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01 June 2010

Dear Colleagues,

This issue marks the beginning of the third year for UroToday International Journal, and anniversary issues always call for some reflection on how we are doing. Our primary goal was to elevate access to urology and uro-oncology science for professionals around the world. Since its inception, our readership has grown to over 21,000 individual subscribers and we have a large pool of reviewers from over 40 countries. Over the past 2 years, we have published articles with authors from 32 countries and have attracted subscribers from 206 countries and territories on 6 continents. We have been accepted into the EMCare (Elsevier) as well as EBESCOhost (research database service). We are now "old" enough to have applications currently being evaluated by the PubMed and PubMed Central (National Library of Medicine) and Scopus (Elsevier) database sources. We look forward to their responses. Our publication rate has grown from 6 articles in the first several issues to 22 in the present collection. We have also been able to continue our stated goal of rapid turnaround times from submission to publication. We could not achieve this success without the dedication of both our reviewers and authors.

The current issue contains a variety of articles, many of which are on current topics of high interest to the professional community. We are glad to announce several articles in basic science, because one of our goals is to increase our publication of basic science research. This type of research forms the foundation of any profession and we welcome your submissions.

Studies involving tissue engineering and regeneration are beginning to show promise for future application to patients with renal failure. Hopefully, these studies will one day solve the many problems associated with dialysis and renal transplantation. The topical review on cell-based approaches to renal tissue regeneration by Agcaoili et al provides an in-depth summary of related literature and a thoughtful discussion about the current limitations and future potential for this area of research.

Another basic science investigation, written by Uvelius and Kanje, is on the topic of plasticity of neurons following preganglionic and postganglionic pelvic injuries. Their results have immediate implications for patients needing a prostatectomy.

The current issue has two randomized, prospective investigations on the topic of alpha-blockers for the treatment of symptomatic benign prostatic hyperplasia (Griwan et al; Dash et al). The patients in both studies were from India. Because most previously reported studies involved patients from North American or European countries, it was interesting to note that dietary and lifestyle differences did not seem to alter the effects of the investigated drugs.

Another prospective, randomized, placebo-controlled, double-blind drug investigation was written by Asgari et al. They found significant, positive effects from the herbal drug Hypericum perforatum (St. John's wort) for the treatment of premature ejaculation.

Nomikos et al investigated the importance of the digital rectal examination (DRE) for prostate cancer detection in men with prostate-specific antigen (PSA) levels < 3 ng/mL and lower urinary tract symptoms. The authors compared literature on DRE for screening the general population with DRE in urological practice and emphasized the importance of keeping it standard in the specialist setting. Their concern is that many of the cancers detected by DRE alone are potentially curable but may have worse outcomes if the physician waits until PSA reaches an abnormal level.

Finally, this issue contains a number of interesting case reports. Two that are quite rare include a patient with renal tuberculosis during pregnancy (Benatta and Sallami) and a patient with situs inversus totalis (Shapiro et al).

We are pleased to host the 1^st Annual UroToday International Journal reception following the AUA meeting in San Francisco honoring our authors, reviewers, and editors who have provided support by sharing their work and time. We look forward to future collaborations with professionals from around the world as we continue to grow.

Kind regards,

K-E Andersson
Editor-In-Chief
UIJ

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01 June 2010

A 30-year female with history of ulcerative colitis and partial colectomy presented with rectal bleeding and fecal and urinary incontinence. She had active colitis with granulation tissue, crypt abscess formation, extensive regenerative changes, and lymphoid aggregate formation. She also had a contracted bladder and vesicovaginal fistula. She underwent total proctocolectomy and cystectomy. Simultaneous urinary and fecal diversion was achieved with a double-barreled wet ileostomy (DBWI). The anterior pelvic exenteration was technically challenging secondary to prior surgery, but no major complications were encountered. This is the second known reported case following development of the DBWI technique in 2005. The case shows that DBWI can be safely performed after total colectomy and pelvic exenteration, with no serious complications or morbidity in the first 19 months. This technique may be particularly advantageous for patients with fistulous intestinal tracts.

KEYWORDS: Pelvic exenteration; Urinary diversion

CORRESPONDENCE: Sertac Yazici, MD, Hacettepe University School of Medicine, Department of Urology, Sihhiye, Ankara 06100, Turkey ().

CITATION: Urotoday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.02

ABBREVIATIONS AND ACRONYMS: DBWI, double-barreled wet ileostomy; UC, ulcerative colitis.

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01 June 2010

The kidneys serve a number of important roles that are required to maintain normal human physiologic function. Chronic kidney disease is a leading cause of mortality and morbidity, and a substantial number of these patients progress to end-stage renal disease. End-stage disease involves multiple organ systems and requires renal replacement therapy. Currently, the gold-standard treatment for this condition is renal transplantation, which can restore complete kidney function. However, renal transplantation is limited by the critical shortage of transplant organs and by complications that can result from chronic immunosuppressive therapy and graft failure. Recent advances in cell technologies have allowed for development of cell-based approaches for kidney tissue regeneration. Efforts are ongoing to identify reliable cell sources, develop ideal growth environments and innovative differentiation factors, and discover synthetic and naturally-derived materials for use as an ideal support structure for tissue regeneration. However, numerous challenges must be met in order to translate these techniques into clinically relevant therapies.

KEYWORDS: End-stage renal disease; Kidney; Renal tissue regeneration; Regenerative medicine; Tissue engineering; Cell-based therapy.

CORRESPONDENCE: James J. Yoo, MD, PhD, Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Medical Center Boulevard, Winston Salem, NC 27157, USA ().

CITATION: Urotoday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.22

ABBREVIATIONS AND ACRONYMS: 3-D, 3-dimensional; ESRD, end-stage renal disease; EPO, erythropoietin; hAFSC, human amniotic fluid-derived stem cells; MSC, mesenchymal stem cells; PEC, parietal epithelial cells; RT-PCR, reverse transcriptase polymerase chain reaction; Sca-1, stem cell antigen-1.

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01 June 2010

INTRODUCTION: Premature ejaculation (PE) is one of the most prevalent forms of male sexual dysfunction. The benefits of Hypericum perforatum for treatment of PE are unknown, although it is hypothesized that its effect on depression and neurotransmitter activity may be beneficial. The authors assessed the efficacy and safety of H. perforatum for the treatment of PE.

METHODS: A prospective, double-blind, randomized, placebo-controlled design was used. Participants were 50 married men with PE. They were 18-50 years old and were evaluated between January 2007 and December 2008. Patients were randomly assigned to one of 2 equal groups. Group 1 received 3 daily tablets of hypericum extract (150 mg per tablet). Each tablet contained 160μg of hypericin. Group 2 received a placebo. All participants recorded intravaginal ejaculation latency time (IELT) and completed the International Index of Erectile Function (IIEF-5) questionnaire before and after treatment. Side effects were self-reported using a questionnaire. Results were compared using chi-square and paired t tests.

RESULTS: Forty-two patients completed the study. Hypericum extract was discontinued due to anejaculation (n = 2) and erectile dysfunction (n = 1); 5 patients taking the placebo were lost to follow-up. There was a significant group difference in mean IELT (P < .001); IELT increased from 1.17 minutes to 5.8 minutes in the group taking hypericum extract. Patients taking hypericum extract also had significantly higher IIEF-5 ratings for the measures of intercourse satisfaction and overall satisfaction (P < .001). There were no significant group differences in mean IIEF-5 ratings of orgasmic function, erectile function, or sexual desire. Mild adverse events of headache, constipation, and photosensitivity were seen in 6 patients (27%) taking hypericum extract.

CONCLUSION: H. perforatum (St. John's wort) may be an effective and safe treatment for PE, possibly because of its effect on neurotransmitters such as serotonin.

KEYWORDS: Hypericum perforatum; Premature ejaculation; IELT; IIEF-5; Drug therapy.

CORRESPONDENCE: Siavash Falahatkar, MD, Urology Research Center, Guilan University of Medical Sciences, Razi Hospital, Sardare Jangal Street, Rasht, Guilan 41448, Iran ().

CITATION: UroToday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.21

ABBREVIATIONS AND ACRONYMS: 5HT, 5-hydroxytryptamine; IELT, intravaginal ejaculation latency time; IIEF-5, International Index of Erectile Function; PE, premature ejaculation; SJW, St. John's wort; SSRI, selective serotonin reuptake inhibitors.

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01 June 2010

Nonregression of Mullerian ducts in individuals who are phenotypically male with an XY genotype is a rare occurrence. This condition usually presents as unilateral or bilateral undescended or partially descended testes. Additionally, it is often associated with inguinal swellings. These swellings are caused by an undescended testis and may be bilateral, or they may present as unilateral if both testes are in the same inguinal region (transverse testicular ectopia). Inguinal swellings may also result from embryological remnants of the Mullerian duct. Most males with this disorder have azoospermia. The present report is a very rare case of a 28-year-old male who presented with unilateral inguinal swelling on the left side. Exploration of the inguinal canal on suspicion of an inguinal hernia revealed a hypoplastic uterus, single nodular ovary, and coiled Fallopian tube with an easily discernable fimbrial end. Histology confirmed hernia uteri inguinalis. No testicular tissue could be located in the inguinal canal. The right testis had a normal volume and was descended completely in the scrotum. Quite uniquely, this individual possessed a normal stature, sperm count, and fertility. These characteristics are very rarely documented in association with persistent Mullerian duct systems in men.

KEYWORDS: Azoospermia; Hernia uteri inguinalis; Mullerian duct; Transverse testicular ectopia.

CORRESPONDENCE: Dr. Niladri Kumar Mahato, Associate Professor, Department of Anatomy, Sri Aurobindo Institute Of Medical Sciences (SAIMS), Indore-Ujjain Highway, Bhawrasala, Indore, Madhya Pradesh, 452 010 India ().

CITATION: UroToday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.09

ABBREVIATIONS AND ACRONYMS: DMP, dysgenetic male pseudohermaphroditism; DSD, disorder of sexual development; MGD, mixed gonadal dysgenesis; MIF, Mullerian inhibiting factor; PMDS, persistent Mullerian duct syndrome.

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01 June 2010

INTRODUCTION: Patients who sustain direct bladder trauma are at significant risk of bladder rupture. Contemporary literature supports conservative management for extraperitoneal (EP) bladder rupture using catheterized bladder drainage, and surgical repair with postoperative catheterization for intraperitoneal (IP) bladder rupture. A cystogram is standard practice for evaluating the integrity of the bladder prior to catheter removal, but indications and timing are not clearly defined. The aim of this retrospective study was to review the types of bladder injury and the results of cystography follow-up.

METHODS: A total of 15,046 patients were admitted to the authors' hospitals with traumatic injuries (including iatrogenic injuries) between January 2000 and March 2006. Patients with isolated, noncomplex bladder injuries were further evaluated for age, sex, cause of the injury, diagnostic methods used, type of management, follow-up results, and complications.

RESULTS: A total of 40 patients (0.03%) had isolated bladder injuries. The median age was 40.9 years. There were 24 males and 16 females. The bladder injuries were iatrogenic in 18 patients (45%), due to blunt trauma in 16 patients (40%), and due to penetrating gunshot wounds in 6 patients (15%). Of the 18 iatrogenic injuries, 12 were secondary to gynecological procedures; 14 of the 16 blunt trauma injuries were secondary to motor vehicle accidents. IP bladder ruptures were found in 24 patients (60%); EP bladder ruptures were found in 16 patients (40%). All patients underwent either surgical (70%) or conservative (30%) management and follow-up fluoroscopic cystography 7-21 days later. All cystograms were normal.

CONCLUSION: Iatrogenic and blunt injury represented the majority of bladder injuries. Follow-up cystograms were all normal and may not be required if catheter removal is planned after 14 days of drainage and the patient is asymptomatic. This recommendation applies to conservatively managed isolated EP and surgically repaired noncomplex IP bladder injuries only.

KEYWORDS: Cystography; Urinary bladder; Intraperitoneal and extraperitoneal injury; Iatrogenic.

CORRESPONDENCE: Dr. Ahmad Al-Sameraaii, Department of Urology, The St. George Hospital, Gray Street, Kogarah 2217, New South Wales, Australia ().

CITATION: Urotoday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.20

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; IDC, indwelling disposable catheter; EP, extraperitoneal; IP, intraperitoneal

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01 June 2010

INTRODUCTION: The purpose of the study was to evaluate the efficacy and safety of a once-daily dose of alfuzosin (10 mg) and tamsulosin (0.4 mg) in men from India with lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH).

METHODS: In this prospective study, 100 patients with LUTS due to BPH attending general surgery and urology departments were evaluated between October 2008 and November 2009. Patients were randomly assigned to a group taking alfuzosin 10 mg or a group taking tamsulosin 0.4 mg once daily, both without dose titration. The outcome measures were uroflowmetry results (Qmax, average flow rate, total flow time, and maximum flow time), ultrasonography results (PVR volume and prostate size), Quality of Life (QOL) scores, and International Prostate Symptom Scores (IPSS). Adverse events were recorded. Data were analyzed using t and Fisher exact tests.

RESULTS: Both alfuzosin and tamsulosin improved LUTS. All comparisons of every outcome measure (baseline to 1 month, baseline to 3 months, and 1 month to 3 months) showed statistically significant, progressive change for both patient groups. There were no significant group differences for any outcome measure. Both alfuzosin and tamsulosin were well tolerated, with similar reports of dizziness (6%), headache (4%), and asthenia (4%). The only significant group difference was for abnormal ejaculation, which was only reported by 2 of the 50 patients (4%) taking tamsulosin.

CONCLUSION: Treatment with both alfuzosin and tamsulosin significantly improved all measures of uroflowmetry, ultrasonography, and quality of life. Both medications were well tolerated, but ejaculatory abnormalities were observed only in patients taking tamsulosin.

KEYWORDS: Alpha blocker; Alfuzosin; Tamsulosin; LUTS; BPH.

CORRESPONDENCE: Mahavir Singh Griwan, MD, Department of General Surgery, Pt. BD Sharma, Postgraduate Institute of Medical Sciences, 4/6 J, Medical Enclave, Rohtak, Haryana 91, India ().

CITATION: UroToday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.14

ABBREVIATIONS AND ACRONYMS: BPH, benign prostatic hyperplasia; IPSS, International Prostate Symptom Score; LUTS, lower urinary tract symptoms; PVR, postvoid residual; Qmax, maximum flow rate; QOL, quality of life.

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01 June 2010

Situs inversus totalis is a rare congenital condition. It is characterized by left-right transposition of the internal viscera, including the great vessels, liver, and spleen. Previous reports of radical nephrectomy for suspicious renal masses in these patients have all been performed with an open surgical technique. The present case is the first known report of laparoscopic nephrectomy for treatment of solid renal mass in an individual with situs inversus. The surgery was performed safely following proper preparation and careful dissection of the altered anatomy.

KEYWORDS: Laparoscopic nephrectomy; Surgical technique; Situs inversus.

CORRESPONDENCE: Steven Brandes, MD, Washington University School of Medicine, Division of Urology, 4960 Children's Place, Campus Box 8242, St. Louis, MO 63110, USA ().

CITATION: UroToday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.16

ABBREVIATIONS AND ACRONYMS: COPD, chronic obstructive pulmonary disease; RCC, renal cell carcinoma.

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01 June 2010

INTRODUCTION: Patients with end-stage renal disease who are on long-term dialysis support have a very high mortality. Nearly half of deaths on dialysis are secondary to myocardial infarction, cardiac arrest, malignant arrhythmias, and other cardiac causes. The purpose of the present study was to compare electrocardiogram (ECG) disturbances before and after hemodialysis.

METHODS: The participants were 144 patients on dialysis who met specific inclusion criteria. Their mean (SD) age was 56.27 (14.2) years. A cross-sectional study was conducted between June and December, 2009. Twelve-lead ECGs were performed in identical conditions for all patients, 10 minutes before and 10 minutes after the midweek morning hemodialysis session. Duration and amplitude of P wave and QRS complex, and duration of QTc and QTd were calculated. ECGs were analyzed by a single observer who was blind to all patient information. The Kolmogorov Smirnov, Wilcoxon signed rank, and McNemar tests were used to compare the variables before and after hemodialysis.

RESULTS: The mean duration of the QRS complex and QTc were significantly higher after dialysis (P = .043 and P = .007, respectively). There were no significant differences in the mean P wave duration or mean QTd (P > .05). There was a significant increase in the mean P wave and QRS complex amplitudes after hemodialysis (P = .0001). There were no significant differences between the number of patients with normal and abnormal values before and after dialysis for the duration of QRS complex, P wave, QTc, or QTd, or the amplitude of the P wave and QRS.

CONCLUSION: In the present study, ECG changes before and after hemodialysis presented as a significant increase in duration and amplitude of QRS, amplitude of P wave, and duration of QTc. ECG changes, especially QT intervals, should be monitored in patients with a history of hemodialysis in order to decrease cardiac complications.

KEYWORDS: Electrocardiographic analysis; Hemodialysis.

CORRESPONDENCE: Gholamreza Mokhtari, MD, Urology Research Center, Guilan University of Medical Sciences, Razi Hospital, Sardare Jangal Street, Rasht, Guilan 41448, Iran ().

CITATION: Urotoday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.03

ABBREVIATIONS AND ACRONYMS: ECG, electrocardiography/electrocardiogram; QRS-c, QRS complex; QTc, QT interval corrected for heart rate; QTD, QT dispersion.

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01 June 2010

INTRODUCTION: Tegaserod, a selective 5-HT4 agonist, is a promotility agent used for the treatment of adults with irritable bowel syndrome with constipation and chronic idiopathic constipation. In children, constipation is commonly associated with lower urinary tract symptoms (LUTS). The purpose of the present retrospective investigation was to assess the effectiveness of tegaserod to treat children with refractory LUTS and either persistent constipation or persistent abdominal pain following resolution of constipation.

METHODS: A chart review was conducted for all patients who had not responded to a bowel program (high fiber diet, increased fluid intake, stool softeners, senna laxatives) and were treated with tegaserod over a 2-year period. Inclusion criteria included LUTS and persistent constipation or persistent abdominal pain even though constipation appeared to be adequately controlled. Tegaserod dosing started at 2 mg twice daily and increased to a maximum of 6 mg twice daily until the patient had regular bowel movements and experienced no abdominal pain. The dose was reduced if patients exhibited signs of diarrhea or cramping. Senna laxative use was discontinued for all patients following tegaserod initiation. Treatment response was determined by presence of symptoms and measurement of postvoid residual (PVR) urine at baseline and final evaluation.

RESULTS: A total of 19 patients (11 girls, 8 boys) with a mean age of 9.3 years (range, 3-15 years) received tegaserod treatment. At baseline, 16 patients had an elevated PVR (mean = 91.2 mL) and 11 patients had a history of recurrent urinary tract infections. Tegaserod was well tolerated by all patients with no discontinuations; 2 patients had a dose reduction from 6 mg to 2 mg twice daily. All patients had resolution of abdominal pain. Urinary incontinence improved in all but 4 patients and there was complete resolution of urinary urgency, urinary frequency, and urinary tract infections. The average PVR volume of 14.2 mL after treatment was significantly reduced when compared with pretreatment levels (P = .0005).

CONCLUSION: The effects of tegaserod may be due to more than changes in stool volume in the colon, because there was a reduction in LUTS and improved emptying of the bladder.

KEYWORDS: Lower urinary tract symptoms; Constipation; Children; Tegaserod; Serotonin or 5-HT

CORRESPONDENCE: Israel Franco, MD, Section of Pediatric Urology, 150 White Plains Rd, Tarrytown, NY 10591, USA ().

CITATION: Urotoday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.17

ABBREVIATIONS AND ACRONYMS: CIC, chronic idiopathic constipation; IBS-C, irritable bowel syndrome with chronic constipation; LUTS, lower urinary tract symptoms; OAB, overactive bladder; PVR, postvoid residual; UTI, urinary tract infection.

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01 June 2010

INTRODUCTION: Alpha-1 adrenoceptor antagonists are the mainstay for treatment of symptomatic benign prostatic hyperplasia (BPH). Tamsulosin and alfuzosin, the most commonly prescribed drugs, have good efficacy and safety. However, there is paucity of data comparing the modified release (MR) or sustained release (SR) formulas. The purpose of the present study was to compare the efficacy and safety of tamsulosin-MR 0.4 mg with alfuzosin-SR 10 mg in patients with symptomatic BPH.

METHODS: A total of 90 patients participated in the single-blind, parallel-trial design. Patients were randomly assigned to equal groups, receiving tamsulosin-MR (0.4 mg) or alfuzosin-SR (10 mg). Both were taken once daily for 12 weeks. The International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax) were determined before and at 6 weeks and 12 weeks after the initiation of therapy. The number of adverse events was recorded.

RESULTS: Patients in both groups had a significant mean change in both IPSS and Qmax at the end of 6 weeks and 12 weeks of therapy (P < .001). There was no significant group difference in mean IPSS or Qmax at 6 weeks. At 12 weeks, the group receiving tamsulosin had a significantly lower IPSS (P = .048) and a significantly higher Qmax (P = .045) than the group receiving alfuzosin. Adverse events were infrequent and not statistically different between groups. Dizziness and impotence were most common with tamsulosin; dizziness and fatigue were most common with alfuzosin.

CONCLUSION: Tamsulosin-MR was significantly more effective than alfuzosin-SR in improving IPSS score and Qmax at the end of 12 weeks of treatment, although the group differences in outcome measures were small.

KEYWORDS: Tamsulosin; Alfuzosin; BPH; IPSS; Qmax.

CORRESPONDENCE: Amitabh Dash, MD, A-3, MIG Flats, Prasad Nagar, Phase II, New Delhi, 110005, India ().

CITATION: UroToday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.19

ABBREVIATIONS AND ACRONYMS: BOO, bladder outlet obstruction; BPH, benign prostatic hyperplasia; IPSS, International Prostate Symptom Score; LUTS, lower urinary tract symptoms; MR, modified release; PVR, postvoid residual; Qmax, maximum urinary flow rate; SR, sustained release.

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01 June 2010

INTRODUCTION: Pelvic surgery can result in injuries to the parasympathetic innervation of the pelvic organs. Such injuries can involve both preganglionic and postganglionic lesions. The purpose of the present study was to describe activation of the pelvic ganglion cells by the transcription factors ATF3 and p-c-Jun after preganglionic or postganglionic lesions in the rat.

METHODS: ATF3, p-c-Jun, and ED1 were monitored in rat pelvic ganglia 4 days after preganglionic and postganglionic lesions using immunocytochemistry.

RESULTS: Control ganglia exhibited weak nuclear staining for p-c-Jun but not ATF3. Postganglionic lesions induced ATF3 and p-c-Jun in neuronal nuclei. In contrast, preganglionic lesions induced ATF3 and p-c-Jun mainly in the nuclei of satellite cells and Schwann cells, although some neuronal nuclei were intensely p-c-Jun positive. No neurons expressing ATF3 were found. Staining by ED1 showed an increased number of macrophages in the ganglia after preganglionic lesions.

CONCLUSION: The authors hypothesize that the induction of nuclear ATF3 and p-c-Jun in Schwann cells and satellite cells is induced by degeneration, and that the expression of p-c-Jun and ATF3 in neuronal nuclei reflects activation of sprouting mechanisms.

KEYWORDS: Pelvic ganglion; p-c-Jun; ATF3; Denervation; Decentralization

CORRESPONDENCE: Bengt Uvelius, MD, Department of Urology, Skane University Hospital, SE-20502 Malmo, Sweden ().

CITATION: UroToday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.18

ABBREVIATIONS AND ACRONYMS: NO, nitric oxide; PBS, phosphate-buffered saline; TH, tyrosine hydroxylase; VIP, vasoactive intestinal peptide.

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01 June 2010

INTRODUCTION: The purpose of the present study was to compare the outcomes of patients receiving sequential chemoimmunotherapy using mitomycin (MMC) and bacillus Calmette-Guerin (BCG) with the outcomes of patients receiving BCG alone for the treatment of recurrent superficial bladder tumors.

METHODS: A total of 56 patients with recurrent Ta or T1 bladder tumors were enrolled in this prospective randomized study. Group 1 (n = 29 patients) received MMC instillation immediately after resection followed by weekly instillation for 4 weeks. Patients then received BCG monthly for 1 year. Group 2 (n = 27) received only BCG, instilled weekly for 6 weeks and then monthly for 1 year.

RESULTS: There was a significant treatment effect for both groups, as indicated by a reduction in mean recurrence rate and recurrence index (P = .001). However, the difference in recurrence rate and recurrence index distributions after treatment was significant in favor of group 1. The mean follow-up period was 24 months (range, 3-30 months). Recurrent tumors were found in 9 patients (31%) in group 1 and 16 patients (70%) in group 2 at the end of the follow-up period. Kaplan-Meier estimates were significantly different throughout the follow-up period. MMC followed by monthly BCG was significantly superior to BCG in the time to initial recurrence (log rank (P < .0024).

CONCLUSIONS: Patients receiving BCG single-agent immunotherapy and patients receiving sequential chemoimmunotherapy using MMC instillations followed by monthly BCG instillation both had significant treatment effects. However, the difference in recurrence rate and recurrence index distributions after treatment was significant in favor of the group receiving the sequential therapy.

KEYWORDS: Sequential chemoimmunotherapy; Bladder cancer; BCG; MMC.

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

CITATION: UroToday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.06

ABBREVIATIONS AND ACRONYMS: BCG, bacillus Calmette-Guerin; MMC, mitomycin; TUR, transurethral resection.

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01 June 2010

A vesical calculus weighing more than 100 g is categorized as a giant urinary bladder stone. Male preponderance for urinary bladder calculi is well known. A rare case of a giant bladder calculus weighing 565 g and occurring in a female patient is reported. The stone was removed by open cystolithotomy. Possible etiological factors are discussed, some of which are unique to this case.

KEYWORDS:Urinary bladder; Infection; Stone; Surgery

CORRESPONDENCE: Dr Rikki Singal, c/o Dr Kundan Lal Hospital, Ahmedgarh, Distt-Sangrur, 148021, Punjab, India ().

CITATION: Urotoday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.15

ABBREVIATIONS AND ACRONYMS: UTI, urinary tract infection.

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01 June 2010

Inverted papilloma (IP) of the urinary tract is an uncommon tumor that is usually regarded as benign. The exact cause of IP is presently unknown, although various theories have been postulated. It typically occurs during the fifth or sixth decade of life. Although IP has been reported in the pediatric age group, its occurrence in a young female during pregnancy has never been reported. The present case is a 24-year-old female who presented with gross hematuria in the 16th week of pregnancy. She had IP of the urinary bladder with extensive squamous metaplasia. Immunohistochemistry showed positivity with human papillomavirus strain 16. Transurethral resection of the bladder tumor was completed and there was no recurrence 16 months later. Squamous metaplasia has been defined as a diagnostic feature of IP, but its extensive presence during pregnancy raises questions about the influence of hormones on its development.

KEYWORDS: Inverted Papilloma; Pregnancy; Squamous metaplasia; Urinary bladder

CORRESPONDENCE: Dr. Punit Tiwari, Department of Urology, Institute of Post Graduate Medical Education and Research, SSKM Hospital, 242, AJC Bose Road, Kolkata, West Bengal, 700020, India ().

CITATION: Urotoday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.13

ABBREVIATIONS AND ACRONYMS: HPV, human papillomavirus; IP, inverted papilloma

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01 June 2010

Prostatitis is the name given to a group of disorders that share surprisingly little in the way of etiology, symptoms, and treatment. Frequently, the diagnosis and management of these conditions is empiric, inadequate, ineffective, and contrary to the published literature of the past 10 years. In the present commentary, 23 "theses" are presented as a plea to physicians managing these patients to modify their ingrained approaches and incorporate simple evidence-based changes that can greatly improve outcomes and patient quality of life.

KEYWORDS: Prostatitis; Chronic pelvic pain syndrome

CORRESPONDENCE: Daniel Shoskes, MD, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Desk Q10-1, Cleveland, Ohio, 44195, USA ().

CITATION: UroToday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.11

ABBREVIATIONS AND ACRONYMS: GU, genitourinary; LUTS, lower urinary tract symptoms; NIH, National Institutes of Health; PSA, prostate-specific antigen; UTI, urinary tract infection.

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01 June 2010

A bifid blind-ending ureter is an extremely rare congenital anomaly of the upper urinary tract. Lithiasis inside the blind-ending branch has only been reported in a few cases. This unusual ureteric condition appears to be most common in female patients. A 53-year-old woman was admitted with right lumbar colic pain. A kidney-ureter-bladder X-ray revealed a spherical radiopaque shadow, projected on the right side of the sacrum in the region of the lower third of the right ureter. An intravenous pyelography showed a distal stone in the right ureter, with mild hydronephrosis and a hydroureter. Ureteroscopy and retrograde pyelography revealed a right blind-ending bifid ureter. The blind-ending branch, originating in the distal third of the ureter, contained a stone that caused obstruction of the normal branch. The stone was treated with endoscopic lithotripsy. At the 3-month follow-up evaluation, the patient was stone-free and asymptomtic. The clinical significance of this malformation is discussed in light of the current literature.

KEYWORDS: Blind-ending ureter; Bifid ureter; Abnormalities; Intravenous urography; Ureter; Calculus.

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

CITATION: Urotoday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.11

ABBREVIATIONS AND ACRONYMS: IVU, intravenous urography; RP, retrograde pyelography.

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01 June 2010

INTRODUCTION: The assessment of creatine kinase (CK) in human sperm cells is an unbiased indicator of sperm maturity and fertilization potential. Elevated CK values are associated with an increased number of functional abnormalities and increased cytoplasmic residues. The CK-Mi isoenzyme in human sperm is of mitochondrial origin. Increased spermatozoal CK activity is associated with high CK cell levels. The objective of the present study was to compare the biochemical marker CK with morphological changes of the head, neck, and tail. The authors also investigated the assessment of CK activity in human sperm to obtain an objective biochemical marker of sperm maturity and fertilization potential.

METHODS: The activity of CK was assessed for seminal plasma-deprived spermatozoa in 126 men. The participants were divided into 2 groups. Patients in group 1 (n = 64) had reduced spermatozoa count. They were subdivided into: group 1a (n = 28) patients with moderate oligospermic characteristics (spermatozoa count 5.1 - 20 x 10⁶/mL), and group 1b (n = 36) patients with severe oligospermic characteristics (spermatozoa count < 5 x 10⁶/mL). Group 2 (n = 62) was a comparison group of patients with normospermic characteristics (spermatozoa count > 20 x 10⁶/mL; motility > 0.30). Semen analysis was performed according to World Health Organization guidelines. The CK-Mi isoenzyme was separated from CK-B using DEAE Sephadex™ A-50 columns, and agarose gel electrophoresis was used for separating the CK-Mi isoenzyme. The total CK activity was assessed with a spectrophotometer.

RESULTS: CK was significantly higher in the group with severe oligospermia (mean [SD] = 1.9 [2.2] UI/10⁸ sperm cells) than in the group with normospermia (0.097 [0.026] UI/10⁸ sperm cells) (P < .01). The group with oligospermia had a significantly lower CK-Mi/CK ratio (0.16 [0.10]) than the group with normospermia (0.36 [0.12]) (P = < .01).

DISCUSSION: The concentration of CK and synthesis of CK-Mi isoforms reflect normal spermatogenesis and can be used for predicting human sperm maturity and fertilization potential. CK appears to be a sensitive indicator of spermatozoa quality and maturity for men with male-factor infertility.

KEYWORDS: Oligospermia; Normospermia; Creatine kinase; Isoenzyme CK-Mi

CORRESPONDENCE: Professor Sava Micic, MD, PhD, Institute of Urology and Nephrology, Resavska 51, Belgrade 11000, Serbia ().

CITATION: UroToday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.08

ABBREVIATIONS AND ACRONYMS: CK, creatine kinase; CK-Mi, CK of mitochondrial origin.

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01 June 2010

INTRODUCTION: Controversy remains as to the value of digital rectal examination (DRE) for detecting prostate cancer in men presenting with lower urinary tract symptoms and low prostate-specific antigen (PSA) levels. The purposes of the present retrospective investigation were to: (1) evaluate the positive predictive value (PPV) of an abnormal DRE in patients with PSA < 3 ng/mL, (2) describe the stage and grade of the cancers detected, and (3) describe the treatment modalities used for patients at each clinical stage.

METHODS: A prospectively maintained prostate biopsy service database of consecutive men undergoing prostate biopsies from April 2004 to April 2006 was reviewed. Patients with PSA < 3 ng/mL and definitely abnormal DRE were divided into 3 groups according to PSA range. The relationship between abnormal DRE and positive prostate biopsy was determined. The International Prostate Symptom Score (IPSS), clinicopathologic features of prostate cancer, and the treatments used for each clinical stage were summarized.

RESULTS: From 1235 men who underwent prostate biopsies, 59 (4.6%) had PSA < 3 ng/mL and an abnormal DRE. Their mean age was 63.4 years. Fifteen of the 59 patients had true-positive DRE; 44 patients had false-positive DRE. The PPV of an abnormal DRE for detecting prostate cancer was 25.4%. The incidence of prostate cancer was 13.3%, 33%, and 53.3% in patients with abnormal DRE and PSA levels of 0.1-1.0 ng/mL, 1.1-2.0 ng/mL, and 2.1-2.9 ng/mL, respectively. Patients with significant LUTS (IPSS > 19) were likely to have false-positive DREs (P = .019). Patients with mild LUTS (IPSS < 7) and abnormal DREs tended to have positive prostate biopsies (P = .030). Modalities used to treat the 15 patients with cancer included active monitoring, brachytherapy, and external beam radiotherapy in 3 (20%), 5 (33.3%) and 4 (26.6%) patients, respectively. Hormonal deprivation was used for 1 patient; radical prostatectomy was used for 2 patients.

CONCLUSIONS: DRE has a significant role in detecting prostate cancer in men presenting with PSA < 3 ng/mL. The higher the PSA, the greater the possibility of detecting prostate cancer in this selective cohort.

KEYWORDS: Digital rectal examination; Low PSA; Prostate cancer diagnosis

CORRESPONDENCE: Michael Nomikos MD, FEBU, Consultant Urologist, Knossou 275, Heraklion, Crete, 71409,Greece ().

CITATION: Urotoday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.07

ABBREVIATIONS AND ACRONYMS: DRE, digital rectal examination; GP, general practitioner; IPSS, International Prostate Symptom Score; LUTS, lower urinary tract symptoms; PPV, positive predictive value; TRUS, transrectal ultrasound.

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01 June 2010

Emphysematous pyelitis (EP) is a rare infection of the urinary collecting system due to gas-forming bacteria. It is an uncommon form of acute pyelonephritis that has been reported sporadically in the literature. The present case of EP was complicated by renal calculi. The patient had surgery to remove the calculi 4 months after the initial diagnosis. During the 4-month interim between diagnosis and surgery, she had no antibiotic therapy. A presurgical CT showed the same stone burden with no evidence of abscess. There was a complete resolution of gas in the collecting system. At the 6-month follow-up evaluation, the patient was asymptomatic and the kidney remained stone-free.

KEYWORDS: Emphysematous pyelitis; Calculi; CT scan.

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

CITATION: UroToday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.10

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; EP, emphysematous pyelitis; EPN, emphysematous pyelonephritis; KUB, kidney, ureter, bladder.