Issue 6: December 2010

UIJ Volume 3 Issue 6 2010

Letter from the Editor - December 2010

Dear Colleagues,

Welcome to the December 2010 issue of the UIJ. I am pleased to announce that all articles published in the UroToday International Journal are now indexed by SCOPUS and Excerpta Medica Database (Embase). Scopus is the largest abstract and citation database that contains both peer-reviewed research literature and Web sources. It has nearly 18,000 titles from more than 5,000 publishers. Embase contains over 23 million indexed biomedical records from more than 7,500 journals. These two major indexing sources provide readers with easy access to our articles and assure our authors of extensive coverage for their papers.

In this issue, Newman et al assesses the effects of darifenacin on the reduction in the number of incontinence episodes and diary days where no incontinence episodes are reported (termed "dry days") in a population of patients with incontinence and overactive bladder. The authors analyzed data from three-phase III fixed-dose, randomized, placebo-controlled studies (n = 1059). The results demonstrate that darifenacin treatment significantly reduces the number of incontinence episodes and increases the number of patients experiencing 3 or more consecutive dry days. Similar results were shown in the two-year, open label study, demonstrating significant improvement in health-related quality of life scores.

Halachmi et al examine renal cancer recurrence following nephron-sparing surgery in 229 patients. Significant predictors of oncological failure include: tumor size less than 4 cm, central tumor location, multifocal tumors, and male gender. Further, the findings include that warm ischemia time greater than 20 minutes is a significant predictor of recurrence. The oncological effectiveness of nephron-sparing surgery is compared to reported outcomes of radical nephrectomy.

Pandith et al evaluate the frequency and distribution of FGFR3 somatic mutations in bladder tumors. The authors examined DNA preparations from paired tumor and adjacent normal tissue specimens from 65 patients with transitional cell carcinoma (TCC). The authors identified Codon S417Y, a new mutation. The pattern and distribution of FGFR3 mutations were significantly associated with low-grade and low-stage tumors. The frequency of mutation decreased significantly with an increase in tumor invasiveness. The results indicate that FGFR3 mutations can be useful in distinguishing superficial from invasive bladder lesions.

Wang et al study 56 patients receiving renal transplant to evaluate the efficacy and safety of a preoperative high-dose (1.5 mg/kg) and postoperative short-term low-dose (0.5-1 mg/kg) prophylactic application of rabbit antihuman thymocyte immunoglobulin (ATG-R) plus immunosuppressive therapy. They compared the outcomes to a control group receiving only immunosuppressive therapy. ATG-R treatment resulted in a significantly lower incidence of delayed graft function and acute rejection within 6 months, without increasing the incidence of lung infection.

Abraham et al identified 745 men with a documented varicocele and severe oligospermia from a 10-year database review. The authors compare the outcomes of patients receiving laparoscopic correction with those receiving open varicocelectomy. The results demonstrate similar improvements in semen parameters and in the number of successful pregnancies. The authors conclude that laparoscopy appears to be an effective option for management of infertility due to a varicocele.

Tamer Aboushwareb provides a state-of-the-art review article on approaches to renal tissue engineering. The author describes the properties of stem cells and considerations of usefulness in regenerative medicine. He presents methods for identifying renal progenitor cells and their potential contributions for regeneration and renal repair. Finally, he describes disease-specific cellular therapies for renal dysfunction.

In this final issue of 2010, I thank the UIJ staff, reviewers, authors, and readers for your continued support. I extend my wishes to each of you that you may enjoy a healthy and productive 2011.


Karl-Erik Andersson

Risk Factors for Acute Urinary Retention in Patients With Benign Prostatic Hyperplasia From the Islamic Republic of Iran


INTRODUCTION: Acute urinary retention (AUR) is a serious complication in patients with benign prostatic hyperplasia (BPH). Some risk factors for AUR are known. However, it is important to study patients in different geographic locations because of cultural, dietary, medical, and lifestyle differences. The purpose of the present retrospective investigation was to compare patients with BPH and without AUR to patients with BPH and AUR from the Islamic Republic of Iran on a variety of possible risk factors.

METHODS: We reviewed files of 430 adult patients with BPH who were admitted for surgery from 2003 through 2008. The examined variables were: patient age, PSA, prostate volume, previous history of AUR, anesthesia, smoking, alcohol consumption, opium addiction, diabetes mellitus, hypertension, cardiovascular disease, and other comorbid diseases. There were 270 patients (66.2%) without a history of AUR and 138 patients (33.8%) with a history of AUR. Data for the 2 patient groups were compiled and compared using chi-square, Mann-Whitney, or Fisher exact tests. Logistic regression was calculated for the variables that resulted in significant group differences.

RESULTS: Mean (SD) patient age was 68 (9) years and 72 (9) years for patients without and with AUR, respectively (P < .003). Patients with AUR had a significantly larger mean prostate volume of 62.8 (23) mL, compared with 48 (21) mL for patients without AUR (P < .0001). Significantly more patients without AUR had low PSA levels (P < .001). However, the largest number of patients in both groups had a PSA over 4 ng/mL (44.8% of patients without AUR; 57.2% of patients with AUR). There was no significant group difference in the number of patients consuming alcohol or the number with opium addiction, hypertension, cardiovascular disease, or other underlying diseases (P > .05). Significantly more patients without AUR had diabetes mellitus (P < .001). Significantly more patients with AUR were smokers (P < .001).

CONCLUSIONS: Patient age, high prostate volume, high serum PSA, and smoking were the main risk factors for AUR. These outcomes were consistent with previous research with patients from other geographic locations.

Siavash Falahatkar, Ali Hamidi Madani, Ahmad Enshaei, Ehsan Kazemnejad, Seyedeh Samaneh Ahmadi, Keivan Gholamjani Moghaddam, Aliakbar Allahkhah

Urology Research Center, Guilan University of Medical Science, Razi Hospital, Rasht, Islamic Republic of Iran

Submitted September 16, 2010 - Accepted for Publication October 29, 2010

KEYWORDS: Acute urinary retention; Benign prostatic hyperplasia; Prostate-specific antigen; Prostate volume; Risk factor.

CORRESPONDENCE: Ali Hamidi Madani MD, Assistant Professor of Urology, Urology Research Center, Guilan University of Medical Science, Razi Hospital, Sardar Jangal Street, Rasht, 41448, I.R.Iran ().

CITATION: UroToday Int J. 2010 Dec;3(6). doi:10.3834/uij.1944-5784.2010.12.15

ABBREVIATIONS AND ACRONYMS: AUR, acute urinary retention; BPH, benign prostatic hyperplasia; DM, diabetes mellitus; LUTS, lower urinary tract symptoms; MTOPS, medical therapy of prostatic symptoms; QoL, quality of life; PSA, prostate-specific antigen; TURP, transurethral resection of the prostate; TWOC, trial without catheter.



Vesicouterine Fistula Following Vaginal Birth After Cesarean in a Woman With Grand Multiparity: A Case Report and Review of the Literature


Vaginal birth after cesarean (VBAC) is rare in multiparous women in the developed world. A vesicouterine fistula (VUF) is a rare complication of VBAC. The present case is the first known report of a patient with grand multiparity who presented with a VUF after her fourth VBAC. A tentative diagnosis was made following her cystogram on postpartum day 1; the definitive diagnosis was reached with cystoscopy on postpartum day 4. Successful uterine-sparing repair of the fistula was obtained via laparotomy with fistula closure and an omental flap. A review of potential diagnostic and management methods is presented.

Sarah A Smith,1 Fatima Z Husain,2 Paul J Rusilko,2,3 Raymond A Bologna,2,3 J Kenneth Davis1,4

1 Department of Obstetrics and Gynecology, Akron General Medical Center, Akron, OH, USA

2 Department of Urology, Akron General Medical Center, Akron, OH, USA

3 Department of Urology,Northeastern Ohio Universities College of Medicine and Pharmacy, Rootstown, OH, USA

4 Department of Obstetrics and Gynecology, Northeastern Ohio Universities College of Medicine and Pharmacy, Rootstown, OH, USA

Submitted August 28, 2010 - Accepted for Publication October 14, 2010

KEYWORDS: Vesicouterine fistula; VBAC; Vaginal birth after cesarean

CORRESPONDENCE: Sarah A. Smith, DO, Department of Obstetrics and Gynecology, Akron General Medical Center, 224 W. Exchange Street, Suite 120, Akron, OH 44302, USA ().

CITATION: Urotoday Int J. 2010 Dec;3(6). doi:10.3834/uij.1944-5784.2010.12.06

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; IVP, intravenous pyelogram; MRI, magnetic resonance imaging; VBAC, vaginal birth after cesarean section; VUF, vesicouterine fistula.



Prophylactic Use of Rabbit Antihuman Thymocyte Immunoglobulin in Renal Transplantation


INTRODUCTION: Patients receiving a renal transplant were studied to: (1) evaluate the efficacy and safety of a prophylactic application of rabbit antihuman thymocyte immunoglobulin (ATG-R) plus immunosuppressive therapy, and (2) compare the outcomes to those of a control group of patients receiving only immunosuppressive therapy.

METHODS: A total of 922 recipients receiving allograft renal transplantation in our hospital were enrolled between May 2003 and March 2009. Patients with inferior conditions in pregnancy history, blood transfusion history, repeated transplantation, panel reaction antibody, lymphocytotoxicity test, and human leukocyte antigen matching were assigned to the experimental group (n = 156). They received conventional immunosuppressive therapy plus a single-bolus preoperative high dose (1.5 mg/kg) and a short-term postoperative low dose (0.5-1 mg/kg) of ATG-R prophylactic treatment. A control group (n = 766) received only the immunosuppressive therapy. The incidence rates of delayed graft function (DGF), acute rejection (AR) within 6 months and lung infection within 6 months, and the 1-year patient and kidney survival rates of the patients in the experimental and control groups were compared.

RESULTS: The incidence of DGF was significantly lower in the experimental group than the control group (1.92% vs 8.49%; P < .01). The incidence of AR within 6 months was also lower in the experimental group (5.13% vs 10.97%; P < .05). There were no significant group differences in the incidence of lung infection within 6 months or 1-year patient and kidney survival rates. Survival rates for transplant recipients were 98.72% and 98.43% for the experimental group and control group, respectively.

CONCLUSION: A preoperative high dose and a postoperative short-term low dose of prophylactic ATG-R could markedly reduce the incidence of DGF and AR but not increase the incidence of lung infection in highly sensitive renal transplant recipients. This protocol may be an effective and feasible ATG immune-induction therapy.

Ke Wang, Lin Wang, De-kang Sun, Jun-jie Zhao, Chang-ping Men, Feng-chun Wan, Dong-fu Liu, Zhen-li Gao

Organ Transplantation Center, Yantai Yuhuangding Hospital, Yantai, China

Submitted August 29, 2010 - Accepted for Publication October 9, 2010

KEYWORDS: Renal transplantation; Rabbit antihuman thymocyte immunoglobulin; Prophylactic application.

CORRESPONDENCE: Dr. lin wang, Organ Transplantation Center, Yantai Yuhuangding Hospital, Yantai Yuhuangding East Road, Yantai, Shandong, 20264000, China ().

CITATION: UroToday Int J. 2010 Dec;3(6). doi:10.3834/uij.1944-5784.2010.12.04

ABBREVIATIONS AND ACRONYMS: AR, acute rejection; ATG-R, rabbit antihuman thymocyte immunoglobulin; DGF, delayed graft function; HLA, human leukocyte antigen; PRA, panel reaction antibody; WBC, white blood cell count.
Drug abbreviations: AZa, azathioprine; CsA, cyclosporine A; FK-506, tacrolimus; MMF, mycophenolate mofetil; MP, methylprednisolone; MZR, mizoribine; Pred, prednisone.



Right Renal Vein Augmentation in Deceased Donor Kidney Transplantation: Importance of the Contiguous Inferior Vena Cava


INTRODUCTION: The short, thin-walled right renal vein (RRV) makes anastomosis and hilar hemostasis challenging in deceased donor kidney transplantation. The right renal artery is twice the length of the vein. The purposes of the present retrospective study were to: (1) describe a surgical technique that uses the contiguous inferior vena cava (IVC) segment to lengthen the right renal vein, and (2) report the surgical outcomes.

METHODS: A total of 44 right deceased-donor kidneys were transplanted into 44 recipients between March 2005 and February 2010. Recipient ages ranged from 19-68 years (28 females; 16 males). We used the contiguous IVC to augment short renal veins in the right kidney allografts. This resulted in a horizontal extension of the RRV, with outflow through the orifice of the left renal vein (LRV). Augmented right renal veins were anastomosed end-to-side to the external iliac vein, and the right renal arteries with aortic patches were anastomosed end-to-side to the external iliac artery in all recipients except 1. Surgical outcomes were assessed.

RESULTS: Among the 44 kidney recipients, 39 were first transplants and 5 were second transplants. The kidneys were placed on the right side (n = 38), left side (n = 5), and into the peritoneum (n = 1). The mean RRV augmentation time was 32 minutes (range, 24-49 minutes); completion of back-table dissection added another 40 minutes. The cold ischemia times ranged from 3 hours 50 minutes to 19 hours. The rewarming times ranged from 34-44 minutes. Immediate graft function was noted in 37 kidneys; 3 patients required dialysis for delayed graft function; 4 patients had slow graft function but did not require dialysis. In a follow-up period ranging from 8 months to 5 years, no graft was lost from vascular complications following the augmentation of the RRV. All 44 venous anastomoses were safe and easy, and kinking of the renal artery was avoided because the reconstructed vein matched the length of the artery.

CONCLUSION: Augmentation of the short RRV utilizing the contiguous IVC is a safe, simple, and reliable procedure that avoids graft loss from vascular complications in deceased donor renal transplantation.

Taqi F Toufeeq Khan,1 Mirza Anzar Baig,1 Rafat Zahid,1 Dujanah Mousa2

1 Division of Kidney Transplant Surgery, Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia

2 Division of Transplant Nephrology, Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia

Submitted September 13, 2010 - Accepted for Publication October 19, 2010

KEYWORDS: Deceased donor right kidney; Short renal vein; Contiguous caval segment; Back-table augmentation.

CORRESPONDENCE: Dr. Taqi F Toufeeq Khan, Division of Kidney Transplant Surgery, PO Box 7897/624N, Riyadh Military Hospital,Riyadh, 11159, Kingdom of Saudi Arabia ().

CITATION: Urotoday Int J. 2010 Dec;3(6). doi:110.3834/uij.1944-5784.2010.12.08

ABBREVIATIONS AND ACRONYMS: IVC, inferior vena cava; LRV, left renal vein; RRV, right renal vein.



Laparoscopic Extraperitoneal Cystolithotomy (Single-Incision Laparoscopic Surgery): A Sutureless, Tubeless Technique


Three bladder calculi were removed from an 73-year-old adult male by laparoscopic extraperitoneal cystolithotomy (single-incision laparoscopic surgery), a sutureless and tubeless procedure. Surgery was performed without difficulty. No problems of stone fragmentation, prostatic bleeding, or sepsis were encountered. The entire procedure lasted only a few minutes, thereby minimizing the patient's time under anesthesia. Laparoscopic extraperitoneal cystolithotomy is safe and easy to learn. It should be part of all urologists armamentarium against bladder calculi. Similar procedures have been reported in children for removal of calculi after bladder augmentation.

Richard D Levin

Urodocs, PA, Aventura, Florida, USA

Submitted October 25, 2010 - Accepted for Publication November 7, 2010

KEYWORDS: Laparoscopic; Extraperitoneal; Cystolithotomy; Sutureless; Tubeless.

CORRESPONDENCE: Richard D. Levin, MD, Urodocs PA, 210-17 NE 34th place, Spinnaker Bay at the Waterways, Aventura, Fl 33180, USA ().

CITATION: Urotoday Int J. 2010 Dec;3(6). doi:10.3834/uij.1944-5784.2009.08.16

ABBREVIATIONS AND ACRONYMS: LUTS, lower urinary tract symptoms; SILS, single-incision laparoscopic surgery; TURP, transurethral resection of the prostate.



Managing Patients With ‘Wet’ Overactive Bladder: Results of Pooled Studies Show Efficacy of Darifenacin as Measured by ‘Dry Days’


INTRODUCTION: Incontinence is a bothersome symptom in patients with overactive bladder (OAB) and a main symptom for help-seeking behavior. Our analysis of three phase III studies aimed to assess the effect of darifenacin on the number of Dry Days and incontinence episodes (IEs) in participants with OAB with incontinence.

METHODS: Pooled data from three randomized, placebo-controlled, fixed-dose studies (n=1059) were analyzed. Participants with OAB received 12 weeks' treatment with once daily darifenacin 7.5 mg (n=337) or 15 mg (n=334) or placebo (n=388). The number of participants achieving ≥ 3 consecutive Dry Days was the primary analysis endpoint. Health-related quality of life (HRQoL) was assessed using the King's Health Questionnaire (KHQ).

RESULTS: Significantly more participants taking daridenacin at week 12 achieved ≥ 3 consecutive Dry Days versus placebo (52.6% versus 39.8%, respectively; P ≤ .001). Significant improvements were observed in participants with mild (< 14 IEs/week) and moderate/severe (≥ 14 IEs/week) OAB with incontinence. Participants with ≥ 3 consecutive Dry Days had statistically significantly greater improvements in IEs, IEs resulting in a change of pads/clothing, micturitions/day, episodes of urgency and KHQ scores, compared with those who did not achieve ≥ 3 consecutive Dry Days. Darifenacin was well tolerated.

CONCLUSIONS: Darifenacin treatment significantly increased the number of participants achieving ≥ 3 consecutive Dry Days and significantly reduced the number of IEs. Similar improvements were observed with long-term treatment and were associated with significant improvements in HRQoL. These findings indicate that darifenacin is an effective treatment for participants with 'wet' OAB.

Diane Newman,1 William S Aronstein,2 Yodit Seifu,3 Andrea Larson-Peters,4 Lidia Mongay3

1 Division of Urology, University of Pennsylvania, Philadelphia, PA, USA

2 CTI Clinical Trial and Consulting Services, Cincinnati, OH, USA

3 Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA,

4 Procter & Gamble, Cincinnati, OH, USA

Submitted August 2, 2010 - Accepted for Publication October 27, 2010

KEYWORDS: Antimuscarinic agents; Darifenacin; Overactive bladder; Urinary incontinence.

CORRESPONDENCE: Diane Newman, Co-Director, Penn Center for Continence and Pelvic Health, Director, Clinical Trials, Division of Urology, University of Pennsylvania Medical Center, 9 Penn Tower, 34th & Civic Center Blvd, Philadelphia, Pennsylvania 19104, USA ().

CITATION: UroToday Int J. 2010 Dec;3(6). doi:10.3834/uij.1944-5784.2010.12.11

ABBREVIATIONS AND ACRONYMS: AE, adverse event; IE, incontinence episode; HRQoL, health-related quality of life; KHQ, King's Health Questionnaire; LOCF, last-observation-carried-forward;OAB, overactive bladder.



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