Issue 1: February 2010

UIJ Volume 3 Issue 1 2010

Letter from the Editor - February 2010

Dear Colleagues,

It is a pleasure to welcome you to our first issue in 2010. The UIJ is consistently read by over 20,000 individual subscribers in 206 countries throughout the six continents of the globe. It is truly a unique scientific publication in that it is free for authors to submit manuscripts; it remains open access and resides on a custom platform, unlike any other journal that allows for searchable content within the entire database. It facilitates searchable content with topics, key words or any phrase and will rapidly provide a listing of all articles that include any of the above.

Several studies in the current issue are related to management of ureteral stones. Tawfiek stated that the ideal treatment procedures for large (> 1 cm) proximal ureteral stones have not been defined. Therefore, he divided 147 patients into a group treated with extracorporeal shockwave lithotripsy (ESWL) and a group treated with a semirigid ureteroscope and lithoclast. He found a statistically significant group difference at the 1-month evaluation, when 58% of the patients were stone free after ESWL and 92% were stone free after ureteroscopy. A study by Salem et al is about steinstrasse (stone street), an obstructive column of stone fragments retained in the ureteral lumen after ESWL. Spontaneous expulsion is reported in about 37% of cases; otherwise, ureteroscopy, percutaneous nephrolithotomy, or additional ESWL treatment is needed. The authors compared a group of 44 patients receiving tamsulosin (0.4 mg daily) for management of steinstrasse with a control group of equal size and similar characteristics. After 28 days, stone expulsion occurred in 72.7% of the patients receiving tamsulosin and 56.8% of the patients in the control group; the difference was statistically significant.

The objective of a randomized, controlled study by Abdel-Meguid was to compare transurethral resection of the prostate in saline (TURPis) using the TURis system with the standard monopolar TURP, to determine evidence of safety and efficacy. The results of the investigation in the context of current literature show that TURPis has the potential to become a preferred method for treatment of benign prostatic hyperplasia (BPH).

Although the focus of many articles in this journal is clinical, basic science research is always welcome. Geyer et al compared tissue distribution and brain penetration of the antimuscarinic drugs trospium chloride and oxybutynin in a mouse model. Additionally, the role of the drug efflux carrier P-glycoprotein for hepatobiliary and urinary excretion and the blood-brain barrier permeability of oxybutynin were evaluated by using knockout mice that were deficient in P-glycoprotein. The authors report that brain penetration of oxybutynin highly exceeded that of trospium chloride at an equal dosage. Implications for patients who are elderly or have disease conditions are discussed.

Finally, Merkle provides a timely review in response to the well known Selenium and Vitamin E Cancer Prevention Trial (SELECT) published in 2009. The SELECT Trial demonstrated that these supplements, alone or in combination, did not prevent prostate cancer in a population of relatively healthy men. Merkle discusses some possible limitations to the study and presents literature with contradictory evidence.

In this first issue of 2010, we introduce the Editorial Board for this year. We extend our gratitude to the retiring board members and our new board members, along with all of our reviewers, for their service. We look forward to the new research that our readers will share with us this year and welcome your submissions.

Kind regards,

K-E Andersson

Renal Brucelloma in a Herniated Kidney


Brucella is a common zoonotic infection worldwide that can target many organs. Nonetheless, genitourinary involvement is uncommon, with renal abscess formation being exceptionally rare. The authors present a rare case with extensive renal involvement in a patient previously undiagnosed with brucellosis. The patient's kidney herniated through the femoral canal into the thigh. The breadth of disease found on imaging is dramatic in comparison to the patient's mild presentation of chronic, nonspecific symptoms.

KEYWORDS: Brucellosis; Hydronephrosis; Renal abscess

CORRESPONDENCE: Siamak Daneshmand, MD. Section of Urologic Oncology, Oregon Health & Science University, 3303 SW Bond Ave, CH10U, Portland, OR 97239 USA ().

CITATION: UroToday Int J. 2010 Feb;3(1). doi:10.3834/uij.1944-5784.2010.02.11



Differences in the Brain Penetration of the Anticholinergic Drugs Trospium Chloride and Oxybutynin


INTRODUCTION: This study was performed to compare tissue distribution and brain penetration of the anticholinergic drugs trospium chloride and oxybutynin in a mouse model. Additionally, the role of the drug efflux carrier P-glycoprotein for hepatobiliary and urinary excretion and the blood-brain barrier permeability of oxybutynin were evaluated by using knockout mice that were deficient in P-glycoprotein.

METHODS: Radio-labeled trospium chloride and oxybutynin were administered orally (1 mg/kg) to wild-type and P-glycoprotein deficient knockout mice. Tissue distribution of the drugs was analyzed after 12 hours. Additionally, oxybutynin was applied intravenously to gall bladder cannulated mice of both types. Drug excretion into bile and urine was analyzed over 2 hours by catheterization.

RESULTS: Absolute drug concentrations in the brain were almost 200-fold higher for oxybutynin (~200 ng/g) compared with trospium chloride (~1 ng/g) when applied at an equal dosage of 1 mg/kg orally, whereas concentrations in the liver were only 15-fold different (~300 ng/g for oxybutynin and ~20 ng/g for trospium chloride). P-glycoprotein deficient knockout mice after oxybutynin application showed no significant differences in brain penetration or drug excretion into bile and urine when compared with wild-type mice.

CONCLUSION: Brain penetration of oxybutynin highly exceeds that of trospium chloride at an equal dosage (1 mg/kg, given orally). In contrast to trospium chloride, brain penetration of oxybutynin is not restricted by the drug efflux carrier P-glycoprotein because oxybutynin is not a P-glycoprotein substrate in vivo.

KEYWORDS: Trospium chloride; Oxybutynin; P-glycoprotein; Multidrug resistance gene 1 (mdr1); Blood-brain barrier; Transport

CORRESPONDENCE: Prof. Dr. Joachim Geyer, Institute of Pharmacology and Toxicology, Justus Liebig University of Giessen, Frankfurter Str. 107, 35392 Giessen, Germany ().

CITATION: Urotoday Int J. 2010 Feb;3(1). doi:10.3834/uij.1944-5784.2010.02.12



Pure Laparoscopic Repair of Benign Colovesical Fistula Without Colectomy or Proximal Diversion: Report of 2 Cases


The authors report management of 2 patients with symptomatic colovesical fistula due to diverticular disease of the colon. Initial laparoscopy showed that there was: (1) no active inflammation, malignancy, or abscess; (2) a single fistulous communication without much adhesion; (3) a pliable colon; (4) no distal obstruction or other pathology in the large bowel; (5) a healthy omentum to interpose between the bowel and bladder. Therefore, conventional colectomy and proximal diversion were deferred. Laparoscopic excision of the fistula and closure of the bladder and colon were performed, with interposition of the omentum. To the authors’ knowledge, this is the first report of such a procedure. The 2 patients remained symptom-free after 5 years and 6 months, respectively. Pure laparoscopic repair of a colovesical fistula without colectomy or proximal diversion appears to be feasible, safe, and effective in select patients.

KEYWORDS: Colovesical fistula; Laparoscopy; Colonic divertulosis

CORRESPONDENCE: Dr. Manickam Ramalingam, Department of Urology, PSG Institute of Medical Sciences, Peelamedu, Coimbatore, Tamilnadu 641004, India ().

CITATION: Urotoday Int J. 2010 Feb;3(1). doi:10.3834/uij.1944-5784.2010.02.06



Evaluation of Prolene Mesh as a Transobturator Tape for Treatment of Female Stress Urinary Incontinence


INTRODUCTION: Slings are commonly used to treat female stress urinary incontinence (SUI). Various sling materials have been tried. The objective of this retrospective study was to determine the short-term efficacy, safety, and urodynamic effects of a suburethral sling made of polypropylene mesh and passed through the obturator foramen.

METHODS: The participants were 53 female patients with SUI; 16 (30%) had pure intrinsic sphincter deficiency (ISD) and 37 (70%) had mixed ISD and hypermobility. Preoperative evaluation consisted of history, voiding diary, examination, ascending cystography, urodynamic studies, and routine laboratory investigations. All patients were treated with a polypropylene mesh (Prolene; Ethicon Ltd, Bracknell, UK) suburethral sling. The Prolene mesh was cut into a tape measuring 30 x 1.5 cm and sterilized by autoclave. The mesh was placed at the midurethra and passed through the obturator foramen by Vicryl sutures, loaded on a curved needle that was specially designed to hold the suture. The needle was passed from the outside to the inside. The mesh was anchored to the subcutaneous tissue at the lateral edge of labia majora with Vicryl sutures. One month after surgery, patients had an interview, examination, urine analysis, and pelvic ultrasound to detect residual urine. Urodynamic evaluation was done 3 months postoperatively. Patients were then followed every 3 months through a voiding diary and examination. The mean follow-up period was 18 months.

RESULTS: All procedures were completed with no intraoperative complications, failures, or recurrences of SUI. At the 1-month follow-up, 3 patients (5%) had developed a small erosion of the anterior vaginal wall associated with lower abdominal pain, urgency, dysuria, and urinary tract infection. The patients were managed conservatively with antibiotics and local estrogen cream. At the 3-month follow-up, the erosion healed completely. Three patients (5%) complained of sensory urge incontinence both preoperatively and postoperatively. They were managed with anticholinergics.

CONCLUSION: Preliminary results showed that the suburethral transobturator Prolene mesh sling is a safe, efficient, reproducible, and low-cost technique for treatment of stress urinary incontinence. Complications exist but can be successfully managed.

KEYWORDS: Sling, Transobturator tape (TOT), Prolene, Stress urinary incontinence (SUI)

CORRESPONDENCE: Ahmed Abdelbary, MD, Department of Urology, Bani Swaif University, Bani Swaif, 11371, Egypt ().

CITATION: UroToday Int J. 2010 Feb;3(1). doi:10.3834/uij.1944-5784.2010.02.08



Comparison of Open vs Laparoscopic Nephrectomy: Outcomes and Complications


INTRODUCTION: Nephrectomy is indicated in patients with an irreversibly damaged kidney. The nephrectomy can be performed through open or laparoscopic procedure. Although there is evidence that laparoscopy is the preferred choice, additional evidence is indicated. The purpose of the present investigation was to compare the outcomes of nephrectomy through open and laparoscopic procedures.

METHODS: Between December 2006 and March 2009, 20 patients had laparoscopic nephrectomy and 20 patients had open nephrectomy. The mean patient age was 46.85 years in the group receiving open surgery and 48.15 years in the group receiving laparoscopy, with no significant group difference. Variables included operative time, length of hospitalization, and postoperative duration of nil per os (NPO) state. Complications such as hemorrhage, organ damage, infection, and reoperation were obtained from data in the patient’s medical records. The groups were compared using a t test and chi square.

RESULTS: Mean operative time for open surgery was 176.25 min; mean operative time for laparoscopy was 188.8 min. There was no significant difference in mean operative time between the groups (P = .571). Mean length of hospitalization was significantly longer for patients receiving open surgery than for patients receiving laparoscopy (4.9 days versus 3.45 days, respectively) (P = .004). There were no significant group differences in mean postoperative duration of NPO state for patients receiving open and laparoscopic surgeries (24.6 hours and 28.25 hours, respectively) (P = .542). Operative complications occurred in 6 patients in the open group and in 5 patients in laparoscopic group. There was no significant group difference in complication rates (P = .376).

CONCLUSIONS: The overall outcomes of the two procedures were similar. Laparoscopic nephrectomy, which is a minimal invasive procedure, is a recommended alternative for open surgery.

KEYWORDS: Nephrectomy; Laparoscopic nephrectomy; Open nephrectomy; Radical nephrectomy

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

CITATION: Urotoday Int J. 2010 Feb;3(1). doi:10.3834/uij.1944-5784.2010.02.01



Prophylaxis and Treatment of Prostate Cancers by Nutrition Supplements: A Clinician's View of Facts and Hope After the SELECT Study


The well-known Selenium and Vitamin E Cancer Prevention Trial (SELECT) published in 2009 seems to show that prevention of prostate cancer by nutrition supplements is ineffective. Many opposing studies have found that various vitamins, minerals, and other over-the-counter (OTC) drugs show measurable effects in prostate cancer prevention and treatment. One purpose of the present review is to discuss some possible causes for the negative results in the SELECT study. For example, it is possible that unknown intake of vitamin C influenced their results, because vitamin C alters the effect of selenium. A second purpose of this review is to present evidence from other literature that an effective prophylaxis of prostate carcinoma is possible. Protective evidence from the literature is shown for selenium, lycopene, lignane, vitamin D, and vitamin E; vitamin C and vitamin B are not protective. Supplement combinations are preferable to single agents. Other substances with preliminary data are discussed. In conclusion, there is substantial evidence in the literature that daily use of protective supplements can be beneficial, and that these benefits should not be dismissed based on a single study that did not control all of the baseline variables.

KEYWORDS: Prostate cancer; Vitamin D; Vitamin E; Selenium; Lignane; Lycopine; Nutrition supplementation

CORRESPONDENCE: Walter Merkle, MD, Department of Urology, German Diagnostic Clinic, Aukammallee 33, Wiesbaden, 65191, Germany ().

CITATION: UroToday Int J. 2010 Feb;3(1). doi:10.3834/uij.1944-5784.2010.02.13



Treatment of Large Proximal Ureteral Stones: Extracorporeal Shock Wave Lithotripsy Versus Semirigid Ureteroscope with Lithoclast

See notice of redundant publication at the end of this article.



INTRODUCTION: The purpose of the study was to assess the safety and efficacy of extracorporeal shockwave lithotripsy (ESWL) versus a semirigid ureteroscope with a lithoclast for treatment of large proximal ureteral stones.

METHODS: The participants were 147 patients with large (> 1 cm) upper ureteral stones. ESWL and ureteroscopy were performed for 71 and 76 patients, respectively. The mean stone sizes and standard deviations (SD) were 1.34 cm (SD = 0.03) for the patients receiving ESWL and 1.51 cm (SD = 0.04) for the patients receiving ureteroscopy. There were no significant group differences in stone size (P = .604). ESWL was performed under intravenous sedation with a Siemens modularis litho vario lithotripter. Ureteroscopy was performed under spinal anesthesia with a 7.5 Fr semirigid ureteroscope and lithoclast.

RESULTS: At the 1-month evaluation, 41 out of 71 patients (58%) were stone free after the initial ESWL and 70 out of 76 patients (92%) were stone free after ureteroscopy. The group difference in the stone-free rate was statistically significant (P = .003). The stones were accessible in 72 of the 76 patients (95%) having ureterscopy. Stone fragments were available for analysis from 23 patients receiving ESWL and 70 patients receiving ureteroscopy. The majority of stones in both groups were composed of calcium oxalate dihydrate (COD). No major complications were encountered in either group.

CONCLUSIONS: The present study demonstrates that ureteroscopy with a lithoclast can be considered an acceptable treatment modality for large proximal ureteral calculi. It can be used as an initial treatment for large proximal ureteral stones.

KEYWORDS: Ureteroscopy; Extracorporeal shock wave lithotripsy (ESWL); Proximal ureter; Lithoclast

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

CITATION: Urotoday Int J. 2010 Feb;3(1). doi:10.3834/uij.1944-5784.2010.02.03



Transurethral Resection of the Prostate in Saline Versus Nonconductive Solution to Treat Benign Prostatic Hyperplasia: A Randomized Controlled Study


INTRODUCTION: The objective of this prospective randomized controlled study was to compare transurethral resection of the prostate in saline (TURPis) using the TURis system with the standard monopolar TURP, to determine evidence of safety and efficacy.

METHODS: Patients with symptomatic benign prostatic hyperplasia (BPH), aged 50 years or older, with estimated prostate volume (PV) ≤ 80 mL, maximum flow rate (Qmax) ≤ 15 mL/s, and an International Prostate Symptom Score (IPSS) ≥ 14 were included in the study. A total of 38 patients ranging in age from 52-78 years completed the study. Patients were randomly allocated to receive either TURP or TURPis in a 1:1 ratio. Primary endpoints were: (1) declines in serum sodium (Na+) and hemoglobin (Hb); (2) incidence of TUR syndrome; and (3) changes in IPSS, quality of life (QoL), and maximum flow rate (Qmax). Secondary endpoints included: (1) differences in procedure, irrigation, catheterization, and hospitalization times; (2) variations in blood transfusion, recatheterization, and clot retention rates; (3) changes in prostate specific antigen (PSA), prostate volume (PV), and postvoid residual urine (PVR); and (4) incidences of postoperative complications. Patients were followed for 6 months

RESULTS: The mean PV for the entire study population was 44.1 mL (SD = 2.0; range, 29-78 mL). There were no significant differences between groups on any of the baseline variables. Mean (standard deviation) declines in serum Na+ were 4.8 (1.1) and 0.9 (0.3) mmol/L for the patients receiving TURP and TURPis, respectively (P < .001). Mean declines in Hb were 1.5 (0.6) and 0.7 (0.4) g/dL for the patients receiving TURP and TURPis, respectively (P < .002). The patients receiving TURPis had significantly smaller declines for both of these variables. When compared with the patients receiving TURP, those receiving TURPis had significantly shorter mean times for the procedure (P < .03), irrigation (P < .001), catheterization (P < .02), and hospitalization (P < .02). The patients receiving TURPis had significantly fewer clot retentions (P < .05) than the patients receiving TURP. None of the patients in either group required blood transfusion or demonstrated TUR syndrome. One patient receiving TURP developed a bladder neck contracture; 1 patient receiving TURPis experienced urethral stricture. Efficacy outcomes (IPSS, QoL, Qmax, PSA, PV, and PVR) revealed that all changes from baseline were statistically significant in both groups (P < .05). However, none of the between-group comparisons reached statistical significance.

CONCLUSION: TURPis has the potential to be the new gold standard for BPH treatment. The present study demonstrated that over a 6-month period, TURPis has efficacy similar to TURP. TURPis has additional advantages of smaller declines in serum sodium and hemoglobin, reduced irrigation and catheterization times, shorter hospital stay, and elimination of TUR syndrome.

KEYWORDS: Benign prostatic hyperplasia; Bipolar; Bipolar transurethral resection; Prostate; Transurethral resection syndrome

CORRESPONDENCE: Dr. Taha Abo-Almagd Abdel-Meguid, PO Box 80215, Jeddah 21589, Saudi Arabia ().

CITATION: UroToday Int J. 2010 Feb;3(1). doi:10.3834/uij.1944-5784.2010.02.05



Tamsulosin as an Expulsive Therapy for Steinstrasse After Extracorporeal Shock Wave Lithotripsy: A Randomized Controlled Study


INTRODUCTION: Steinstrasse is a well-known complication following extracorporeal shock wave lithotripsy (ESWL). It has been identified in 5-10% of patients with large stone burdens (> 2 cm) and may necessitate surgical intervention if medical treatment fails. The objective of the present randomized, controlled study was to evaluate the efficacy of tamsulosin as a conservative management of steinstrasse.

METHODS: The participants were 88 patients with unilateral steinstrasse who were treated between January 2005 and December 2008. The patients were randomly allocated into 2 equal groups of 44 patients. There were no significant differences between groups for age, sex, stone location, stone length, or stone fragment size (P > .05). Patients in group 1 (study group) received a single daily morning dose of tamsulosin (0.4 mg) for a maximum of 4 weeks, in addition to pain-relieving therapy. Patients in group 2 (control group) received only the pain-relieving therapy. All patients were checked weekly with a plain x-ray of the urinary tract (PUT), urinary ultrasonography, urine analysis, and serum creatinine level. Pain episodes, day of spontaneous stone expulsion, total analgesic dosage, and drug side effects were recorded. The data were analyzed using chi-square.

RESULTS: Stone expulsion occurred in 32 of the 44 patients (72.7%) receiving tamsulosin and in 25 of the 44 patients (56.8%) in the control group. Patients receiving tamsulosin had a significantly higher stone expulsion rate (P = .017). There were no significant differences between groups for mean stone expulsion time or number of analgesics used. Twelve patients (27.3%) in the group receiving tamsulosin and 19 patients (43.3%) in the control group needed hospitalization; the group difference was statistically significant (P = .017).

CONCLUSION: When compared with no treatment, tamsulosin can significantly facilitate expulsion of retained ureteral stone fragments following ESWL with less need for hospitalization.

KEYWORDS: Tamsulosin; Steinstrasse; Extracorporeal shock wave lithotripsy (ESWL)

CORRESPONDENCE: Esam Eldin Salem, MD, Department of Urology, University Hospital, 22 Mubarak Street, Sohag, 67543, Egypt ().

CITATION: Urotoday Int J. 2010 Feb;3(1). doi:10.3834/uij.1944-5784.2010.02.09



Normalization of Prostate-Specific Antigen and Reduction of Clinical Metastasis Following Zoledronic Acid Treatment in Castrate-Resistant Prostate Cancer


Once prostate cancer reaches a castrate-resistant state with bone metastases, the typical next step in treatment is chemotherapy using agents of the taxoid family. In addition, in documented bony metastases, the biphosphonate zoledronic acid is used to prevent incidence of skeletal events. Zoledronic acid is also used to control bony pain and to increase bone mineral density. The patient in this case report had proven hormone-refractory, chemotherapy-naïve prostate cancer. This is the first documented instance of prostate-specific antigen (PSA) normalization and improvement on bone scan radionuclide imaging in a patient treated with zoledronic acid.

KEYWORDS: Castrate-resistant prostate cancer; Zoledronic acid; Metastasis; PSA

CORRESPONDENCE: Wassim Kassouf, MD, FRCS(C), Division of Urology, McGill University Health Center, 1650 Cedar Avenue, Rm L8-315, Montreal, Quebec H3G 1A4, Canada ().

CITATION: UroToday Int J. 2010 Feb;3(1). doi:10.3834/uij.1944-5784.2010.02.07



Lower Urinary Tract Injuries During Gynecological Operations


INTRODUCTION: The purposes of the present retrospective study were to (1) evaluate the outcomes of emergency urological interventions during gynecological operations, and (2) offer management guidelines for the practicing urologist.

METHODS: The authors evaluated the records of 20 female patients with urinary tract injuries that occurred during gynecological operations between May 2003 and May 2005. The mean patient age was 28 years (range, 20-40 years). The patients were evaluated preoperatively by routine investigations, intraoperatively by ureteric catheterization and/or cystoscopy and ureteric catheterization, and postoperatively by sonography every 3 months for 1 year and by intravenous urography 6 months after surgery.

RESULTS: Urologic injury occurred during cesarean section (n = 12) and hysterectomy (n = 8). Six patients had bladder injuries that were repaired intraoperatively, followed by urethral catheterization. Fourteen patients had distal ureteral injuries that were repaired by ureteric catheterization and/or ureterovesical neoimplantation. Catheters were removed after 1 week. Six months after surgery, all patients had an intact upper urinary tract with no back pressure changes. No reflux or ureteric stricture was observed 1 year after surgical intervention.

CONCLUSION: Iatrogenic injuries to the urinary tract may occur during gynecological surgery. The bladder and distal ureters are the most commonly involved organs. Ureteral catheterization via a cystoscope or directly through the orifices should be used to assess the intactness of the ureter. Key factors to obtaining optimal results are early recognition and immediate repair of the damage.

KEYWORDS: Cesarean section; Ureter; Bladder injury; Cystoscopy; Ureteric catheterization; Ureterovesical reimplantation

CORRESPONDENCE: Ahmed Mohamed Shelbaia, Borg El Atbaa, Faisal Street, Giza, Egypt (; ).

CITATION: Urotoday Int J. 2010 Feb;3(1). doi:10.3834/uij.1944-5784.2010.02.04



Risk Factors and Predictors of Prostate Cancer in Men with Negative Repeat Saturation Biopsy


INTRODUCTION: Despite evidence of increased cancer detection during repeat biopsy, no reports have addressed the likelihood of cancer detection after a negative repeat saturation biopsy or the risk factors that would warrant performing additional saturation biopsies. The investigators tested the hypothesis that a narrowly defined population with 2 biopsies showing no prostatic intraepithelial neoplasia (PIN) or atypia is effectively ruled out as having a risk of prostate cancer.

METHODS: The authors retrospectively evaluated 655 patients that had repeat saturation prostate biopsies from April 2002 to January 2009. Repeat saturation biopsy included patients who had 2 or more biopsies with at least the most recent being a saturation biopsy of 20 cores or more. Repeat biopsy was performed if prostate-specific antigen (PSA) rose significantly after the last biopsy. The variables analyzed were PSA, age, race, number of previous biopsies, number of cores taken, inflammation on pathology specimens, total prostate volume, and digital rectal exam (DRE) results.

RESULTS: Of the 655 patients with repeat saturation biopsies, 236 were truly negative, defined as no cancer, atypia, or PIN. In a mean follow-up of 33.2 months (range, 0-70) 70 of the 236 patients (30%) clinically required a repeat saturation biopsy. Of these, 10 (4.2%) developed prostate cancer. Most patients who were diagnosed with cancer had a PSA >10 ng/mL at the first saturation biopsy, as opposed to PSA <10 in="" the="" group="" that="" did="" not="" develop="" prostate="" cancer="" a="" multivariate="" analysis="" comparing="" patients="" developed="" with="" those="" remained="" free="" significant="" predictors="" of="" future="" were:="" higher="" number="" previous="" biopsies="" i="">P = .006), higher number of cores taken (P = .02), decreased total prostate volume (P = .03), and change in PSA (P = .0002). PSA at first saturation biopsy (P = .006) and PSA at final follow-up evaluation (P = .0001) were significantly different between patients with and without prostate cancer.

CONCLUSION: Patients with a history of negative saturation biopsy have around a 4% chance of being diagnosed with prostate cancer over a mean follow-up period of 33 months. Biopsy detection of prostate cancer in those men who had an additional biopsy because of elevated PSA or change in DRE resulted in a detection rate of 14%, which is clinically substantial. Patients with a rising PSA may warrant a lower threshold for subsequent repeat saturation biopsy. Saturation biopsy as repeat biopsy detects almost all significant cancers and may obviate the need for future biopsy in men who are carefully followed with clinical examinations.

KEYWORDS: Prostate biopsy; Saturation biopsy; Prostate-specific antigen (PSA)

CORRESPONDENCE: J. Stephen Jones, MD. Cleveland Clinic Glickman Urological Institute, Department of Urology, 9500 Euclid Ave, Cleveland, OH, 44195 USA ().

CITATION: UroToday Int J. 2010 Feb;3(1). doi:10.3834/uij.1944-5784.2010.02.10



Superselective Endovascular Embolization of Congenital Renal Arteriovenous Malformation


Renal congenital, idiopathic, or acquired arteriovenous (AV) malformations are uncommon entities. Most symptomatic congenital renal AV malformations require active treatment. Arterial embolization is currently considered the treatment method of choice. The authors present a case of a 33-year-old male who presented with renal colic and macroscopic hematuria. Investigation showed renal AV malformation, which was successfully treated with selective embolization of the vessels using coils and glue.

KEYWORDS:Renal arteriovenous malformation; Selective embolization

CORRESPONDENCE: Ploutarchos Anezinis, Urologic Department of Venizeleion General Hospital, 40 Ermi Street, Heraclion, Crete, Greece P.C. 71409 ().

CITATION: UroToday Int J. 2010 Feb;3(1). doi:10.3834/uij.1944-5784.2010.02.02