Issue 3: June 2010

UIJ Volume 3 Issue 3 2010

Emphysematous Pyelitis Complicated by Renal Calculi: A Case Report


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.



Sequential Chemoimmunotherapy Using Mitomycin Followed by Bacillus Calmette-Guerin (MCC + BCG) Versus Single-Agent Immunotherapy (BCG) for Recurrent Superficial Bladder Tumors


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.



Comparison of Alfuzosin and Tamsulosin Once Daily for Treatment of Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia: A Randomized, Prospective Study


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.



Tumor Recurrence Following Nephron-Sparing Surgery for Renal Cancer: Rate, Patterns, and Predictors


INTRODUCTION: Tumor recurrence following nephron-sparing surgery (NSS) for renal carcinoma is a major concern. The aim of this retrospective study was to assess the rate, patterns, and predictors of tumor recurrence in patients following NSS for renal cancer.

METHODS: Between 1993 and 2008, 229 patients underwent NSS via flank incision for renal cell carcinoma. Patients without metastases at diagnosis (using CT and bone scan) were included in the outcome analysis. Categorical variables were compared with the Fisher-Irwin exact test. Kaplan-Meier was used to determine the probability of overall survival and probability of recurrence curves; significance was tested with the log-rank. The Cox hazard survival model was used to identify whether any of the demographic or clinical variables were predictive of the probability of recurrence.

RESULTS: During a mean (SD) follow-up time of 45 (34) months, tumor recurrence was observed in 13 patients (5.6%). Mean follow-up time for detection of oncological failure was 51 months. All patients with oncological failure were males, with a mean age of 61 years (median 58; range, 51-74 years). The average size of the enucleated lesion was 5 cm (range, 4-7 cm). Intraoperative frozen sections and postoperative pathological examination of the surgical margins were negative in all cases. Predictors of oncological failure included: warm ischemia time > 20 minutes (P = .012), tumor size ≥ 4 cm (P = .001), central tumor location (P = .015), multifocal tumors (P = .001), and male gender (P = .01). The probability of overall disease recurrence at 12 and 60 months was 1.8% and 4.0%, respectively. The overall cancer-specific survival rate was 93.8%. The 12-month and 60-month metastasis-free survival rates were 99.1% and 98.4%, respectively. Recurrence was due to surgeon-related and tumor-related patterns.

CONCLUSIONS: NSS is an effective surgery with satisfactory long-term cancer control. Predictors of recurrence were consistent with previous literature except for warm ischemia time > 20 minutes (noted for the first time). Reasons for cancer relapse include seeding during surgery, residual disease, distant dissemination, and new tumor growth. Careful tumor handling and extensive perirenal fat resection are within the surgeon's control and may reduce failure rates.

KEYWORDS: Renal cell carcinoma; Nephron-sparing surgery; Cancer recurrence.

CORRESPONDENCE: CORRESPONDENCE: Sarel Halachmi MD, Department of Urology, Bnai Zion Medical Center, 47 Golomb St. 31048, Haifa, Israel ().

CITATION: Urotoday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.12.17

ABBREVIATIONS AND ACRONYMS: NSS, nephron-sparing surgery; RCC, renal cell carcinoma.



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