Issue 5: October 2010

UIJ Volume 3 Issue 5 2010

Prostate Cancer Presenting With Neurologic Deficits and Visual Symptoms: Uncommon Presentation of a Common Malignancy


Intracranial metastases from prostate adenocarcinoma are very unusual, and initial presentation with symptomatic brain involvement is especially rare. We describe a 65-year-old male who presented with blurred vision and was found to have abducent nerve involvement and high-grade metastatic prostate cancer. Computed tomography of his head revealed a destructive lesion involving the clivus. He was started on hormonal treatment and his visual symptoms improved. Repeat scans after 6 months revealed resolution of the clivus lesion. Prostate cancer can occasionally present with neurologic manifestations, predominantly due to metastatic involvement of the skull bone. Awareness of this possibility could lead to accurate diagnosis. Initiation of appropriate therapy can successfully reverse the neurologic deficits.

Ashish Bhargava,1 Hussein Aoun,2 Mehsati Herawi,3 Ulka Vaishampayan1

1 Department of Internal Medicine, Wayne State University, Karmanos Cancer Institute, Detroit Michigan, USA

2Department of Radiology, Wayne State University, Karmanos Cancer Institute, Detroit Michigan, USA

3 Department of Pathology, Wayne State University, Karmanos Cancer Institute, Detroit Michigan, USA

Submitted July 8, 2010 - Accepted for Publication September 15, 2010

KEYWORDS: Prostate adenocarcinoma; Brain metastasis; Hormonal therapy

CORRESPONDENCE: Ashish Bhargava, MD, Department of Internal Medicine, 2E University Health Center, 4201 St. Antoine, Detroit, MI 48201, USA ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.11

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; MRI, magnetic resonance image; PSA, prostate-specific antigen.



Encysted Urachal Abscess Associated With a Premalignant Lesion in an Adult Male


Congenital anomalies of the urachus are uncommon in adults. If these anomalies persist into adulthood, they very frequently present as complications of the anatomical entity. Encysted urachal abscesses with associated premalignant urothelium of the bladder wall have been very rarely reported. A 56-year-old male presented with infraumbilical pain and swelling. He was diagnosed as having an infected urachal cyst. The cyst did not communicate with the bladder or the umbilicus. On surgical exploration, the interior of the bladder wall near the urachal connection showed an exophytic mass. Histopathological analysis revealed that it was an exophytic papillomatous metaplasia of the bladder urothelium. The remnants of urothelium within the urachal cyst demonstrated normal transitional epithelium. Long-term follow-up was recommended because the features of papillary urothelial neoplasm exhibit a low malignancy potential. The present case is unique because it presents a rare combination of: (1) an encysted urachal abscess, (2) a blind urachal diverticulum, and (3) an exophytic, potentially malignant papillomatous lesion of the bladder epithelium close to its apex.

Niladri Kumar Mahato,1 Mukesh M. Mittal,1 Rajeev Aggarwal,2 Kavita M. Munjal3

1 Department of Anatomy, Sri Aurobindo Institute of Medical Sciences (SAIMS), Indore, Madhya Pradesh, India

2 Department of Surgery, Sri Aurobindo Institute of Medical Sciences (SAIMS), Indore, Madhya Pradesh, India

3 Department of Pathology, Sri Aurobindo Institute of Medical Sciences (SAIMS), Indore, Madhya Pradesh, India

Submitted July 10, 2010 - Accepted for Publication July 30, 2010

KEYWORDS: Adenocarcinoma; Pappilaoma; Urachus; Urothelium

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

CITATION: Urotoday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.01



Scrotal Schwannoma: A Case Report


INTRODUCTION: Schwannoma is a benign, encapsulated neoplasm with an overall low incidence. It typically occurs in the head and neck regions and seldom develops in the scrotum. Histology shows 2 distinctive patterns (Antoni type A or type B) and several variants including cellular, ancient, glandular, and epithelioid. A 45-year-old male presented with a 1-year history of a painless, slowly growing, left-sided scrotal mass. Ultrasonography revealed an intrascrotal, extratesticular, soft-tissue mass without local invasion. The mass was successfully and totally excised without opening it and without remnant. Histopathology revealed an Antoni type A, cellular variant schwannoma of the scrotum.

Tarek A Salem

Urology Department, Suez Canal University, Ismailia, Egypt

Submitted July 20, 2010 - Accepted for Publication July 30, 2010

KEYWORDS: Schwann cell; Schwannoma; Neurolemmal sheath.

CORRESPONDENCE: Dr. Tarek Salem, Department of Urology, Suez Canal University, Faculty of Medicine, Ismailia 31911, Egypt ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.02




Fournier's Gangrene in a Man Who Was HIV-Positive With a High CD4 Count: An Unusual Presentation of a Complex Rectoscrotal Fistula


Fournier's gangrene is a potentially life-threatening, necrotising fasciitis of the perineal and/or genital region. Known risk factors include diabetes, alcoholism, and immunosuppression. Often described as idiopathic, a cause can usually be found such as trauma, catheterization, or anorectal fistula. We report a case of Fournier's gangrene in a 52-year-old man who was HIV-positive but had an underlying complex fistula that was discovered during the course of his treatment. He was successfully treated with surgical intervention and antibiotics. This patient was not typical of most previously described cases because: (1) he had a low viral load and previously high CD4 count; (2) there was no initial evidence of traditional portals of entry for organisms; (3) there was no evidence of sexually-transmitted infection found in surgical specimens; and (4) the complex fistula was the likely nidus of infection.

Sandra Chika Ndirika,1 Rex Melville,2 James Green1

1 Department of Urology, Whipps Cross University Hospital, London

2 Department of Sexual Health, Whipps Cross University Hospital, London

Submitted July 22, 2010 - Accepted for Publication September 16, 2010

KEYWORDS: Fournier's gangrene; Necrotising fasciitis; HIV/AIDS infection

CORRESPONDENCE: Miss S. C. Ndirika, Department of Urology, Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London, E11 9LR; ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.12

ABBREVIATIONS AND ACRONYMS: AIDS, acquired immune deficiency syndrome; CD4, cluster of differentiation 4; FG, Fournier's gangrene; HIV, human immunodeficiency virus.



Tension-Free Vaginal Tape Versus Transobturator Tape for Treatment of Female Stress Urinary Incontinence: A 2-Year Follow-Up Investigation


INTRODUCTION: The purpose of the study was to compare intraoperative, perioperative, and long-term (2-year) safety and efficacy of procedures using tension-free vaginal tape (TVT) versus transobturator tape (TOT) for the treatment of female stress urinary incontinence (SUI).

METHODS: Participants were 120 female patients with SUI. They were randomly assigned to 2 equal groups, receiving either TVT or TOT. All patients were evaluated by history, physical examination, urine culture, pelviabdominal ultrasound, and urodynamics; they also completed the International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF). Patients were followed for 2 years. The groups were compared for operative outcomes, complications, maximum flow rates (Qmax) before surgery and at 3-month follow-up intervals, cure rates, and ICIQ-SF scores.

RESULTS: Patients receiving TVT had significantly higher intraoperative blood loss (P < .001) and longer operative times (P < .001). There was no significant group difference in length of hospital stay. Qmax levels decreased after surgery, with no group differences at any follow-up evaluation. Minor complications occurred in < 10% of all patients, with no significant group differences. The success rate was 93.3 % (cure 83.3%; improved 10%) following use of TVT and 96.6% (cure 86.6%; improved 10%) following use of TOT; group differences were not significant. All patients with failed procedures had VLPP < 60 cmH20 and grade III SUI. Mean preoperative ICIQ-SF scores, a quality of life measure, were significantly lowered for all patients following surgery with no significant group differences.

CONCLUSION: Use of TVT and TOT in surgery result in similar outcomes, including cure rates. Based on the results of this 2-year study, both procedures have similar morbidity and should be considered safe and effective.

Osama Abdelwahab, Hammouda Sherif

Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt

Submitted August 18, 2010 - Accepted for Publication September 24, 2010

KEYWORDS: Stress urinary incontinence; Transobturator tape (TOT); Tension-free vaginal tape (TVT).

CORRESPONDENCE: Osama Abdelwahab, MD, 1st Gameel Street, Makkah Tower, 11513, Benha, Egypt ().

CITATION: Urotoday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.13

ABBREVIATIONS AND ACRONYMS: ICIQ-SF, International Consultation of Incontinence Questionnaire-Short Form; ISD, intrinsic sphincteric dysfunction; PVR, postvoid residual; Qmax, maximum flow rate; SUI, stress urinary incontinence; TOT, transobturator tape; TVT, tension-free vaginal tape; VLPP, Valsalva leak point pressure.



Five-Year Survival After Multimodal Approach in a Patient With Muscle-Invasive Transitional Cell Carcinoma of the Bladder and Adrenal Metastasis


A 59-year-old male presented with painless hematuria. Cystoscopy revealed a 6 cm solid lesion on the bladder wall. Transurethral resection of the mass showed a pT2 G3 transitional cell carcinoma (TCC). Staging computed tomography demonstrated a solitary left adrenal metastasis that was confirmed on fine-needle aspiration. He then underwent 6 cycles of gemcitabine and cisplatin. Postchemotherapy positron emission tomography demonstrated no glucose-avid areas. Left adrenalectomy and radical cystectomy were performed. There is no evidence of disease recurrence 62 months after the procedure. In metastatic TCC, postchemotherapy surgery is controversial but may provide significant survival benefit to patients with limited systemic disease that responds well to chemotherapy. This report adds to the growing body of evidence that supports a more aggressive multimodal approach to metastatic TCC in select patients. Other patient selection criteria are discussed.

Shuo Liu,1 Vincent Tse,1 Martin Stockler,2 Betty Lin3

1 Department of Urology, Concord Repatriation General Hospital, Sydney, Australia

2 Department of Medical Oncology, Concord Repatriation General Hospital, Sydney, Australia

3 Department of Anatomical Pathology, Concord Repatriation General Hospital, Sydney, Australia

Submitted August 17, 2010 - Accepted for Publication September 10, 2010

KEYWORDS: Adrenal; Bladder cancer; Metastasis; Survival

CORRESPONDENCE: Dr. Shuo Liu, Department of Urology, Concord Repatriation General Hospital, Hospital Road, Concord, Sydney NSW 2139, Australia ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.09

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; GC, gemcitabine and cisplatin; PET, positron emission tomography; TCC, transitional cell carcinoma.



Spontaneous Intraperitoneal Perforation of the Bladder Secondary to Tuberculosis


Spontaneous perforation of the bladder is a rare clinical condition that should be suspected in patients with acute abdomen and a history of tuberculosis. The present case is a 43-year-old male with a history of pulmonary tuberculosis and repeated urinary infections. Based on his presenting symptoms, perforation of the appendix was suspected. Laparotomy revealed several hundred milliliters of urine in the peritoneal cavity. There was also a marked inflammatory response with exudate throughout the peritoneum. A 3 cm defect was found in the posterior wall of the bladder. The bladder was retracted, with very thick and fibrous walls. Laborious radical peritoneal debridement was performed, followed by peritoneal lavage and bladder repair. Postoperatively, the patient was treated with antibiotics. Despite the clinical measures taken, the patient progressed with continuing sepsis and poor clinical course. Rupture of the urinary bladder must be included in the differential diagnosis of an acute abdomen. This is a rare but potentially fatal condition with a high mortality rate if not treated early.

Sataa Sallami,1 Mohamed M Gargouri,1 Mourad Tayeb,1 Mohamed Ben Slima,2 Mounir Makhlouf2

1 Department of Urology, La Rabta Hospital-University, Tunis, Tunisia

2 Department of Surgery, La Rabta Hospital-University, Tunis, Tunisia

Submitted May 17, 2010 - Accepted for Publication June 1, 2010

KEYWORDS: Urinary bladder; Perforation; Spontaneous; Abdomen; Acute; Tuberculosis.

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

CITATION: Urotoday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.06

ABBREVIATIONS AND ACRONYMS: MRI, magnetic resonance image; TB, tuberculosis.



Perioperative and 5-Year Oncological Outcomes Following Open Radical Cystectomy for 200 Patients: A Single Center Experience


INTRODUCTION: Contemporary benchmarks of the short-term and long-term outcomes of open radical cystectomy (ORC) that can be used for future comparison of minimally invasive techniques are incomplete. The purpose of this prospective study was to evaluate the perioperative and 5-year oncological results of ORC with urinary diversion.

METHODS: Between 2004 and 2009, 200 patients undergoing ORC with urinary diversion were prospectively enrolled. Indications for ORC included: (1) muscle-invasive bladder cancer detected by transurethral resection, or (2) high-grade stage Ta, T1, or carcinoma in situ that was refractory to repeated transurethral resection and intravesical immunotherapy or chemotherapy. Patients with metastatic disease were excluded. Mean patient age was 65.1 years. Perioperative, histopathologic, and postoperative follow-up data were recorded and analyzed statistically.

RESULTS: Ileal conduits were constructed in 159 (79.5%) patients; an ileal orthotopic neobladder (Studerâ's procedure) was constructed in 41 (20.5%) patients. Mean operating time was 275 minutes. Mean estimated blood loss was 690 mL. Blood transfusion was required in 37 (18.5%) patients. Mean hospital stay was 6.1 days. Major and minor complications were recorded in 16 (8%) and 31 (15.5%) of the patients, respectively. Perioperative mortality was recorded in 2 (1.5%) patients. Pathologically organ-confined and nonorgan-confined cancer was found in 135 (67.5%) and 65 (32.5%) patients, respectively; 33 (16.5%) patients had pathologically confirmed lymph nodes. Median follow-up was 60.1 months. Local recurrence and distant metastases were recorded in 16 (8%) and 9 (4.5%) patients, respectively. The 5-year disease-free survival, cancer-specific survival, and overall survival rates were 75.5%, 71.5%, and 63.5%, respectively. Survival rates were significantly higher for patients with organ-confined cancers and negative lymph nodes.

CONCLUSIONS: Open radical cystectomy has an acceptable perioperative morbidity and mortality, along with a favorable 5-year oncological efficacy. Minimally invasive techniques need long-term prospective comparison with this approach before they can be accepted as a standard treatment for urinary bladder malignancy.

Nayan K Mohanty, Anup Kumar, Pawan Vasudeva, Manoj Jain, Sanjay Prakash, Rajender P Arora

Department of Urology, V.M. Medical College & Safdarjang Hospital, New Delhi, India

Submitted July 22, 2010 - Accepted for Publication September 6, 2010

KEYWORDS: Urinary bladder; Carcinoma; Radical cystectomy

CORRESPONDENCE: Professor Nayan K Mohanty, C-II/124, Moti Bagh-I New Delhi, 110 029, India ().

CITATION: Urotoday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.08

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; LRC, laparoscopic radical cystectomy; ORC, open radical cystectomy; RRC, robotic radical cystectomy; TCC, transitional cell carcinoma.



Gonadotropin-Releasing Hormone Antagonists: From Basic Science to the Clinic in Patients With Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms


Gonadotropin-releasing hormone (GnRH) antagonists represent a new pharmacological class with several potential clinical indications. Although some of these indications (eg, prostate cancer) are clearly established, others are still in an exploratory phase and await confirmatory clinical trials to prove their clinical value in the treatment of target patients. Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are still investigational indications for GnRH antagonists. Although there have been several successful and hence promising proof-of-concept clinical trials, the conflicting confirmatory data on cetrorelix and lack of clarity on the putative mechanism of action leaves us with work to do before this indication can be declared established. In this short review article, we outline the rationale for the use of GnRH antagonists in LUTS associated with BPH, summarize briefly the available clinical data (phase II and III trials) with the different compounds, touch upon the proposed mechanisms of action, and try to set perspectives for this field of research.

Enrico Colli, László B. Tankó

Global Clinical Research and Development, Urology, Ferring Pharmaceuticals, Copenhagen, Denmark

Submitted September 13, 2010 - Accepted for Publication September 27, 2010

KEYWORDS: GnRH antagonists; Benign prostatic hyperplasia; Mechanisms of action; Clinical trials.

CORRESPONDENCE: Enrico Colli, MD, Head of Urology, Global Clinical R&D, Ferring Pharmaceuticals, Kay Fiskers Plads 11, 2300 Copenhagen S, Denmark ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.14

ABBREVIATIONS AND ACRONYMS: BPH, benign prostatic hyperplasia; GnRH, gonadotropin-releasing hormone; IPSS, International Prostate Symptom Score; LUTS, lower urinary tract symptoms, Qmax, maximum urinary flow rate.



Retroperitoneal Ganglioneuroma Presenting as a Right Renal Mass in an Adult Patient: A Case Report and Literature Review


Ganglioneuromas are benign tumors arising from the neural crest. The reported case is a 47-year-old female who presented with right lumbar pain that increased progressively in intensity over the last 3 years. Computed tomography revealed a homogeneous mass located just above and behind the right kidney. The patient underwent a tumorectomy through a lumbar approach. Histology revealed a primary extra-adrenal retroperitoneal ganglioneuroma. Related literature is reviewed.

KEYWORDS: Retroperitoneum; Sympathetic nervous system, Ganglioneuroma; Surgery.

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

CITATION: Urotoday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.03

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; GN, ganglioneuroma; MRI, magnetic resonance imaging.



The Effects of Ureterorenoscopy on Renal Function


INTRODUCTION: The effects of dilatation and increased pressure in the ureter and renal pelvis following ureterorenoscopy (URS) are not well documented. The purpose of the prospective study was to evaluate renal function in patients undergoing URS for treatment of ureteral calculi.

METHODS: URS was performed on 30 patients between March and June, 2009. The mean (SD) patient age was 38.8 (12.2) years. There were 23 males and 7 females. Biochemical tests of renal function in the serum and urine were performed before the URS and on the 7th postoperative day. Outcome measures were compared before and after URS for all patients, and separately for patients with or without a double-J stent, using paired t tests. Probability < .003 indicated significant differences, following a Bonferroni adjustment.

RESULTS: Out of 17 measures of renal function, there was a significant postsurgery increase in the amount of proteinuria excreted in the 24-hour urine (P = .001). Ureteral stents were inserted in 19 (63%) patients. Patients with and without DJ stents had a significant increase in proteinuria in 24-hour urine (P = .001 for both patient groups). There were no other significant differences. The mean URS duration was 40 minutes. The mean amount of serum physiological fluid consumed was 1860 mL (SD, 1474.2; range, 250-7500 mL). A pneumatic lithotripter was used in 27 (90%) of the cases to shatter the calculi. There were no surgical complications or significant changes in arterial blood pressure.

CONCLUSIONS: The URS procedure did not significantly alter any measure of renal function except for urine proteinuria in 24 hours, which increased following surgery for patients with or without DJ stents.

Mustafa Aldemir, Efe Önen, Önder Kayıgil

Department of 2nd Urology, Ankara Atatürk Teaching and Research Hospital, Ankara, Turkey

Submitted August 7, 2010 - Accepted for Publication September 3, 2010

KEYWORDS: Ureterorenoscopy; Renal functions; Ureteral stent

CORRESPONDENCE: Mustafa Aldemir, MD, Aydinlikevler Mahallesi Arilik Sokak No: 5/5, P.O. Box 06130, Ankara, Turkey ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.07 ABBREVIATIONS AND ACRONYMS: CRP, c-reactive protein; DJ, double J; URS, ureterorenoscopy.



En Bloc Bilateral Kidney, Aorta, and Vena Cava Transplantation From a Deceased Pediatric Donor to an Adult Recipient: A Case Report


Kidney transplantation is the treatment of choice for end-stage renal disease. There has been reluctance to transplant small pediatric deceased donor kidneys into adults because of possible vascular and urinary complications and insufficient nephron mass. The present case is a successful renal transplantation from a pediatric cadaver donor to an adult recipient. Both kidneys and a segment of inferior vena cava (IVC) and aorta were resected en bloc. One end of both the aorta and IVC was completely closed; the other ends were anastomosed to the internal iliac artery and the external iliac vein of the recipient, respectively. Renal DTPA scan of the transplanted kidney showed good perfusion and function. Recipient BUN, creatinine, urinary output, and blood pressure were acceptable. There have been no complications or signs of rejection 20 months later. The use of the en bloc technique may obviate the otherwise adverse effect of very small donor size on transplantation outcome.

Gholamreza Mokhtari, Farshid Pourreza, Seyed Alaeddin Asgari, Hossein Hemmati, Ahmad Enshaei, Seyedeh Atefeh Emadi, Amin Afsharimoghaddam

Urology Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran

Submitted July 6, 2010 - Accepted for Publication August 23, 2010

KEYWORDS:En bloc; Kidney transplant; End-stage renal disease.

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

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.04

ABBREVIATIONS AND ACRONYMS: ESRD, end-stage renal disease; IVC, inferior vena cava.



Electron Microscopic Evaluation of the Urethroileal Junction and Proximal Urethra in Females With Hypercontinence Following Orthotopic Ileal Neobladder Diversion


INTRODUCTION: Hypercontinence following orthotopic bladder diversion occurs in up to 40% of female patients. Its cause is still debated. The purpose of the study was to compare the histological makeup of specimens biopsied from the urethroileal junction and proximal urethra in female patients with normal voiding patterns and hypercontinence following orthotopic diversion.

METHODS: The participants were 11 females who had received orthotopic diversion after radical cystectomy with a Hautmann small intestinal neobladder. One year after the surgery, 5 patients were normally voiding without significant residual and 6 patients were hypercontinent (defined as voiding with > 150 mL residual urine or inability to void). All patients had cystoscopy and biopsy from the urethroileal junction and proximal urethra. A specially configured transurethral resection loop with a very small V-shaped tip was used to minimize the biopsy. The specimens were subjected to hematoxylin and eosin stain for light microscopy and processed for electron microscopy examination. Specimens from the 2 groups were compared for: (1) presence or absence of smooth muscle fibers, their number, and their orientation; (2) presence or absence of nerve fibers and their number.

RESULTS: Examination of the specimens from both groups showed only areas of connective tissue with scattered myelinated nerve fibers and smooth muscle fibrils. No obvious difference was found between patients with normal voiding characteristics and patients with hypercontinence regarding the number or orientation of smooth muscle fibers or nerve fibers.

CONCLUSION: The high incidence of hypercontinence in females undergoing cystectomy and orthotopic diversion could not be attributed to a difference in histological architecture in the area of the urethroileal anastomosis and the proximal urethra in this small sample. The level of urethral resection appears to be the primary evidence-supported cause of this condition.

Mohamed Ismail,1 Mohamed Wishahi,1 Takek Swellam,1 Soheir Mansy,2 Hoda Yehia2

1 Department of Urology, Theodore Bilharz Research Institute, Giza, Egypt

2 Department of Electron Microscopy, Theodore Bilharz Research Institute, Giza, Egypt

Submitted August 16, 2010 - Accepted for Publication September 15, 2010

KEYWORDS: Hypercontinence; Females; Orthotopic diversion

CORRESPONDENCE: Dr. Mohamed Ismail, Department of Urology, Theodore Bilharz Research Institute, 12311 Giza, PO Box 30, Giza, Egypt ().

CITATION: UroToday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.10



Success of Extracorporeal Shockwave Lithotripsy for Distal Ureteric Stones in Patients With and Without Hydronephrosis


INTRODUCTION: The purpose of the present study was to verify whether ureteral obstruction due to solitary distal ureteric stones affects the outcome of extracorporeal shock wave lithotripsy (ESWL).

METHODS: The prospective study included 120 patients with solitary distal ureteral stones that were 6-15 mm in length and located below the lower border of the sacroiliac joint. Patients were assigned to one of 4 groups according to the degree of dilatation of the urinary system. Group 1 (n = 51; 42.5%) had no dilatation; group 2 (n = 41; 34.2%) had mild dilatation; group 3 (n = 20; 16.6%) had moderate dilatation; group 4 (n = 8; 6.7%) had severe dilatation. All patients underwent ESWL using the Siemens Lithostar Plus lithotripter (Siemens Corp; New York, NY, USA). Outcome measures were stone-free rates, number of treatment sessions, stone clearance time, and number and power of the shock waves used. Groups were compared using t and chi-square tests.

RESULTS: Three months after the last ESWL session, 95 patients (79.2%) were stone free, 6 patients (5%) had insignificant residual stones, and 19 patients (15.8%) had treatment failure. There was no significant difference in the ESWL outcomes across groups (P = .41). Patients with hydronephrosis required significantly more treatments than patients without obstruction (P < .002). The mean number of days needed to clear the stones progressively increased as hydronephrosis severity increased (P = .007). The groups with hydronephrosis required a significantly larger mean number of shock waves (P < .001). There was no significant group difference in the mean shock wave power used (P = .39).

CONCLUSIONS: The presence or degree of hydronephrosis did not significantly affect the overall success of ESWL in treating single distal ureteral stones measuring ≤ 15 mm. However, the presence of hydronephrosis significantly increased the retreatment rate and number of shock waves needed to clear the stone. Hydronephrosis also increased the interval to stone clearance.

Hashem Hafez, Mohamed Hassan Ali, Tarek Salem

Department of Urology, Faculty of Medicine, Suez canal University, Ismailia, Egypt

Submitted July 22, 2010 - Accepted for Publication August 23, 2010

KEYWORDS: Stones; Lower ureter; Extracorporeal shock wave lithotripsy.

CORRESPONDENCE: Dr. Tarek Salem, Department of Urology, Suez Canal University, Faculty of Medicine, Ismailia 31911, Egypt ().

CITATION: Urotoday Int J. 2010 Oct;3(5). doi:10.3834/uij.1944-5784.2010.10.05

ABBREVIATIONS AND ACRONYMS: ESWL, extracorporeal shock wave lithotripsy