Volume 4

UIJ Volume 4 2011

Spontaneous Bladder Rupture in a Patient With Adult Ehlers-Danlos Syndrome Without Bladder Diverticulae


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: Case Report With Review of the Literature


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.


The Effect of Voiding Position on Uroflowmetric Parameters in Healthy Young Men


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.


Primary Renal Carcinoid Tumor Presenting as an Unusual Calcific Mass


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 With Bone Metastasis: Case Report of a Missed Diagnosis


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.


Primary Renal Leiomyosarcoma: A Brief Case Report


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.


Intrarenal Pseuodoaneurysm After Percutaneous Nephrolithotomy: A Rare and Important Complication of Minimally Invasive Surgery


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


Incidental Finding of an Appendicular Mass During Surgery In a Living Donor Kidney Recipient: A Case Report


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.


Early Endoscopic Management of Posttraumatic Posterior Urethral Stricture


INTRODUCTION: Some studies of primary realignment of urethral stricture show higher long-term complication rates than those observed in patients treated with delayed repair, but the results are not thoroughly documented. The purpose of this study was to evaluate the results of early endoscopic management of posttraumatic posterior urethral stricture by visual internal urethrotomy (VIU).

METHODS: Participants were 14 males with posterior urethral strictures following a car accident. All patients had partial injuries to the urethra. The strictures were 1-2 cm long. Participant mean age was 21 years (range, 18-26 years). Patients were evaluated by medical history, clinical examination, laboratory investigations, and radiological imaging. VIU was done within 2 weeks of trauma. Follow-up examinations were done at 1, 3, 6, 12, and 24 months after surgery. Outcome measures were flow rates and postoperative complications.

RESULTS: All patients were continent with satisfactory flow rates. One patient had impotence, but his condition was improved at the 6-month follow-up. Other complications included dysuria (n = 5), urinary tract infection (UTI) (n = 2), and urge incontinence associated with UTI (n = 1). After 12 months, 1 patient required surgical intervention due to a decrease in flow rate and recurrence of stricture.

CONCLUSION: Based on this report of 14 patients, early endoscopic urethral realignment surgery is a safe procedure with few complications. Endoscopic restoration of urethral continuity may be considered for early treatment of posttraumatic posterior urethral stricture.

Ahmed Shelbaia

Submitted March 15, 2011 - Accepted for Publication April 8, 2011

KEYWORDS: Stricture posterior urethra; Early management; Visual internal urethrotomy

CORRESPONDENCE: Dr.Ahmed Shelbaia, MD, Borg Elatbaa, Faisal Street, 5th Floor, Flat 5, Giza, Egypt ().

CITATION: UroToday Int J. 2011 Jun;4(3):art43. doi:10.3834/uij.1944-5784.2011.06.13.

ABBREVIATIONS AND ACRONYMS: UTI, urinary tract infection; VIU, visual internal urethrotomy.


Free Uroflow Versus Pressure-Flow Urodynamic Outcomes: Does the Transurethral Catheter Cause a Measurement Artifact?


INTRODUCTION: The effect of a transurethral catheter on urodynamic pressure-flow studies has been questioned, especially for patients with bladder outlet obstruction (BOO). The purpose of this retrospective study was to compare urodynamic outcomes measured during free uroflowmetry with pressure-flow studies using a transurethral catheter.

METHODS: We retrospectively reviewed the records of 22 adult patients who had voided volume that did not differ by more than 20% during 2 assessments: free uroflow and pressure-flow with a transurethral 5 Fr catheter in situ. The outcome measures were maximum flow (Qmax), average flow rate, voiding time, time to Qmax, and flow acceleration. Free uroflow and pressure-flow outcomes were compared using paired t tests. A Bonferroni adjustment was applied; probability < .01 was considered statistically significant.

RESULTS: There were 17 males and 5 females. The mean age was 39.9 years (range, 18-80 years). The urodynamic findings were reported as: normal (n = 6), hypocontractile detrusor (n = 5), BOO (n = 5), overactive bladder symptom complex (n = 4), and low pressure-low flow system (n = 2). Qmax was significantly higher during free uroflow than during pressure-flow recordings (P = .001). Average flow rate was also significantly higher during free uroflow (P < .001). Voiding time was significantly slower and acceleration was significantly faster during free uroflow (both with P = .001). There was no significant difference between recording conditions in the time to Qmax.

CONCLUSION: There appears to be a significant decrease in some uroflow measurements with a 5 Fr urethral catheter in situ during pressure-flow studies, which is contrary to the previous claim that any catheter smaller than 6 Fr does not alter the results. This measurement artifact needs to be considered when interpreting urodynamic studies, particularly if the patient has BOO. To compensate for differences between the free uroflow rate and uroflow rate with a catheter, the free uroflow rate and detrusor pressure may need to be considered when evaluating the degree of BOO.

Gajanan S Bhat, Girish G Nelivigi, Chandrashekhar S Ratkal, Venkatesh G K

Submitted February 19, 2011 - Accepted for Publication March 10, 2011

KEYWORDS: Bladder outlet obstruction; Urodynamics

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):art37. doi:10.3834/uij.1944-5784.2011.06.08

ABBREVIATIONS AND ACRONYMS: BOO, bladder outlet obstruction; Pdet, detrusor pressure; Qmax, maximum flow.


Giant Hydronephrosis Due to Congenital Ureteropelvic Junction Obstruction


Giant hydronephrosis caused by congenital ureteropelvic junction obstruction is very rare, particularly now that imaging techniques are more widely available. We introduce a 16-year-old boy who presented with abdominal pain and distention. He had a cystic mass in the central and right side of the retroperitoneum that filled the space from the right subdiaphragmatic area superiorly to the pelvis inferiorly. It measured 35 cm x 23 cm x 20 cm. His pelvic capacity was 8050 mL. The parenchyma of the right kidney was not observed; the left parenchyma was normal. We performed a right thoracoabdominal nephrectomy. Early diagnosis is essential to the prevention of this disorder.

Volkan Bulut, Gökhan Koç, Ali Feyzullah Sahin, Yavuz Balaban, Isık Hasan Özgü

Submitted February 2, 2011 - Accepted for Publication April 8, 2011

KEYWORDS: Giant hydronephrosis; Ureteropelvic junction

CORRESPONDENCE: Dr. Volkan Bulut, Urology Department, Tepecik Training and Research Hospital, gaziler cad., Izmir, 35010, Turkey ().

CITATION: UroToday Int J. 2011 Jun;4(3):art41. doi:10.3834/uij.1944-5784.2011.06.11

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; UPJ, ureteropelvic junction; VUCA 19-9, voided urine carbohydrate antigen 19-9.


Prevalence of Acquired Renal Cystic Disease in Patients With End-Stage Renal Disease Receiving Hemodialysis


INTRODUCTION: The effect of hemodialysis on acquired cystic renal disease (ARCD) in patients with end-stage renal disease (ESRD) is not fully understood. The purpose of the study was to determine the prevalence of ARCD in patients with ESRD from our institution and to investigate the relationship between ARCD and the duration of hemodialysis.

METHODS: This prospective cross-sectional study was conducted between August 2008 and August 2009. We evaluated a total of 410 patients with ESRD; 182 patients were still undergoing hemodialysis at the end of the study period and 228 patients had hemodialysis followed by renal transplantation. Patients with autosomal dominant polycystic kidney disease were excluded. Patients had renal sonography evaluations before and during hemodialysis. Chi-square was used to compare the categorical distribution of the total number of patients with ESRD with the subset of patients with ARCD for the outcome measures of age, sex, duration of hemodialysis, and causes of ESRD.

RESULTS: A total of 34 cases were excluded due to lack of cooperation. From the remaining 376 patients, 31 (8.2%) had ARCD, 80 (21.3%) had a simple renal cyst, and the remaining 265 (70.5%) had noncystic ESRD. The mean age was 45 years (SD = 17; range, 10-85 years). The largest percentage of the total population of patients with ESRD was 20-39 years old; the largest percentage of patients with ARCD was > 60 years old (P < .001). There was no significant difference in the sex distribution of the total group and the subset of patients with ARCD. The mean duration of hemodialysis for all patients in the study was 27 months (SD = 14; range, 1 month to 17 years). Most of the total population of patients with ESRD were on dialysis for < 1 year; most patients with ARCD were on dialysis for > 5 years (P < .001). The majority of both the total number of patients and the patients with ARCD had hypertension or hypertension plus diabetes mellitus.

CONCLUSION: Patients who are on long-term hemodialysis should be monitored for the development of ARCD.

Gholamreza Mokhtari, Homa Karami, Atefeh Ghanbari, Ahmad Enshaei

Submitted February 13, 2011 - Accepted for Publication April 8, 2011

KEYWORDS: Chronic renal failure; End-stage renal disease; Hemodialysis; Acquired kidney cyst

CORRESPONDENCE: Homa Karami MD, 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):art42. doi:10.3834/uij.1944-5784.2011.06.12

ABBREVIATIONS AND ACRONYMS: ARCD, acquired cystic renal disease; CT, computed tomography; ESRD, end-stage renal disease.


Laparoscopic Surgery in a Patient With Bilateral Adrenal Myelolipoma


Adrenal myelolipoma is a rare benign adrenal tumor composed of adipose tissue and hematopoietic elements. Myelolipomas are often asymptomatic. The preferred diagnostic imaging modality is computed tomography (CT), which shows focal fatty density within the mass. Surgical intervention is recommended if the mass is larger than 5 cm. A 52-year-old female patient was referred for chronic dull abdominal pain. CT demonstrated left side (6.5 cm x 7 cm) and right side (1 cm x 2.5 cm) well-outlined adrenal masses with a fat density in the suprarenal regions. They were hormonally nonfunctional. The patient underwent laparoscopic left adrenalectomy. The right mass was left intact because of its small size. There were no complications. Histopathological examination revealed myelolipoma. Laparoscopic adrenalectomy can be a safe and effective treatment for select cases.

Siavash Falahatkar, Ahmad Enshaei, Samaneh Esmaeili, Amin Afsharimoghaddam

Submitted January 31, 2011 - Accepted for Publication April 8, 2011

KEYWORDS: Myelolipoma; Adrenal; Laparoscopy

CORRESPONDENCE: Dr. Ahmad Enshaei, 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):art40. doi:10.3834/uij.1944-5784.2011.06.10

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; ML, myelolipoma; MRI, magnetic resonance image; US, ultrasound.


Safety and Efficacy of the Ophira Mini-Sling System: One Year Follow-Up From a Multicenter International Clinical Trial


INTRODUCTION: The Ophira mini-sling system (Promedon; Cordoba, Argentina) 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. It minimizes surgical trauma and enables an outpatient procedure. First-year follow-up results are reported.

METHODS: The study was a prospective clinical trial conducted from February 2008 to March 2010. Participants were 149 female patients with stress urinary incontinence from Brazil and Argentina. Their mean age was 53.9 years (SD = 9.5; range, 36-71 years). All patients received a medical history, physical examination, stress test, standardized 1-hour pad test, and urodynamic study. Patients also completed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and Urogenital Distress Inventory (UDI-6). All underwent treatment with the Ophira mini-sling system. The procedure was conducted under local (73%), general (18%), or regional anesthesia (9%). A vertical 1 cm long vaginal incision was performed at 1 cm from the urethral meatus to deliver the prosthesis. Patients repeated the presurgical tests at 1, 3, 6, and 12 months after surgery. Outcome measures were postvoid residual volume, pad and stress test results, ICIQ-SF and UDI-6 scores, and complications. Means and standard deviations were calculated and tabled.

RESULTS: The mean (SD) operative time was 12.6 (7.4) minutes. One patient receiving the procedure under local anesthesia had severe intraoperative pain and needed intravenous sedation. Severe bleeding and technical problems with the device were not observed. The mean follow-up was 9 months; 91 patients had 12 months of follow-up evaluations. Postvoid residual volumes were variable across time. Pad tests showed less urine leakage after surgery. The percentage of patients with a positive stress test dramatically decreased after surgery. ICIQ-SF and UDI-6 scores also decreased. Major complications were not observed. Minor complications were mesh exposure (n = 3), urinary retention (n = 3), urinary tract infection (n = 8), and de novo urge incontinence (n = 7).

CONCLUSIONS: The Ophira mini-sling system appears to be an effective, minimally invasive option for the treatment of stress urinary incontinence.

Paulo Palma, Cassio Riccetto, Rodrigo Castro, Sebastian Altuna, Viviane Herrmann, Ricardo Miyaoka

Submitted March 18, 2011 - Accepted for Publication April 6, 2011

KEYWORDS: Female urinary incontinence; Treatment; Minimally invasive surgery; Mini-sling

CORRESPONDENCE: Dr. Ricardo Miyaoka, Rua Durval Cardoso, 172, Jardim Guarani, Campinas, Sao Paulo, Brazil ().

CITATION: Urotoday Int J. 2011 Jun;4(3):art44. doi:10.3834/uij.1944-5784.2011.06.14.

ABBREVIATIONS AND ACRONYMS: ICIQ-SF, International Consultation on Incontinence Questionnaire-Short Form; SUI, stress urinary incontinence; TOT, transobturator tape; TVT-S, tension-free vaginal tape-Secur; UDI-6, Urogenital Distress Inventory; UTI, urinary tract infection.


Letter from the Editor - April 2011

Dear Colleagues,

This is the second issue of the UIJ being delivered on our new platform. One significant goal in this upgrade is supporting the continuous international readership growth. The UIJ is now read in over 190 countries and territories around the globe with an individual subscriber base of over 29,000 healthcare providers and researchers.

Also new in this month is the CME activity available exclusively from the UIJ, Frequently Asked Questions in the Management of Castrate-Resistant Prostate Cancer (CRPC), an expert panel interview. The faculty includes Pamela I. Ellsworth, MD, FACS, Program Chair, Associate Professor of Surgery Division of Urology The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA. Christopher P. Evans, MD, FACS Professor and Chairman Department of Urology University of California, Davis School of Medicine, Sacramento, California, USA and Fred Saad, MD, FRCS Professor and Chairman of Urology Director of Urologic Oncology University of Montreal Endowed Chair in Prostate Cancer University of Montreal Faculty of Medicine Montreal, Canada.

In the current issue, Aggarwal et al. discuss the problems inherent in using a manual paper database system to monitor ureteric stent placement and removal. Their results showed that stent removal documentation was not completed in over one third of 379 stent procedures, and follow-up revealed that 22.4% of the stents exceeded the 6-month maximum indwelling time recommended by the stent manufacturers. The authors review literature showing similar findings from other centers and discuss the advantages of automated electronic follow-up systems.

Krongrad and Lai describe preliminary results of an ongoing clinical trial. Six patients with severely symptomatic chronic prostatitis were treated with a laparoscopic prostatectomy and followed for 1 year. The patients were selected from among those who had failed every previous medical, surgical, and complementary treatment. All patients reported resolution of their symptoms following surgery. This protocol is approved by the Western Institutional Review Board and the study is listed on the searchable National Institutes of Health clinical trials Web site. It may be considered controversial by some readers and the authors acknowledge that it requires further validation. However, their results indicate that this procedure may be an option for some carefully selected patients.

Finally, the case report by Laryngakis et al. provides insight into the cause of exercise-induced hematuria. The authors used cystoscopy to evaluate a 54-year-old marathon runner with painless gross hematuria. Results revealed multiple erythematous lesions of the bladder that were associated with a small filling defect of the left posterior bladder wall. They also found submucosal hemorrhages and a shaggy prostatic urethral mucosa. The authors recommend a complete work-up (cytology, cystoscopy, upper tract evaluation) for any patient with this disorder.



Karl-Erik Andersson


Renal Failure Secondary to Transurethral Resection of Bladder Tumors at the Ureteric Orifice: A Serious, Poorly Known Complication


We report a case of severe bilateral distal ureteral stenosis in a 76-year-old male. The stenosis was caused obstructive renal failure after transurethral resection of a periorificial bladder tumor and early postoperative bacillus Calmette-Guerin therapy instillation to prevent recurrence.

Sataa Sallami, Sami Ben Rhouma. Ali Horchani

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

Submitted November 5, 2010 - Accepted for Publication December 11, 2010

KEYWORDS: Ureter; Bladder neoplasms; Postoperative complications; Endoscopy.

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

CITATION: UroToday Int J. 2011 Apr;4(2):art8. doi:10.3834/uij.1944-5784.2011.02.08

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; TURBT, transurethral resection of bladder tumor.



Prognostic Value of the Anatomical Location of Upper Urinary Tract Urothelial Carcinoma


INTRODUCTION: The prognostic significance of pyelum versus ureteral urothelial carcinomas is controversial. The objective of the study was to evaluate the prognostic value of the anatomical location of transitional cell carcinoma (TCC) in the upper urinary tract.

METHODS: We retrospectively analyzed data from 51 patients with upper urinary tract TCC (UTTCC) from a single institute. Patients were treated surgically between 1995 and 2007. Tumor location and other clinicopathological variables were evaluated regarding cancer recurrence and survival. Recurrence and cancer-specific survival probabilities following tumor resection were analyzed using the Kaplan-Meier method and log rank test. Univariate and multivariate analyses were performed using Cox proportional hazards regression model.

RESULTS: Mean patient age was 69.5 years (range, 25-87 years); median follow-up was 43.8 months (range, 37-142 months). TCCs were in the pyeleum or the calyx (n = 33), the ureter (n = 9), and in both locations (n = 9). There was no significant difference between the number of patients with transmural tumor growth (pT3-pT4) in the proximal ureter or pyelum (41%) when compared with distally located tumors (18.2 %) (P = .30). The majority of the patients (67%) had pT2 or pT3 primary tumors. None of the patients with Ta/cis, T1, or T2 primary tumors had nodal or distant metastatic disease, either initially or during follow-up. Median overall and disease-specific survivals were 37.9 months and 40.1 months, respectively. The repartition of tumor stage and grade was similar in the pyelum pelvis and the distal ureter (P = .06 and P = .46, respectively). The tumor location did not significantly affect the 3-year bladder recurrence rate (P = 0.83). The disease-specific survival rates were 88.2% for patients with tumors in both the pyelum and distal ureter locations. There was no significant impact of UTTCC location on 3-year survival.

CONCLUSION: Tumor location does not appear to be an independent prognostic factor for patients with UTTCC. Patients with pyelum or distal ureter TCC with the same tumor grade and stage had the same risk of bladder cancer recurrence and survival. We recommend the same surveillance protocol regardless of the tumor location.

Sataa Sallami,1 Sami Ben Rhouma,1 Karim Cherif,1 Nidhameddine Kchir,2 Ali Horchani1

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

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

Submitted November 5, 2010 - Accepted for Publication December 6, 2010

KEYWORDS: Upper urinary tract; Transitional cell carcinoma; Prognosis; Recurrence; Survival rate.

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

CITATION: UroToday Int J. 2011 Apr;4(2):art10. doi:10.3834/uij.1944-5784.2011.02.10

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; TCC, transitional cell carcinoma; UTTCC, upper urinary tract transitional cell carcinoma.



Differential Diagnosis and Management of Megacalyces (Puigvert's Disease): A Case Report


Megacalyces is a rare congenital urinary anomaly consisting of nonobstructive dilated calyces. The renal pelvis and ureter have a normal caliber. We report an asymptomatic unilateral megacalyces in a 22-year-old woman. She had an increased number of dilated calyces on the right kidney and a cluster of small calculi over the lower pole. The largest stone in the lower calyx was 5 mm. The renal pelvis and ureter were normal and there was no evidence of obstruction. In the absence of functional symptoms and because of the small urinary stone size, we decided on surveillance. A follow-up examination 22 months later showed that the patient is still asymptomatic and the stone sizes are unchanged. We discuss literature related to the clinical features, differential diagnosis, and management of this condition.

Sataa Sallami, Adel Dahmani, Sami Ben Rhouma, Sabeur Rebii, Ali Horchani

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

Submitted November 10, 2010 - Accepted for Publication December 11, 2010

KEYWORDS: Malformation; Congenital; Renal abnormalities; Calyx; Megacalices.

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

CITATION: UroToday Int J. 2011 Apr;4(2):art13. doi:10.3834/uij.1944-5784.2011.02.13

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; IVU, intravenous urography.



Urethral Leiomyoma in Females: Report of 3 Cases


Urethral leiomyomas are rare benign tumors arising from the smooth muscle of the urethra. We describe 3 female patients aged 40, 38, and 35 years, respectively. Each presented with a mass protruding from the urethral meatus. Other characteristics included urethral bleeding, dysuria, and dyspareunia. There were no reports of obstructive voiding. We explain the procedures needed for differential diagnosis. All patients underwent transvaginal excision of the mass and were free of recurrence at the 2- or 3-year follow-up. Related literature is reviewed.

Siddalingeshwar Ishwarappa Neeli, Sharanbasavesh B Alur, Suresh U Kadli, Pravin B Patne

Department of Urology, KLE University, J.N. Medical College, Belgaum, Karnatak, India

KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belgaum, Karnatak, India

Submitted November 17, 2010 - Accepted for Publication January 19, 2011

KEYWORDS: Female urethra; Leiomyoma; Urethral tumor; Spindle cell neoplasm.

CORRESPONDENCE: Dr. Siddalingeshwar Neeli, Associate Professor & Consultant Urologist, Department of Urology, KLE University's J. N. Medical College and KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belgaum-590010, India ().

CITATION: UroToday Int J. 2011 Apr;4(2):art24. doi:10.3834/uij.1944-5784.2011.04.06

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; MRI, magnetic resonance image.



Runner’s Bladder: Exercise-Induced Hematuria With Lower Urinary Tract Pathology


Exercise-induced hematuria is an uncommon clinical entity experienced by long-distance runners and participants in other sports. The source and mechanism of bleeding have been debated. We explain the pathology in a 54-year-old male using cytoscopic evidence. The patient had multiple episodes of painless gross hematuria that occurred immediately after long-distance running. Cystoscopy performed 3 days after an episode revealed multiple erythematous lesions of the posterior bladder wall and prostatic urethra. There was shaggy prostatic urethral mucosa. After a 2-week period without long-distance running, repeat cystoscopy revealed nearly complete resolution of the bladder and prostatatic urethral lesions. Transurethral bladder and prostatic urethral biopsies identified no malignancy or dysplasia. This is one of the few known cases of exercise-induced gross hematuria with evidence of bladder and prostatic abnormalities on cystoscopy. A complete work-up for gross hematuria must be performed to avoid missing an underlying abnormality that presents incidentally or secondary to exertion.

Nicholas A Laryngakis,1 Scott R Caesar,1 Jeffrey S Berns,2 Alan J Wein1

1 Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

2 Renal-Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Submitted November 16, 2010 - Accepted for Publication January, 6, 2011

KEYWORDS: Hematuria; Runner's bladder; Cystoscopy; Bladder injury; Urothelium; Cystitis cystica.

CORRESPONDENCE: Scott R. Caesar, M.D, Resident, Division of Urology, Department of Surgery, University of Pennsylvania Health System, 3400 Civic Center Blvd, 3rd Floor, West Pavilion, Rm 3-333W, Perelman Center for Advance Medicine, Philadelphia, PA 19104 USA ().

CITATION: UroToday Int J. 2011 Apr;4(2):art19. doi:10.3834/uij.1944-5784.2011.04.01

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; FISH, fluorescence in situ hybridization.



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