Volume 4

UIJ Volume 4 2011

Letter from the Editor - December 2011

Dear Colleagues,

The close of the year is approaching and this is a time both to summarize what has been achieved during 2011 and to look forward. With this December issue of UroToday International Journal, we have completed another successful year for the journal, with the publication of many interesting articles, covering the whole field of urology. Thanks are due to our authors, reviewers, and readers—with your continued contributions we can look forward to a productive 2012 with confidence. Since we foster free manuscript submission, peer review, and publication for all of our authors, we anticipate an ever-growing breadth of the latest findings that we look forward to sharing with our readers in the year ahead.

Among the many interesting contributions, Saito et al. present information from phase II placebo-controlled clinical trials on mirabegron, a novel selective β3-adrenoceptor agonist, still in development for the treatment of OAB. Mirabegron represents a welcome addition to antimuscarinic drugs for the treatment of OAB, showing a good efficacy and a side effect profile different from those of the antimuscarinics.

Gittelman et al. compare the impact of degarelix and leuprolide on the quality of life for male cancer patients. They not only present the similarities between the two drugs, but the significant benefits of degarelix in patients with metastases.

Khalil et al. discuss scrotal scintigraphy and quantitative imaging, demonstrating the beneficial approach for patients with acute scrotal pain, and the emergence of quantitative imaging as an accurate diagnostic tool.

A bladder-preserving treatment, Bacillus Calmette-Guérin (BCG) therapy has confirmed value in reducing tumor recurrence, but when does it fail? Kamel and associates define BCG failure based on their summary of major urological guidelines and standards.

Although there is much interest in urinary incontinence, in Spain, studies are lacking. Martinez-Agulló et al. present a study of urinary incontinence, overactive bladder, and enuresis of the Spanish population in order to shed some light on the affected population.

A study by Shelbaia et al. outlines the successful management of ureteric calculi using Stone Cone, assessing its efficacy and safety during pneumatic lithotripsy.

Essam et al. validate improved Snodgrass repair results using a double-layer vascularized dartos flap. Coupled with Snodgrass, a urethral dartos flap reduces fistula complication, and provides excellent urine flow and esthetic results.

Sallami et al. outline the benefits of uteroscopic lithotripsy with local anesthesia, which provides a more rapid procedure that neither increases the risk of complication nor compromises the procedure results.

We also present a series of case reports that include topics such as bladder melanosis, acute scrotum, and sub-urethral diverticulum.

It has been an exciting and worthwhile year, and we are confident that where UIJ flourishes, advances are sure to follow. Thank you for your continued support.

Kind Regards,

Karl-Erik Andersson

A β3 Agonist, Mirabegron for the Treatment of Overactive Bladder


Overactive bladder syndrome (OAB) has a negative impact on quality of life and social functioning. Although antimuscarinic drugs are the first line of treatment for OAB, adverse effects and the limitations of efficacy hinder their use. β-adrenoceptors are found in the bladder body and mediate relaxation to noradrenalin. Stimulation of β3-adrenoceptor subtypes has been shown to relax bladder smooth muscle in humans. Mirabegron, a novel selective β3-adorenoceptor agonist, is in development for the treatment of OAB. Phase II placebo-controlled clinical trials showed that mirabegron significantly improved the majority of variables when administered to patients with OAB. Mirabegron is well tolerated with significant efficacy in reducing the number of incontinence episodes and the mean micturition frequency. Commonly reported adverse effects were gastrointestinal adverse events and headache. The lower propensity of dry mouth and constipation while taking mirabegron may make it an attractive drug candidate.

Motoaki Saito, Fotios Dimitriadis, Fumiya Ohmasa, Seiya Inoue, Keisuke Satoh

Submitted: Oct 10, 2011 Accepted for Publication: October 27, 2011

KEYWORDS: Mirabegron; Adrenergic β3 receptor; Bladder; OAB (overactive bladder); LUTS (lower urinary tract symptoms)

CORRESPONDENCE: Fotios Dimitriadis, MD, PhD, Division of Molecular Pharmacology, Tottori University School of Medicine, 86 Nishimachi, Yonago 683-8503, Japan ().

CITATION: UroToday Int J. 2011 Dec;4(6):art 70. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.03

Acronyms and Abbreviations: ACh, acetylcholine; M1-4, muscarinic su types, 1-4 respectively; PLC, Phospholipase-C; IP3/DAG, Inositol 1,4,5 Trisphosphate/1,2-Diacylglycerol; NA, noradrenalin; AC, adenylyl cyclase; cATP, cyclic adenosine triphosphate


Ureteroscopic Management of Proximal Ureteric Calculi Using Stone Cone


Aim of the work: To assess the efficacy and safety of Stone Cone during ureteroscopic pneumatic lithotripsy of proximal ureteric calculi.

Setting and design: From June 2009 to June 2010, 119 patients were included and underwent ureteroscopic management of proximal ureteric calculi with the help of Stone Cone and pneumatic disintegration.

Material and method: Our patients were divided into 2 groups. Ureteroscopic management of proximal ureteric calculi with pneumatic lithotripsy was done in group 1, and ureteroscopic management of upper ureteric stones with the help of Stone Cone and pneumatic lithotripsy was done in group 2.

Results: Patients were divided into 2 groups. Group 1 included 62 patients that underwent standard ureteroscopic pneumatic lithotripsy without Stone Cone. Group 2 included 57 patients that underwent pneumatic lithotripsy using Stone Cone as ureteral occlusion during ureteroscopy. The success rate was 87% in group 1 and 94.7% in group 2. The complication rate ranged from 3.5 to 8%. There were 4 cases of haematuria (6.4%) and one case of ureteral perforation (1.6%) in group 1. In group 2, 2 cases (3.5%) of haematuria occurred. Operative time was highly significant in group 2 and not in group 1; it was 20 to 35 minutes in group 2 versus 30 to 50 minutes in group 1.

Conclusion: Stone Cone is an instrument used during ureteroscopi lithotripsy of proximal ureteric calculi. It can be considered a very effective instrument in blocking the upward migration of ureteric calculi, enabling its safe removal.

Ahmed Shelbaia, Sherif Abd ELRahman, Ali Hussein

Submitted June 15, 2011 - Accepted for Publication Sept 12, 2011

KEYWORDS: Proximal ureteric calculi; Stone Cone; Pneumatic lithotripsy; Ureteroscopy

CORRESPONDENCE: Ahmed Shelbaia, Urology Department, Cairo University Hospital, Borg El Atbaa, Faisal Street, Cairo, Egypt (ahmedshelbaia2007@hotmail)

CITATION: Urotoday Int J. 2011 Dec;4(6):art68. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.01 


An Unusual Cause of Acute Scrotum in a 65-Year-Old Man



Testicular pain has several etiologies, including torsion, trauma, inflammation, and malignancy. Testicular torsion is a rare cause of scrotal pain in adult men. Few reports have commented on testicular torsion in the geriatric population. It is more common in young adults, and it usually develops as a consequence of certain congenital abnormalities in pediatric and adolescent patients. We report a case of a 65-year-old man who presented with left testicular pain and bilateral groin swelling for 5 days. Surgical exploration was performed and showed left testicular torsion with a right inguinal hernia. In conclusion, testicular torsion should be considered in the differential diagnosis of an acute scrotum regardless of the patient’s age. Our case report of testicular torsion in the elderly patient offers a contribution to literature regarding the presentation and management of adult onset testicular torsion.

Eng Hong Goh, Putera Mas Pian, Praveen Singam, Christopher Chee Kong Ho, Guan Hee Tan, Badrulhisham Bahadzor, Zulkifli Md Zainuddin

Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre

Submitted: May 12, 2011

Accepted for Publication: July 3, 2011

KEYWORDS: Testicular torsion; Elderly; Presentation

CORRESPONDENCE: Eng Hong Goh, Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, 56000, Malaysia ().

CITATION: UroToday Int J. 2011 Dec;4(6):art 71. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.04


Congenital Renal Arteriovenous Malformation Is a Rare Cause of Hematuria and Ureteric Obstruction


Renal arteriovenous malformation (rAVM) is a rare benign cause of hematuria. We present a case of a 40-year-old female with hematuria and renal colic secondary to a rAVM, as well as a review of the literature. rAVM has a female-to-male ratio of 3 to 1 and can be categorized as either congenital or acquired. Congenital rAVM constitutes 25 to 30% of all rAVM. Acquired rAVM could be categorised as iatrogenic, traumatic, inflammatory, and malignant. The diagnostic and therapeutic option of choice is renal angiography and embolisation. rAVM embolisation allows the maximal preservation of nephrons. Post-rAVM embolisation, 40 to 61% of patients are at risk of post-embolisation syndrome. Total or partial nephrectomy is reserved for recalcitrant rAVMs. Additionally, it is the treatment of choice in centers without angiography.

Yeng Kwang Tay, Dan Spernat, Patrick J Page, Caroline Dowling

Submitted: August 11, 2011 - Accepted for Publication: September 23, 2011

KEYWORDS: Renal arteriovenous malformation; Renal AVM; Hematuria; Ureteric obstruction

CORRESPONDENCE: Yeng Kwang Tay, MD, Department of Urology, Monash Medical Centre, East Bentleigh, 3165, Victoria, Australia. ()

CITATION: UroToday Int J. 2011 Dec;4(6):art 79. http://dx.doi.org/10.3834/uij. 1944-5784.2011.12.12




Comparison of the Impact of Degarelix and Leuprolide on the Health-Related Quality of Life of Patients with Prostate Cancer: Results of a 12-Month Phase III Clinical Trial


Introduction: The objective of this study was to compare health-related quality of life (HRQoL) with degarelix (240 mg in month 1 and then 80 mg monthly, administered subcutaneously) or leuprolide (7.5 mg/month intramuscularly) in men with prostate cancer.

Methods: HRQoL was assessed at baseline and throughout a 12-month randomized, open-label, parallel-group clinical trial using standard SF-12 and EORTC QLQ-C30 questionnaires. HRQoL outcomes were compared between treatments using trend, change score, and response analyses.

Results: HRQoL data from 401 subjects were included in this analysis; 205 receiving degarelix 240/80 mg and 196 receiving leuprolide 7.5 mg. Over the 12-month treatment period, patients experienced worsening of most HRQoL domains except for bodily pain, general health (both SF-12), and diarrhea (QLQ-C30). No treatment group differences in HRQoL were noted at day 28 or 6 months. At 12 months, mean SF-12 scores for the mental component summary (p = 0.02) and mental health (p = 0.04) were significantly higher in degarelix- compared with leuprolide-treated patients. Treatment with leuprolide had a seemingly more favorable impact on insomnia (QLQ-C30; p = 0.04) and bodily pain (SF-12; p = 0.006) compared with degarelix. Patients with metastatic disease treated with degarelix reported significant improvements in the role-emotional domain (SF-12; p = 0.02), global health status (QLQ-C30; p = 0.04), and appetite loss (QLQ-C30; p = 0.02) at 12 months compared with leuprolide.

Conclusions: After 12 months of treatment, the HRQoL of patients with advanced prostate cancer treated with the GnRH antagonist degarelix is similar to that of patients treated with leuprolide. The study also indicates benefits with degarelix treatment in the metastatic population.

KEYWORDS: Degarelix; Gonadotropin-releasing hormone agonist; Gonadotropin-releasing hormone antagonist; Health-related quality of life; Leuprolide; Prostate

CORRESPONDENCE: Bo-Eric Persson, MD, Director, Medical Sciences, Urology/Oncology Global Marketing, Ferring International Center SA, Chemin de la Vergognausaz 50, 1162 St-Prex, Switzerland ().

CITATION: UroToday Int J. 2011 Dec;4(6):art 81. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.14


A Case of Bladder Melanosis Associated with Recurrent Urinary Tract Infections


Bladder melanosis is a very rare clinical entity that has reportedly been associated with a wide variety of urinary symptoms. Reports also exist of an association with bladder malignancy. We describe a case with a 58-year-old man under urological investigation following 2 urinary tract infections. Several flat, blackened areas within the bladder were observed at cystoscopy, which histology revealed was due to increased melanin deposits within bladder urothelial cells; i.e., melanosis. This finding is of uncertain significance, and regular cystoscopic follow-up was thought to be prudent. At 3 months, appearances were unchanged; however, at 6 months, the bladder’s appearance was entirely normal with resolved changes of melanosis.

KEYWORDS: Bladder melanosis; Melanosis vesica

CORRESPONDENCE: Sara Lightowlers, MB, BChir, West Suffolk Hospital, Bury St. Edmunds, Suffolk, United Kingdom, IP33 2QZ ().

CITATION: UroToday Int J. 2011 Dec;4(6):art 73. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.06



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