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



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