Issue 2: April 2010

UIJ Volume 3 Issue 2 2010

Letter from the Editor - April 2010

Dear Colleagues,

The UIJ has grown to be read in over 165 countries with an individual subscriber base of over 20,000 individuals. This growth has only been possible because of the work that the authors have done to produce the papers accepted through the fast-tracked peer-review process. The reviewers have also been dedicated to their roles in reviewing the manuscripts and offering their comments in a timely manner, consistent with the vision of the journal. I am pleased to introduce the selection of outstanding articles, one from each category from past publications that are being recognized as recipients of the first annual Editor's Awards for Excellence.

2008-2009 Editor's Award of Excellence: Basic Science Hammouda HM, Hassan YS, Abdelateef AM, Morsi MG, Ali MM, Abdelnaeim M. Post-Tubularized Incised Plate Urethroplasty Healing: An Experimental Randomized Study in 40 Dogs. UroToday Int J. 2009 Oct;2(5).

2008-2009 Editor's Award of Excellence: Clinical Trial Olshansky B, Spierings ELH, Brum J, Mongay L, Egermark M, Seifu Y.Validation of the Differential Cardiovascular Effects of the Antimuscarinic Agents Darifenacin and Tolterodine in a Randomized, Placebo-Controlled, 3-Way Crossover Study. UroToday Int J. 2009 Aug;2(4).

2008-2009 Editor's Award of Excellence: Original Study Dickstein RJ, Baker EH, Siroky MB. Outcome of Patients with Abnormal Upper Tract Cytology and Negative Initial Workup. UroToday Int J. 2009 Dec;2(6).

Gamal WM, Rashid A, Zaki M, Salem E, Mostafa M, Abuzeid A, Osman MM. Modified N-Shaped Ileal Neobladder After Radical Cystectomy.UroToday Int J. 2009 Oct;2(5).

2008-2009 Editor's Award of Excellence: Case Report Eldefrawy A, Katkoori D, De Los Santos R, Manoharan M, Soloway MS. Basal Cell Carcinoma of the Prostate: A Case Report and Review of the Literature. UroToday Int J. 2009 Jun;2(3).

Hutchings DC, Sammons EL, Patel NS, Sullivan ME. Solitary Metastasis of Cervical Carcinoma to the Kidney: A Case Report and Review of the Literature.UroToday Int J. 2009 Dec;2(6).

2008-2009 Editor's Award of Excellence: Topical Review Westerling D. Bladder Pain: Clinical Assessment and Treatment. UroToday Int J. 2009 Aug;2(4).

The authors will be honored along with the editorial board of the UIJ at a reception to be held in San Francisco, California, USA. The current issue offers a unique look at problems in defining treatment success following radical prostatectomy and radiation therapy for adenocarcinoma of the prostate. The authors Barrett and Hertzfeld treated patients with brachytherapy alone and found that 73.6% of their patients had an undetectable PSA level (< 0.1 ng/mL) that was consistently associated with a disease-free state at a median follow-up of 85.2 months, and 98% of patients with PSA ≤ 0.2 had subsequent nonrising PSA. When the results were compared with current literature, the authors concluded that brachytherapy appears to have success that is similar to prostatectomy.

Shigemura et al compared the results of prostate biopsies from the transitional zone only, peripheral zone only, and combined transitional and peripheral zones. They found that transitional zone biopsies resulted in significantly lower cancer detection rates, and concluded that biopsies from this zone may not be necessary for patients with serum PSA < 10 ng/mL.

Valdivia-Uria et al developed an alternative laparoscopic technique for distal ureterectomy used to treat ureteral and bladder perimeatic mucosa through thermal ablation, and they present promising long-term results.

Authors continue to contribute fantastic case studies that allow for all of us as readers to gain a perspective on select impacts of clinical practice and basic research. The 3 unique cases with genitourinary sarcoidosis as the initial presentation and no systemic manifestation, described by El-Zawahry et al, provide insight into an extremely rare disorder. The complex management issues involved with intersex disorders of sexual development are thoughtfully discussed in Kumar et al. Finally, studies involving basic science are always welcome. Lo et al described contractility of the detrusor muscle in the transverse and longitudinal directions in young rats.

I am honored to present you with these open-access, peer-reviewed articles. We are grateful for your continued support.


Kind regards,

K-E Andersson

Differences in Transverse and Longitudinal Rat Detrusor Contractility Under K+ Channel Blockade


INTRODUCTION: Bladder contractility in the transverse direction is often overlooked, because longitudinal strips are the regular tissues of choice in most contractility studies. In the present study, the effects of K+ channel blockers on transverse and longitudinal rat detrusor contractility were compared.

METHODS: Detrusor strips in transverse and longitudinal directions were dissected from young adult rats. Isometric tension was monitored using a myograph. The effects of tetraethylammonium chloride (TEA), 4-aminopyridine (4-AP), glibenclamide (Glib), iberiotoxin (IbTX), charybdotoxin (ChTX), and apamin on carbachol (CCh)-induced contractions were examined.

RESULTS: No contractile differences were present between transverse and longitudinal strips following CCh stimulation. Equal sensitivity to 4-AP and IbTX was detected in transverse and longitudinal strips. Pretreatment with Glib or ChTX resulted in greater suppression of CCh contractions in longitudinal strips. Although apamin suppressed contractions in both transverse and longitudinal strips, CCh potency was lower in transverse strips only.

CONCLUSION: Functional heterogeneity of transverse and longitudinal detrusor contractility was revealed from selective K+ channel blockade. Longitudinal strips were more susceptible to ATP-sensitive and intermediate-conductance Ca2+-activated K+ channel blockades, whereas transverse strips were affected more by blockade of small-conductance Ca2+-activated K+ channels. The potential importance in evaluating multidirectional contractility in pharmacologic studies of detrusor smooth muscle is reinstated.

KEYWORDS: K+ channel; Rat detrusor; Contraction; Transverse; Longitudinal

CORRESPONDENCE: Willmann Liang, PhD, School of Biological Sciences, Nanyang Technological University, Singapore 637551 ().

CITATION: Urotoday Int J. 2010 Apr;3(2). doi:10.3834/uij.1944-5784.2010.04.07

ABBREVIATIONS AND ACRONYMS: 4-AP, 4-aminopyridine; BK, large conductance Ca2+-activated K+; CCh, carbachol; ChTX, charybdotoxin; CRC, concentration-response curve; Emax, maximal fitted response; Glib, glibenclamide; IbTX, iberiotoxin; IK, intermediate conductance Ca2+-activated K+; SK, small conductance Ca2+-activated K+; TEA, tetraethylammonium chloride



Recent Developments in Percutaneous Nephrolithotomy: Benefits of the Complete Supine Position


Percutaneous nephrolithotomy (PCNL) is usually performed in standard prone, semisupine, flank, or complete supine (csPCNL) position. Correct patient positioning is mandatory to facilitate the procedure and prevent complications. When compared with other positions, the csPCNL offers the potential advantages of less patient handling, the need to drape only once, less risk of colon injury, and the ability to perform simultaneous PCNL and ureteroscopic procedures. If PCNL is performed initially with spinal or regional anesthesia and general anesthesia is needed, the change is easier in this position. The supine position allows better access to the airway and may be less hazardous than other positions, especially for patients with compromised cardiopulmonary function, morbid obesity, or those who require a prolonged procedure. There is better drainage with the Amplatz sheath, and stone fragment evacuation is facilitated. The benefits of ultrasound-guided PCNL include no exposure to radiation for the patient or operating room staff, no need for dye materials, and no chance for injury to the surrounding tissues and organs. In ultrasound-guided PCNL, all of the tissues between the skin and kidney can be visualized directly. The present authors performed csPCNL with a subcostal upper-pole puncture and found that the kidney is situated lower than it is located in the prone position. As a result, access to the upper pole is feasible and associated with less complication. Overall, csPCNL is safe, effective, and suitable for most patients. Literature on csPCNL, imaging modalities, tract creation, tubless PCNL, and mini-PCNL is reviewed.

KEYWORDS: Percutaneous nephrolithotomy; Supine surgical position; Sonography; Imaging; Body mass index (BMI); Upper pole access

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. 2010 Apr;3(2). doi:10.3834/uij.1944-5784.2010.04.03

ABBREVIATIONS AND ACRONYMS: BMI, body mass index; CT, computed tomography; csPCNL, complete supine percutaneous nephrolithotomy; ESWL, extracorporeal shock wave lithotripsy; NT, nephrostomy tube



Genitourinary Sarcoidosis: A Single Institution Experience and Review of the Literature


INTRODUCTION: Sarcoidosis is a multisystemic disorder characterized by granulomata in the diseased tissue. Genitourinary (GU) involvement is rare. The authors report 3 patients in whom GU sarcoidosis was the initial presentation without any systemic manifestation.

METHODS: The Medical University of South Carolina database of patients with sarcoidosis between the years 1986 and 2007 was reviewed to identify individuals with GU sarcoidosis. PubMed was searched for other reported cases.

RESULTS: The university database included 934 patients; 3 patients had GU sarcoidosis. All were African-American males, ranging in age from 27-48 years old. All initial laboratory results were normal. Case 1 presented with a painless left epididymal mass and no history of urinary tract infection. Scrotal ultrasound (US) revealed a hypoechoic left testicular lesion and an epididymal mass. Two months later, a repeat US showed bilateral testicular hypervascular epididymal masses. A left radical orchiectomy was performed. Pathology showed granulomatous orchitis. The patient later developed a large right epididymal mass and subcutaneous nodule. Angiotensin converting enzyme (ACE) and lactate dehydrogenase (LDH) were elevated, consistent with sarcoidosis, and CXR showed mediastinal lymphadenopathy. Case 2 presented with painless testicular lumps and no constitutional symptoms. Eventually, CXR showed bilateral hilar adenopathy. Endoscopic bronchial biopsy confirmed the diagnosis. He had atrophic testes with firm left posterior epididymis, and US showed multiple bilateral small hypoechoic lesions. The testicular mass did not respond to steroid therapy and excisional biopsy of the mass, which revealed granulomatous orchitis. Case 3 presented with prostatic nodules. Transrectal US and biopsy showed sarcoidosis. He subsequently developed hypogonadism and inguinal lymphadenopathy. Lymph node biopsy revealed noncaseating granuloma consistent with sarcoidosis. He also developed neurosarcoidosis and bilateral lymphadenopathy.

DISCUSSION: In the authors' institution, GU sarcoidosis was found only in 0.03% of all patients with sarcoidosis. GU involvement is now reported in 72 cases in the literature, but these are the first known cases with GU manifestation as the initial presentation of sarcoidosis. Sarcoidosis should be considered as a part of the workup and differential diagnosis in patients with GU granulomas.

KEYWORDS: Genitourinary sarcoidosis; Sarcoidosis; Testicular granuloma.

CORRESPONDENCE: Stephen J. Savage, MD, Medical University of South Carolina, 96 Jonathan Lucas St., PO Box 250620, CSB 644, Charleston, SC 29425 USA ().

CITATION: UroToday Int J. 2010 Apr;3(2). doi: 10.3834/uij.1944-5784.2010.04.01

ABBREVIATIONS AND ACRONYMS: ACE, angiotensin converting enzyme; AFP, alpha fetoprotein; GU, genitourinary; HCG, human chorionic gonadotropin; MUSC, Medical University Of South Carolina; US, ultrasound.



Real-time Penile Tumescence and Rigidity Monitoring: A Pilot Study in Healthy, Potent Men


INTRODUCTION: RigiScan™ penile monitoring can be used in the provocative (real-time) setting. However, normative data are limited. The goals of the present prospective study were to (1) generate preliminary data on the range of responses of real-time penile monitoring during audio-visual sexual stimuli (AVSS) in healthy, potent men, and (2) determine if there was an association between real-time erectile rigidity in response to AVSS and self-reported measures of erectile function.

METHODS: The participants were 25 potent men. Their ages ranged from 19-58 years. They were arbitrarily divided into younger (< 40 years) and older (≥ 40 years) groups for outcome measure comparisons. An International Index of Erectile Function (IIEF) erectile domain score was obtained. RigiScan™ monitoring was used to record erectile responses of penile tumescence and rigidity to AVSS. A qualified erectile event was defined as penile rigidity > 60% for 3 or more minutes.

RESULTS: The mean IIEF score for all participants was 29.3, with no significant difference between the younger or older groups (P = .95). Three men had no measureable erectile activity in response to the AVSS. For the remaining 22 men, measurable erectile activity ranged from 3-20.5 minutes. The mean time of measurable rigidity was 12.0 minutes and 11.9 minutes for the younger and older groups, respectively. Age and total erection time had a weak negative correlation (Pearson r = -.31). Ten participants (40%) achieved a qualified event of 60% rigidity. A total of 7 of the 15 participants in the younger group and 3 of the 10 participants in the older group had a qualified event. There was no significant difference in IIEF scores between participants with and without qualified events (P = .35).

CONCLUSION: Preliminary results indicate that real-time penile tumescence and rigidity monitoring in potent, healthy males during AVSS is highly variable and not necessarily corroborated by IIEF scores. This variability limits the utility of provocative mode RigiScan™ for determining potency for clinical purposes. A 60% rigidity criteria for a qualified event may underestimate potency. However, the RigiScan™ may still be effective for studies of erectile physiology.

KEYWORDS: Penis; Rigidity; Monitoring; Potent; Men

CORRESPONDENCE: Henry Gottsch, MD, University of Washington, Dept of Urology, 1959 NE Pacific St, BX 356510, Seattle, WA 98195-6510, USA ().

CITATION: UroToday Int J. 2010 Apr;3(2). doi:10.3834/uij.1944-5784.2010.04.15

ABBREVIATIONS AND ACRONYMS: AVSS, audio-visual sexual stimuli; IIEF, International Index of Erectile Function; NPTR, nocturnal penile tumescence and rigidity; VSS, visual sexual stimuli.



Gender Identity in a Female With Intersex Disorder of Sexual Development Due To Congenital Adrenal Hyperplasia: A Management Dilemma


Patients with an intersex disorder of sexual development (DSD) present the urologist with complex evaluation and management challenges. The patient's phenotype, psychosexual differentiation, and chromosomal sex assignment are all important considerations. The timing of gender assignment in the patient's development should be a multidisciplinary decision that includes the patient and family members. The authors present a rare case of a female with intersex DSD due to congenital adrenal hyperplasia of the simple-virilizing (non salt-losing) form. The patient's unique presentation and challenging management, including sex assignment, are described.

KEYWORDS: Female disorder of sexual development; Congenital adrenal hyperplasia; Intersex.

CORRESPONDENCE: Professor N. K. Mohanty, M.S., M.Ch, Additional DG and Head of Department, Vardhman Mahaveer Medical College and Safdarjung Hospital, C – II /124, Motibagh, New Delhi, India - 110021

CITATION: Urotoday Int J. 2010 Apr;3(2). doi:10.3834/uij.1944-5784.2010.04.06

ABBREVIATIONS AND ACRONYMS: CAH, congenital adrenal hyperplasia; DSD, disorder of sexual development; MRI, magnetic resonance image



Laparoscopic-Extended Pyelolithotomy With Concomitant Pyeloplasty: A Case Report



The authors provide the first known report of concomitant laparoscopic-extended pyelolithotomy with pyeloplasty. A 45-year-old male with symptomatic staghorn calculus secondary to pelviureteric junction obstruction underwent concomitant laparoscopic-extended pyelolithotomy and Fenger’s nondismembered pyeloplasty. The feasibility and limitations of the procedures are described. The authors concluded that despite its technical challenges, laparoscopic pyelolithotomy with pyeloplasty is a minimally invasive surgical option that provides the benefit of minimal morbidity with correction of the pelviureteric junction obstruction.

KEYWORDS: Staghorn Calculus; Pelviureteric junction obstruction; Pyeloplasty; Extended pyelolithotomy; Laparoscopy.

CORRESPONDENCE: Dr. Manickam Ramalingam, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore – 641004, Tamilnadu, India ().

CITATION: Urotoday Int J. 2010 Apr;3(2). doi:10.3834/uij.1944-5784.2010.04.04

ABBREVIATIONS AND ACRONYMS: PCNL, percutaneous nephrolithotomy; ESWL, extracorporeal shock wave lithotripsy



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