCE: Osama Abdelwahab, MD, 1st Gameel Street, Makkah Tower, Benha, 11513, Egypt ().

CITATION: Urotoday Int J. 2010 Aug;3(4). doi:10.3834/uij.1944-5784.2010.08.06

ABBREVIATIONS AND ACRONYMS: ASS, antegrade scrotal sclerotherapy; FSH, follicle-stimulating hormone; LH, luteinizing hormone



Tubeless Percutaneous Nephrolithotomy With and Without a Hemostatic Product: A Prospective, Randomized Study


INTRODUCTION: Guidelines for the use of topical hemostatic products have not been established and their necessity for every case is not determined. The purpose of the present prospective, randomized study was to compare the outcomes of tubeless percutaneous nephrolithotomy (PNL) with and without a hemostatic agent.

METHODS: A total of 48 patients with lower calyceal, middle calyceal, or pelvic renal stones ≤ 3 cm were randomly divided into 2 equal groups. All patients received single-stage tubeless PNL through 1 access tract. Group 1 had no local hemostatic agent; group 2 had oxidized regenerated cellulose (Surgicel; Ethicon Inc, Somerville, NJ, USA). Plain kidney, ureter, bladder X-ray and renal ultrasound were performed at the first postoperative day to evaluate the stone-free rate and detect any perinephric hematoma. Postoperative urinary leakage and postoperative hemoglobin (Hb) were also measured. Patients had ultrasound to determine the amount of the perinephric collection before being discharged.

RESULTS: No postoperative urinary leakage through the percutaneous tract was detected in either group. The mean (standard deviation) postoperative reduction in Hb concentration was 1.13 g/dL (1.11) for patients in group 1 and 1 g/dL (0.76) for patients in group 2; the group difference was not significant (P = .20). Most patients had no postoperative perinephric collection; minimal collection of 1 cm x 0.5 cm was detected in 2 cases in group 1 and 3 cases in group 2 (P = .30). No patient in either group had perinephric hematoma. Most patients were stone free: 22 patients (91.7%) in group 1; 20 patients (83.3%) in group 2.

CONCLUSIONS: Topical hemostatic agents may not be needed after an uncomplicated percutaneous renal procedure.

KEYWORDS: Percutaneous nephrolithotomy; Tubeless PNL; Hemostatic agents.

CORRESPONDENCE: Mohamed H. Ali, MD, Lecturer of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt ().

CITATION: Urotoday Int J. 2010 Aug;3(4). doi:10.3834/uij.1944-5784.2010.08.05

ABBREVIATIONS AND ACRONYMS: FDA, Food and Drug Administration; Hb, hemoglobin; KUB, kidney, ureter, bladder; PNL, percutaneous nephrolithotomy.



Value of Office-Based Transrectal Three-Dimensional Ultrasound for Diagnosis of Acute Dysuria of the Prostatic Urethra


INTRODUCTION: The purpose of the study was to compare the accuracy of plain radiography, 2-dimensional (2D), and 3-dimensional (3D) transrectal ultrasound (TRUS) in diagnosing the causes of acute dysuria, as confirmed by urethroscopy or laboratory findings.

METHODS: Participants were 122 men with clinical presentation of acute dysuria who were previously known to be healthy. Their mean age was 28 years (range, 17-49 years). All patients received a plain radiograph of the urinary tract. A SonoAce X8 ultrasound system (Medison America Inc; Cypress, CA, USA) was used to obtain both 2D and 3D TRUS. Voiding-related symptoms, cause of the dysuria, location, and morphology of the lesions were recorded. The results of the plain radiograph, 2D TRUS, and 3D TRUS were compared with the results of urethroscopy or laboratory findings to determine diagnostic accuracy.

RESULTS: Of the total 122 patients, 113 patients (92.6%) had calcular obstruction of the prostatic urethra; 7 patients (5.7%) had variants of severe urethritis; 2 patients (1.6%) had benign urethral polyps. In cases of calcular obstruction, plain radiography revealed 76.7% of radiopaque stones, the 2D TRUS revealed 80.2% of stones, and the 3D TRUS with high threshold revealed 99.1%. Both 2D TRUS and 3D TRUS with low-threshold technique revealed the polyps and accurately defined their pattern and site. Three-dimensional TRUS descriptions of inflammatory lesions and their effect on periurethral tissues were dissimilar from each other and suggestive of different types.

CONCLUSION: Three-dimensional TRUS imaging may play an important role in the pretreatment evaluation of acute dysuria that is caused by different impeding factors.

KEYWORDS: Three-dimensional transrectal ultrasound (3D TRUS); Prostatic urethra; acute dysuria.

CORRESPONDENCE: Salah Elwagdy, MD, Department of Uroradiology, Azhar University, 133 Shubra Street, Dawaran Shubra, Cairo, 11242, Egypt ().

CITATION: UroToday Int J. 2010 Aug;3(4). doi:10.3834/uij.1944-5784.2010.08.16

ABBREVIATIONS AND ACRONYMS: 2D, 2-dimensional; 3D, 3-dimensional; E. coli, Escherichia coli; ROI, region of interest; TRUS, transrectal ultrasound; US, ultrasound.



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