A case of bladder rupture due to intravesical explosion during transurethral resection of prostate (TURP) is presented. Exploratory laparotomy done on clinical suspicion revealed a large inverted “V” shaped bladder tear that was sutured in 2 layers. An incidence of intravesical explosion during TURP is extremely rare. It occurs due to a mixture of explosive gases produced during TURP, with the air introduced into the bladder while activating the electrosurgical instrument. The presentation aims to bring attention to this rare complication once again with a literature review and emphasis on the necessary precautions needed to prevent it.

Rahul Kapoor, Hemant R. Pathak

Submitted April 8, 2011 - Accepted for Publication June 1, 2011

KEYWORDS: Transurethral resection of the prostate; Intravesical explosion; Bladder rupture

CORRESPONDENCE: Rahul Kapoor, Department of Urology, Apollo BSR Hospital, Junwani Road, Bhilai 242002, Chhattisgarh, India ().

CITATION: Urotoday Int J. 2011 Oct;4(5):art 60. doi:10.3834/uij.1944-5784.2011.10.02

Squamous cell carcinoma of the urinary tract is a very rare tumor associated with chronic renal calculi and infection. This tumor is highly aggressive and often detected at an advanced stage with a poor outcome. We hereby describe a case report of a 56-year-old male who presented with hydronephrosis and hydroureter in a non-functioning left kidney with ureteric calculi. Histopathology of the nephrectomy specimen revealed unexpected squamous cell carcinoma with chronic pyelonephritis. The pus culture came out positive for fungus—Geotrichum.

Hamdy AbdelMawla Aboutaleb, Atef Badawy, Ahmed Gamal-eldin, Mohammed Badr-eldin

Submitted April 14, 2011 - Accepted for Publication June 13, 2011

KEYWORDS: Non-functioning kidney; Fungal infection-Geotrichum; Squamous cell carcinoma

CORRESPONDENCE: Anubha Singh Yadav, Department of Urology, Pt. BDS PGIMS, University of Health Sciences, Rohtak ().

CITATION: UroToday Int J. 2011 Oct;4(5):art 62. doi:10.3834/uij.1944-5784.2011.10.04

Dear Colleagues,

The goal of UroToday International is to accelerate the timely and widespread dissemination of new urological research findings, and ultimately to impact clinical outcomes. This objective is most probably similar to all academic publishers, however most others survive by selling subscription use to libraries around the globe where according to a recent article in The Economist, Elsevier, the largest publisher of journals with nearly 2000 titles reported an operating profit margin of 36% while other media has experienced great declines. At the UIJ we offer manuscript submission, peer review and publication free for the authors providing the research and are now charging an annual subscription fee for use of the journal to offset the publications costs. All researchers, reviewers, and the editorial board provide their services for free. I want to express my sincere gratitude to our reviewers and editorial board members who contribute their time and resources to support the goal of free access to publishing, allowing results of important clinical or basic research findings to be provided to over 40,000 individual readers of this journal. We will continue on our journey to establish a new model for publishing that is privately supported to establish a way for all clinicians and scientists, irrespective of age or affiliation, the opportunity to have peer-review of their manuscripts and the power to have them published upon peer approval.

In this issue we have four original studies the first, by Anderson et al, was designed to determine the feasibility and effectiveness of medical hypnosis and cognitive behavioral therapy (CBT) for pain relief, improvement of psychological status, and quality of life in men with chronic prostatitis, (CP) also known as chronic pelvic pain syndrome (CPPS). The authors conclude the CBT and self-hypnosis training for patients with CP/CPPS was feasible, resulted in decreased symptoms, and provided patient self-directed methods to improve sense of control, ability to cope, and dissociation from pain symptoms.

Nederostek and colleagues present a subanalysis of stratification by risk group, race, prostate volume, and neoadjuvant hormone therapy for prostate cancer treated with current, third-generation cryotherapy. The authors conclude that the short-term results from this retrospective analysis justify the continuing use of cryosurgery for the management of localized prostate cancer.

Galal and Fath El-Bab studied the safety and efficacy of one stage ureteroscopy for the treatment of bilaterial ureteric stones. They conclude that the one-stage procedure was safe and effective and reduced anesthesia exposure and potentially provides cost savings.

Al-Sayyad and colleagues present an evaluation of biomarkers to differentiate upper from lower urinary tract infections in children younger than 2 years of age. The differentiation between the upper and lower UTI has important clinical implications in children where UTI is the most common bacterial infection. They conclude that some biomarkers used alone or in combination, help to differentiate between upper and lower UTI and may make more aggressive testing unnecessary in the future. Larger prospective studies will be necessary to confirm this finding.

Also in this issue is a mini report presenting a novel bridge technique designed for a skilled urologist, to simplify the learning curve for the laparoendoscopic single-site (LESS) surgery that includes an incisional LESS (iLESS) approach. The purpose of this report is to describe the method for establishing single-site access using the GelPort and standard instruments in a teaching hospital, as a learning tool toward LESS surgery.

There are also a series of case reports presented providing insights into less common situations that present in urology.

Thank you for your continued support in providing publication-worthy manuscripts - and to our reviewers and editorial board, a special recognition for your contributions in making timely decisions and recommendations. 

Sincerely,

Karl-Erik Andersson

Editor-in-Chief
UIJ

OBJECTIVE: To determine the feasibility and effectiveness of medical hypnosis and cognitive behavioral therapy (CBT) for relief of pain, improvement of psychological status, and quality of life in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

METHODS: Men with refractory chronic pelvic pain who were symptomatic for >3 months were assessed for hypnotic susceptibility after medical, mental health, and social history were obtained. Psychological data from healthy men with no evidence of pain disorders or genitourinary symptoms were used as a comparator group. In 7 weekly sessions, the psychologist/hypnotherapist utilized CBT to challenge and balance negative cognitions associated with symptoms, performed guided imagery and hypnotic intervention, and provided patient training in self-hypnosis for symptom management. Changes in symptom indices, psychometrics, and compliance with home exercises using audiotapes of hypnosis sessions and CBT workbooks were assessed after 3 and 6 months.

RESULTS: Sixteen men with median pain duration of 7 years and high symptomatic pain scores participated. All had moderate to high hypnotic ability. At 6 months after training, the median NIH-CPSI total score decreased 10.5 points (-7 to -27) relative to pretreatment in 57% of patients; McGill pain scores decreased a median of 6.5 points (-2 to -28). Both NIH-CPSI pain and quality of life domain scores significantly improved (P ≤ .02). Most (88%) patients reported continued self-hypnosis effective for symptomatic relief and improved coping.

CONCLUSION: CBT and self-hypnosis training for patients with CP/CPPS was feasible, resulted in decreased symptoms, and provided patient self-directed methods to improve sense of control, ability to cope, and dissociation from pain symptoms. Longer-term follow-up is required to determine the impact of these therapeutic approaches for selected men with this disorder.

KEYWORDS: Prostatitis; Chronic pelvic pain syndrome; Medical hypnosis; Cognitive behavioral therapy

CORRESPONDENCE: Rodney U Anderson, MD, FACS, Department of Urology, S287 Stanford University School of Medicine, Stanford, California 94305-5118, USA ().

CITATION: UroToday Int J. 2011 Aug;4(4):art46. doi:10.3834/uij.1944-5784.2011.08.02.

ABBREVIATIONS AND ACRONYMS: BSI, Brief Symptom Inventory; CAM, complementary and alternative medical; CBT, cognitive behavioral therapy; CNS, central nervous system; CP, chronic prostatitis; CPPS, chronic pelvic pain syndrome; CPSI, Chronic Prostatitis Symptom Index; DSM, Diagnostic and Statistical Manual; GRA, global response assessment; NIH, National Institutes of Health; PPSS, Pelvic Pain Symptom Scale

INTRODUCTION: The purpose of the study was to determine the safety and efficacy of one-stage ureteroscopy for treatment of bilateral ureteric stones.

METHODS: Retrospective data were obtained from the patient database in the Department of Urology at Minia University Hospital between March 2008 and November 2010. There were 34 patients (20 men and 14 women) with a mean age of 38.4 years (SD = 13.6; range,16-82 years). All patients underwent one-stage ureteroscopy for bilateral ureteric stones using an 8 Fr semirigid ureteroscope. A 0.038 inch floppy-tipped guidewire was passed through the selected ureteric orifice, advanced under direct vision, and monitored fluoroscopically. Balloon dilation of the intramural ureter was completed in most cases. Stone treatment was chosen according to its size and occurred by direct extraction or lithotripsy using the pneumatic lithoclast. Postoperatively, unilateral or bilateral ureteral stenting was done for 2 days to 6 weeks. Patients were followed for a minimum of 3 months.

RESULTS: Sixty four ureteroscopic procedures were successfully completed to treat 32 of the 34 patients. Mean stone size was 8.3 mm (range, 3-20 mm). The stones were radio-opaque in 28 patients and dense in 4 patients. A single stone was found in 30 patients (93.75%); 2 patients had multiple stones. Calculi were retrieved intact using baskets for 18 patients; lithotripsy was required for 14. The mean operative time was 85 minutes (range, 35-150 minutes). Intraoperatively, 25 of 32 patients (78.2%) were stone-free bilaterally and another 7 patients (21.8%) were stone-free unilaterally. Thirty patients (93.7%) were stone free 1-month after 1 endoscopic procedure; 2 patients were clear after 2 procedures. Early postoperative complications were rare and included fever in 4 patients; no long-term complications were observed.

CONCLUSION: One-stage ureteroscopy for bilateral ureteric stones is a safe and effective procedure that can achieve stone-free and complication rates that are comparable to those of unilateral ureteroscopy.

Ehab Mohamad Galal, Tarek Khalaf, Fath El-Bab

Submitted April 8, 2011 - Accepted for Publication April 28, 2011

KEYWORDS: One-stage ureteroscopy; Bilateral ureteric stones

CORRESPONDENCE: Ehab Mohamad Galal, MD, Urology Department, Minia University Hospital, Minia City, Egypt().

CITATION:UroToday Int J. 2011 Aug;4(4):art45. doi:10.3834/uij.1944-5784.2011.08.01

ABBREVIATIONS AND ACRONYMS: IVU, intravenous urogram; KUB, kidney, ureter, bladder

A horseshoe kidney (HSK) is the most common congenital renal fusion anomaly. It occurs in approximately 1 in 400 persons, with a 2:1 male:female incidence. Traumatic synchronous, multiorgan injury in the setting of anomalous anatomy adds to the complexity of surgical exposure and creates a formidable hemostatic challenge. We present a 30-year-old male with multiorgan injury secondary to blunt abdominal trauma sustained during a motor vehicle accident. We describe the preoperative evaluation that led to the identification of the HSK and other associated intra-abdominal injuries and the subsequent surgical procedure. Surgical management of blunt abdominal trauma to an HSK is difficult due to multiple variations in vascular anatomy and the location of this renal anomaly. Such anatomical variations can make reconstruction and preservation of the damaged kidney very challenging.

Prakash R Paragi, Pauline H Go, Zachary Klaassen, Mark Ingram

Submitted March 16, 2011 - Accepted for Publication May 11, 2011

KEYWORDS: Horseshoe kidney; Renal; Trauma

CORRESPONDENCE: Prakash R Paragi, MS, MD, Director of Minimally Invasive Surgery, Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ 07039 USA ().

CITATION: Urotoday Int J. 2011 Aug;4(4):art47. doi:10.3834/uij.1944-5784.2011.08.03

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; FAST, Focused Assessment with Sonography in Trauma; HSK, horseshoe kidney; MVA, motor vehicle accident.

INTRODUCTION: Distinguishing upper from lower urinary tract infections (UTI) has important clinical implications in children, especially in those younger than 2 years of age. The objective of this study was to test differences between upper and lower UTIs by using serum and urine biomarkers.

METHODS: Participants were 83 patients with UTI based on suggestive clinical symptoms and at least 1 positive urine culture. All had renal scintigraphy. Children with known concomitant diseases, any type of renal disorder, or a previous diagnosis of vesicoureteral reflux were excluded. Before the initiation of antibiotic treatment, blood was sampled for white blood cell (WBC) count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and procalcitonin (PCT). Urinary interleukin-6 (uIL-6) and macrophage migration inhibitory factor (MIF) were also measured. Data were analyzed using the Mann-Whitney or t test. Sensitivity and specificity were calculated for some variables in isolation and in combination.

RESULTS: There were 61 girls and 22 boys with mean (SD) age of 8.7 (3.4) months and 7.8 (4.5) months, respectively; 49 patients had acute pyelonephritis (APN) and 34 had lower UTI. The mean WBC counts were significantly higher in the group with APN than in the group with lower UTI (P < .01), as were CRP and ESR levels (P < .001). Significantly higher serum PCT, urinary IL-6, and MIF levels were detected in patients with APN when compared with patients with lower UTI (all with P < .001). For the prediction of APN, sensitivity and specificity levels were 95.9% and 88.2% for CRP, 87.8% and 91.2% for PCT, 71.4% and 94.1% for uIL-6, and 93.9% and 97.1% for urinary MIF. The sensitivity and specificity for CRP combined with other biomarkers were 93.9% and 91.2% (PCT with CRP), 95.9% and 91.2% (uMIF with CRP), and 85.7 % and 94.1% (uIL-6 with CRP), respectively.

CONCLUSION: Some biomarkers, used solely or in combination, help to differentiate between upper and lower UTI and may make more aggressive and invasive testing unnecessary in the future.

Ahmed J Al-Sayyad, Salah M EL-Morshedy, Ehab A abd Al Hamid, Nehad A Karam, A Basset A Imam, Rehab A Karam

Submitted April 10, 2011 - Accepted for Publication May 25, 2011

KEYWORDS: Urinary tract infection; Acute pyelonephritis; Biomarkers

CORRESPONDENCE: Ahmed Al-Sayyad MD, FRCSC, Assistant Professor and Consultant of Pediatric Urology, King Abdulaziz University, PO Box 1817 Jeddah 21441, Saudi Arabia ().

CITATION:UroToday Int J. 2011 Aug;4(4):art49. doi:10.3834/uij.1944-5784.2011.08.05.

ABBREVIATIONS AND ACRONYMS: APN, acute pyelonephritis; CRP, C-reactive protein; DMSA, dimercaptosuccinic acid; ELISA, enzymelinked immunosorbent assay; ESR, erythrocyte sedimentation rate; IL-6, interleukin-6; MIF, migration inhibitory factor; PCT, procalcitonin; RPI, renal parenchymal involvement; UTI, urinary tract infection; WBC, white blood cell.

INTRODUCTION: Prostate cryoablation was developed with the intent of maximizing effectiveness while minimizing the morbidity of treating clinically localized prostate cancer. Our focus was to determine Kaplan-Meier (KM) biochemical recurrence-free survival (BRFS) estimates and how they might be affected by neoadjuvant hormone therapy, race, D’Amico risk group, and prostate volume.

METHODS: We retrospectively analyzed data from 190 patients receiving cryoablation for the primary treatment of T1 to T3 prostate cancer from 2003 to 2009. All patients underwent whole-gland prostate cryoablation by a single surgeon using the Cryocare CS System (HealthTronics; Austin, TX, USA). Patients received a prostate-specific antigen and digital rectal examination at 1, 3, 6, 9, 12, 18, 24, and 30 months after surgery. A PSA nadir of ≤ 0.1 ng/mL was used to define treatment success. KM BRFS curves were plotted overall and by subanalysis variable and compared using the log-rank test. Univariate Cox proportional hazard regression models were used to describe the effect of measured variables on risk of biochemical recurrence.

RESULTS: The mean follow-up was 27 months. A total of 153 patients (81%) reached the treatment goal of PSA nadir ≤ 0.1 ng/mL. Using a nadir + 2 ng/mL failure definition, BRFS rates were 94% and 85% for 1 year and 3 years, respectively. High D’Amico risk significantly predicted biochemical recurrence (hazard ratio [HR] = 3.65; P = .045). African American men had a nonsignificant trend toward increased risk (HR= 1.91; P = .12). BRFS did not differ when comparing men who did or did not receive hormone therapy (log-rank test: P = .57) or men with prostate size < 40 g vs ≥ 40 g (P = .72). The majority of complications were minor, with a rate of 12%.

CONCLUSIONS: Although neoadjuvant hormone therapy and prostate volume at the time of surgery were not statistically associated with BRFS, race approached significance and high D’Amico risk group was significant. Our short-term results justify the continuing use of cryosurgery for the management of localized prostate cancer.

KEYWORDS: Cryotherapy; Neoadjuvant Hormone Therapy; Prostate; Prostate Cancer; Prostate Cryoablation

CORRESPONDENCE: LCDR James C. Nederostek, MD, Department of Urology, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA ().

CITATION: Urotoday Int J. 2011 Aug;4(4):art48. doi:10.3834/uij.1944-5784.2011.08.04

ABBREVIATIONS AND ACRONYMS: ASTRO, American Society for Therapeutic Radiology and Oncology; BRFS, biochemical recurrence-free survival; CT, computed tomography; KM, Kaplan-Meier; PSA, prostate-specific antigen; RTOG, Radiation Therapy Oncology Group.

INTRODUCTION: The laparoendoscopic single-site (LESS) technique has advantages over multi-site surgery that include better cosmesis, less incisional pain, and the ability to convert to standard multiport surgery, if needed. A steep learning curve makes the procedure prohibitive for trainees in many centers. To simplify this learning curve, we adopted a bridging technique that includes an incisional LESS (iLESS) approach using a GelPort device (Applied Medical Resources Corp; Rancho Santa Margarita, CA, USA). We describe the iLESS technique and report our initial experiences.

METHOD: The iLESS surgical technique is illustrated on a centrally-located 5 cm right renal mass in a 54-year-old female patient with a poorly functioning right kidney. A single-port supraumbilical nephrectomy was conducted using the GelPort device. The device was inserted through an 8 cm supraumbilical incision. Procedures are fully described and compared with the LESS technique.

RESULTS: The procedure was technically successful. The total operative duration was 2.2 hours, the estimated blood loss was 70 mL, and the hospital stay was 3 days. There were no complications during or after surgery. The total analgesia requirement was 30 mg of morphine. Visual analog pain scores were 7/10 and 2/10 at 1 and 2 days after surgery, respectively.

CONCLUSIONS: The iLESS nephrectomy is technically feasible using standard laparoscopic instruments. Selected patients should have a low body mass index and an anterior abdominal wall thickness of < 6 cm. We expect this procedure to help bridge the gap between standard laparoscopy and LESS, because the GelPort device simulates a modified type of laparoendoscopic single-site surgery. Rigid or flexible instruments are used selectively to provide a smooth learning curve.

Ahmed Al-Sameraaii, Edward Latif, Peter Aslan

Submitted March 20, 2011 - Accepted for Publication June 13, 2011

KEYWORDS: Incisional laparoendoscopic single site; iLESS; Supraumbilical; Single port; Laparoscopic surgery; Gelport

CORRESPONDENCE: Dr. Ahmed Al-Sameraaii, Department of Urology, Hurstville Private Hospital, 37 Gloucester Road, Hurstville, NSW 2220, Sydney, Australia ().

CITATION: UroToday Int J. 2011 Aug;4(4):art51. doi:10.3834/uij.1944-5784.2011.08.07.

ABBREVIATIONS AND ACRONYMS: GIA, gastrointestinal anastomosis; iLESS, incisional laparoendoscopic single-site; LESS, laparoendoscopic single-site.

 

Nitinol retrieval basket is an instrument used by urologists to retrieve stones from the upper urinary tract. We report the innovative way of using an instrument purposely designed for endourology, by a urological surgeon in endovascular surgery. After an initial failed angioplasty, a 62-year-old man with peripheral vascular disease had a second right groin cross over catheterization angioplasty of the calcifi ed left iliac stenotic disease performed by a radiologist. This procedure was complicated by the fracture of the catheter tip in the external iliac. With no snares available at the time of the second angioplasty, a Urology Consultant successfully used a Zerotip 2.4 F Å~ 120 cm Nitinol Stone Retrieval Basket, avoiding an open laparotomy.

Costin Chintea, Ajantha Jayatunga, Alexander Wolinski, Henryk Krasnowski

Submitted April 16, 2011 - Accepted for Publication May 11, 2011

KEYWORDS: Stone retrieval basket; Urology; Endourology; Angioplasty

CORRESPONDENCE: Costin Chintea, 53 Stonehouse Lane, Quinton, Birmingham, West Midlands B32 3DU, United Kingdom ().

CITATION: Urotoday Int J. 2011 Aug;4(4):art4. doi:10.3834/uij.1944-5784.2011.08.08

Renal angiomyolipoma (AML) rarely presents with hemorrhage. We report a case of a large-sized renal angiomyolipoma (12 X 7 X 6.5 cm) with intratumoral and subcapsular spontaneous hemorrhage in a 22-year-old female. The diagnosis was based on radiological features by CT scan and histopathological examination after removal of the tumor. The patient subsequently underwent right nephrectomy. Spontaneous hemorrhage from AML should be expected in large size tumors and fast decision for intervention is mandatory.

Hamdy AbdelMawla Aboutaleb, Mohammed Badr-Eldin

Submitted April 14, 2011 - Accepted for Publication May 19, 2011

KEYWORDS: Angiomyolipoma; Kidney; Hemorrhage

CORRESPONDENCE: Dr. Hamdy AbdelMawla Aboutaleb, Minoufiya University Hospital, Gamal Abdelnasser Street, P. O. Box 32511, Shebin Elkom, Minoufiya, Egypt ().

CITATION: UroToday Int J. 2011 Aug;4(4):art53. doi:10.3834/uij.1944-5784.2011.08.09.

Dear Colleagues,

This issue marks the beginning of the fourth year for UroToday International Journal, and we have continued successfully to achieve our primary goal to elevate access to urology science for professionals around the world. This could not have been achieved without the dedication of both our authors and reviewers.

The current issue contains a variety of articles, many of which should be of high interest to the professional community. Hajebrahimi et al. evaluated the effect of changes in voiding position on uroflowmetric findings of young, healthy male vounteers, and found no statistically significant differences between the standing, sitting, or squatting voiding positions for any of the measured urodynamic outcome parameters: peak flow rate (Qmax), average flow rate, time to peak flow, flow time, and voided volume. Bhat et al. studied the effects of the transurethral catheter comparing free uroflow versus pressure-flow on their outcome measures: maximum flow (Qmax), average flow rate, voiding time, time to Qmax, and flow acceleration. With a small sample size they were able to show an obstructive effect of an in situ 5 Fr urethral catheter during pressure-flow studies, a finding that needs to be confirmed by a randomized prospective investigation. Karami et al studied prospectively the prevalence of acquired renal cystic disease (ARCD) in patients with end-stage renal disease receiving hemodialysis, and they conclude that patients who are on long-term hemodialysis should be monitored for the development of ARCD. Ahmed Shelbaia evaluated the results of early endoscopic management of posttraumatic posterior urethral stricture by visual internal urethrotomy (VIU), and conclude that early endoscopic urethral realignment surgery is a safe procedure with few complications. Miyaoka et al. report the first-year follow-up results on the safety and efficacy of the Ophira Mini-Sling System, which uses a minimally invasive, midurethral low-tension tape that is anchored to the obturator internus muscles bilaterally at the level of the tendinous arc by a single vaginal incision. They conclude that the system appears to be an effective, minimally invasive option for the treatment of stress urinary incontinence.

We are devoting a larger-than-normal portion of this issue to the publication of case reports. Such cases often provide insight into rare conditions, reminding us to be more vigilant during differential diagnosis or more open to alternative ways of managing a given disorder. de Leon et al. present the first known case of atraumatic bladder rupture in an adult with Ehlers-Danlos syndrome. The authors attribute the spontaneous rupture to a weakened bladder wall and caution against overextending the bladder during cystoscopic procedures with these types of patients. Bhat et al. describe a 24-year-old married, phenotypic female. She presented with an inability to conceive and no knowledge of having androgen insensitivity syndrome. The authors discuss the complex physical and psychological issues involved in the management of patients with this disorder. Khan et al. describe a 44-year-old patient with an appendicular mass that was discovered at the beginning of living-donor kidney transplant surgery. Traditionally, the transplant would be aborted and rescheduled following recovery from an appendectomy. However, the authors detail the sequence of events that enabled them to successfully perform both surgical procedures in the same session, and discuss the circumstances when this approach is unlikely to be feasible.

It is our primary goal to publish original studies, and we encourage you to submit the results of clinical or basic science research in all areas of urology. I personally thank the authors and reviewers for their valuable contributions to this journal issue. 

Sincerely,

Karl-Erik Andersson

Editor-in-Chief
UIJ

Ehlers-Danlos syndrome (EDS) is a group of inherited connective tissue disorders due to mutations of the connective tissue genes. It is characterized by the triad of skin hyperelasticity, joint hypermobility, and connective tissue fragility. A 50-year-old man presented with acute clot hematuria and dysuria with no preceding trauma. He had a background of EDS and chronic lower urinary tract symptoms secondary to benign prostatic hyperplasia. The diagnosis of extraperitoneal bladder rupture was made on imaging. This is the first known reported case of spontaneous bladder rupture in an adult with EDS, although there have been 2 reports of children who spontaneously ruptured a bladder diverticulum. We suggest that patients with EDS and evidence of bladder outlet obstruction should be managed closely. Early surgical intervention may be needed. Care should also be taken so that the bladder is not overdistended during cystoscopic procedures.

Jeremiah de Leon, Shuo Liu, Wan Yi Ng, Roy McGregor, Vincent Tse

Submitted January 19, 2011 - Accepted for Publication January 31, 2011

KEYWORDS: Bladder rupture; Ehlers Danlos syndrome; Benign prostatic hyperplasia

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

CITATION:UroToday Int J. 2011 Jun;4(3):art29. doi:10.3834/uij.1944-5784.2011.06.03

ABBREVIATIONS AND ACRONYMS: EDS, Ehlers-Danlos syndrome; TURP, transurethral resection of the prostate.

Androgen insensitivity syndrome (AIS), also known as testicular feminization, encompasses a wide range of phenotypes that are caused by numerous different mutations in the androgen receptor gene. AIS is an X-linked recessive disorder that is classified as complete, partial, or mild based on the phenotypic presentation. The clinical findings include a female type of external genitalia, 46-XY karyotype, absence of Mullerian structures, presence of Wolffian structures to various degree, and normal to high testosterone and gonadotropin levels. The syndrome is illustrated by a 24-year-old phenotypic female who presented with an inability to conceive, normal-appearing external genitalia, an absent uterus and ovaries, and bilateral testes at the level of the internal inguinal ring. Management includes counseling, gonadectomy to prevent primary malignancy in undescended gonad, and hormone replacement. The karyotyping of family members is advocated because of known familial tendencies.

KEYWORDS: Androgen insensitivity syndrome; Androgen receptor gene; Testicular feminization syndrome; Gonadectomy

CORRESPONDENCE: Dr. Gajanan S. Bhat, Resident in Urology, Institute of Nephrourology, Victoria Hospital Campus, Fort Bangalore- 560 002, Karnataka, India ().

CITATION: UroToday Int J. 2011 Jun;4(3):art33. doi:10.3834/uij.1944-5784.2011.06.04

ABBREVIATIONS AND ACRONYMS: AIS, androgen insensitivity syndrome (CAIS, complete; MAIS, mild; PAIS, partial); AR, androgen receptor; LH, luteinizing hormone.

INTRODUCTION: Voiding quality can theoretically be affected by voiding position. It is important to know the effect of voiding position on urometric parameters in order to obtain optimal diagnostic test results, compare data across research investigations, and make recommendations about voiding position for the management of voiding problems. This prospective study was designed to evaluate the effect of changes in voiding position on uroflowmetric findings of young, healthy men.

METHODS: The participants were 31 male volunteers who were asymptomatic of urological disorder. They had an average age of 29.2 years (range, 23-39 years). In each of standing, sitting, and squatting positions, 2 measurements were done (6 separate measurements for each case) and the mean of each pair was determined. Outcome measures were peak flow rate (Qmax), average flow rate, time to peak flow, flow time, and voided volume. A one-way ANOVA was used to compare the voiding positions; a probability value < .05 was considered statistically significant.

RESULTS: The results for the standing, sitting and squatting positions were: mean Qmax of 23.4, 24.4, and 25.8 mL/s, respectively (P = .618); mean for average flow rates of 13.4, 13.0, and 13.9 mL/s, respectively (P = .813); mean flow times of 23.9, 22.1, and 22.9 seconds, respectively (P = .822); mean time to peak flow of 7.8, 8.0, and 6.0 seconds, respectively (P = .119); and mean voided volume of 300, 275, and 290 mL, respectively (P = .631).

CONCLUSION: The present study revealed no statistically significant differences between the standing, sitting, or squatting voiding positions for any of the measured urodynamic parameters. A precise judgment about the effect of voiding position on the uroflowmetric measures of healthy young males needs more investigation using a large number of cases, preferably with heterogeneous typical voiding positions.

Mohsen Amjadi, Sakineh Hajebrahimi, Farzin Soleimanzadeh

Submitted February 7, 2011 - Accepted for Publication March 10, 2011

KEYWORDS: Urodynamics; Uroflowmetry; Voiding position

CORRESPONDENCE: Sakineh Hajebrahimi, Urology Department of Tabriz University of Medical Sciences, Tabriz, Iran ().

CITATION: UroToday Int J. 2011 Jun;4(3):art 35. doi:10.3834/uij.1944-5784.2011.06.06

ABBREVIATIONS AND ACRONYMS: AFR, average flow rate; Qmax, peak flow rate.

Calcification in nonrenal carcinoid tumors is common, but it is extremely rare to find calcification in renal carcinoids. Neuroendocrine cells are not found in normal renal parenchyma. We report a case of a 45-year-old male who presented with vague abdominal pain. Investigations showed that he had a calcified mass in the left kidney. We performed a nephrectomy. Histopathological tests showed that it was a carcinoid tumor. The patient was investigated further, but there was no evidence of any extrarenal primary focus of a carcinoid tumor. Whenever a carcinoid of the kidney is diagnosed, a thorough evaluation for another focus of carcinoid tumor is mandated because 54% of reported cases have metastatic lesions at initial presentation. When present, calcification is considered a stigmata of long-term tumor growth and associated with a more indolent course.

Sanjay Kolte, Darshana Tote, Bhushan Wani, Shivashankar Reddy, Girish Moghe

Submitted December 20, 2010 - Accepted for Publication January 31, 2011

KEYWORDS: Renal calcification; Carcinoid tumor

CORRESPONDENCE: Dr. Sanjay Kolte, 35 Balraj Marg, Dhantoli, Nagpur, Maharashtra, 440012, India ().

CITATION: Urotoday Int J. 2011 Jun;4(3):art28. doi: 10.3834/uij.1944-5784.2011.06.02

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; GI, gastrointestinal.

Renal cell carcinoma (RCC) accounts for 2% of all cancers. Although it often results in lung metastasis, bony metastases are uncommon. RCC may not be diagnosed until after it has metastasized because the primary tumor can grow fairly large without creating symptoms such as flank pain or a mass in the abdomen. We report a 38-year-old male who presented with right loin pain typical of ureteric colic. Clear cell RCC was not diagnosed until histological evaluation was completed after a nephrectomy. A bone scan showed widespread skeletal metastasis. Use of bone scans and other diagnostic tests for suspected RCC is discussed.

Daben Dawam, Mohammed S Naseem, Paul Ryan, Eric Boye, Matin Sheriff

Submitted December 3, 2010 - Accepted for Publication January 26, 2011

KEYWORDS: Renal cell cancer; Diagnosis; Bone scan; Treatment

CORRESPONDENCE: Daben Dawam, 8 Hilton Road, Cliffe Woods, Rochester, Kent ME3 8LA, England ().

CITATION: UroToday Int J. 2011 Jun;4(3):art25. doi:10.3834/uij.1944-5784.2011.06.01

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; ECOG, Eastern Cooperative Oncology Group; RCC, renal cell carcinoma.

 

Renal leiomyosarcomas are rare tumors of the kidney, comprising 0.5% to 1.5% of all malignant renal tumors in adults. A 65-year-old male presented with generalized weakness and flank pain in the right lumbar area for the last 8 months. Radiological imaging revealed a heterogeneous mass in the right kidney, with no lymphadenopathy or venous thrombosis. The tumor measured 15 cm at its greatest axis and replaced almost the entire kidney. His metastatic work-up was negative. He underwent right radical nephrectomy. Histopathology revealed spindle-shaped sarcoma; immunohistochemistry confirmed a primary renal leiomyosarcoma. The patient is doing well 1 year after surgery.

Suresh Kumar, Proshan Jeet, Ranjit Kumar Das, Anup Kumar Kundu, Sandeep Gupta

Submitted December 8, 2010 - Accepted for Publication February 27, 2011

KEYWORDS: Renal mass; Radical nephrectomy; Leiomyosarcoma

CORRESPONDENCE: Dr. Suresh Kumar, Department of Urology, Institute of Post Graduate Medical Education and Research, Seth SukhLal Karnani Memorial Hospital, 601, Doctors PG Hostel, 242 AJC Bose Road, Kolkata- 700020, West Bengal, India ().

CITATION: UroToday Int J. 2011 Jun;4(3):art34. doi:10.3834/uij.10.3834/uij.1944-5784.2011.06.05

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; RCC, renal cell carcinoma.

A renal artery pseudoaneurysm (RAP) is created by high-pressure blood passing from a lacerated artery into the renal parenchyma. It has been reported to occur after trauma, renal biopsy, percutaneous nephrostomy, percutaneous nephrolithotomy (PCNL), and open or laparoscopic partial nephrectomy. The incidence of this rare, potentially life-threatening complication is likely to increase with the increasing popularity of endoscopic renal procedures. We present a case of a 60-year-old male who received PCNL for a calculus in the lower calyx of the left kidney. Twenty days after the PCNL, the patient was readmitted due to severe gross hematuria and clot retention. Angiography revealed a pseudoaneurysm arising from the interlobar artery of the lower pole. RAP is often difficult to diagnose and requires a high index of suspicion. We successfully performed coil angiographic embolization, which is considered the most appropriate treatment. Other treatment options are discussed.

Siavash Falahatkar, Hossein Hemmati, Gholamreza Mokhtari, Ahmad Assadollahzadeh, Aliakbar Allahkhah

Submitted January 16, 2011 - Accepted for Publication March 6, 2011

KEYWORDS: Intrarenal; Pseudoaneurysm; Percutaneous nephrolithotomy; Complication; Minimally invasive surgery

CORRESPONDENCE: Dr. Hossein Hemmati, Urology Research Center, Guilan University of Medical Sciences, Sardare Jangal Street, Rasht, Guilan 41448, Islamic Republic of Iran ().

CITATION: UroToday Int J. 2011 Jun;4(3):art36. doi:10.3834/uij.1944-5784.2011.06.07

An appendicular mass was discovered in a 44-year-old female recipient of a living donor kidney at the beginning of the transplant surgery. The donor nephrectomy was put on hold while the mass was explored. A perforated appendix was found and an appendectomy was completed with suture ligation of its stump. Because all infected tissue was eliminated, we proceeded with the kidney transplant. Immunosuppression treatment was tailored to the special circumstances. Only antithymocyte globulin was used until the patient had return of bowel function. She was discharged home on regular triple immunosuppression and doing well at the 6-month follow-up examination. The incidental discovery of an appendicular mass at the time of transplant surgery may not be an absolute contraindication to immediate kidney transplantation, if the patient meets specific selection criteria.

Toufeeq Khan, Mirza Anzar Baig, Abdul Haleem

Submitted January 1, 2011 - Accepted for Publication April 8, 2011

KEYWORDS: Live donor kidney transplantation; Immunosuppression; Appendicular mass; Appendectomy

CORRESPONDENCE: Dr. Taqi F Toufeeq Khan MD FRCS, Riyadh Military Hospital, P.O. Box 7897/624, Riyadh, 11159, Kingdom of Saudi Arabia ().

CITATION: Urotoday Int J. 2011 Jun;4(3):art39. doi:1944-5784.2011.06.09

ABBREVIATIONS AND ACRONYMS: ATG, antithymocyte globulin; DSA, donor-specific antibodies; IG, immune globulin; IV, intravenous; MMF, mycophenolate mofetil; MP, methylprednisone; PE, plasma exchange; WBC, white blood cell.