Volume 4

UIJ Volume 4 2011

Clean Intermittent Catheterization Following Urethral Stricture Surgery Using a Low Friction Catheter Versus Conventional Plastic Catheter: A Prospective, Randomized Trial


INTRODUCTION: The purpose of the study was to compare clean intermittent catheterization (CIC) after endoscopic urethrotomy for urethral stricture (US) using a low-friction hydrophilic catheter or standard Nelaton polyvinyl chloridePVC) catheter in a randomized study. Patient satisfaction, complications, and US recurrence were determined.

METHODS: This was a prospective, randomized, parallel group, unicenter study conducted between August 2005 and February 2008. Patients had a unique US that was < 2 cm in length with low or moderate spongiofibrosis. A total of 62 male patients were randomized into 2 treatment groups using LoFric (Astra Tech; Molndal, Sweden) or standard plastic catheters. Catheters were inserted into the bladder via the urethra and immediately removed. The procedure was performed twice a month for 3 months and then monthly for 1 year. Follow-up lasted 24 months. Patient perception of ease, pain, and comfort of CIC was scored with a questionnaire; success rates and adverse events were documented.

RESULTS: The median age at the time of treatment was 61.46 years (range, 21-86 years). The two groups were demographically comparable. The LoFric catheter was more comfortable (P = .02) with less pain at insertion (P = .002) than the conventional catheter. Patients were more satisfied with the hydrophilic catheter (P = .003). There were no significant differences in ratings of convenience. There were no significant group differences in complications. Within the first 2 years, 2 patients in the group using the LoFric catheter and 7 patients in the group using the conventional catheter developed urethral stricture. A life-table analysis did not show a significant group difference in the outcome (P = .15).

CONCLUSIONS: CIC is a safe and efficient method of reducing the frequency of urethral stricture recurrence after internal urethrotomy. The Lofric catheter significantly increased the degree of comfort and satisfaction and decreased the feeling of pain when the catheter was removed or inserted, when compared with a conventional PVC catheter. Complication and recurrent rates were comparable between groups. Thus, low-friction catheters may prevent US recurrences with better quality of life.

KEYWORDS: Urethral stricture; Internal urethrotomy; Clean intermittent catheterization; Hydrophilic-coated catheter.

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

CITATION: Urotoday Int J. 2011 Feb;4(1):art7. doi:10.3834/uij.1944-5784.2011.04.07

ABBREVIATIONS AND ACRONYMS: CIC, clean intermittent catheterization; PVC, polyvinyl chloride; US, urethral stricture.


Surgical Management of the Fractured Penis: 10 Years of Experience


INTRODUCTION:The erect penis is very vulnerable to blunt trauma, which is mostly sustained during sexual intercourse or through vigorous manipulations during masturbation or other violent sexual activities. These actions may lead to a fracture of the penis. The purpose of this retrospective study is to review the effect of early surgical exploration and repair of penile fractures and to report the overall healing of these injuries and the patient's ability to regain erectile function.

METHODS: A total of 20 patients presented with a fractured penis between October 1999 and November 2009. Their mean age was 27 years (range, 16-48 years). All were managed with surgical repair within 24 hours of the injury by the same surgeon (HA). Postoperative follow-up occurred monthly up to 6 months. The outcome measures were: (1) patient satisfaction with the cosmetic results, and (2) patient satisfaction with erectile function, as determined by the International Index of Erectile Function (IIEF). Complications during the follow-up period were summarized.

RESULTS: All 20 patients had successful wound healing, although 4 patients who were HIV-positive developed superficial wound infections that were treated by antibiotics. All patients reported normal psychogenic response, nocturnal erection, and full sexual activity at 3 months after surgery. The mean IIEF score was 23.5 out of a total 25 points (range, 22-25).

CONCLUSION: A fractured penis is a urological emergency that is best treated with immediate surgical exploration and repair of the tunica albuginea and any associated injuries. Surgical repair minimizes the incidence of erectile dysfunction.

Hassan Ashmawy

Department of Urology, Mpilo Central Hospital, Bulawayo, Zimbabwe

Submitted November 4, 2010 - Accepted for Publication November 30, 2010

KEYWORDS: Fractured penis; Urethral injury; Erectile dysfunction; Surgical management.

CORRESPONDENCE: Hassan Mahmoud Ashmawy, Consultant Urologist, Mpilo Central Hospital, Senior Lecturer School of Medicine, National University of Science and Technology (NUST), P. O. Box 3682, Bulawayo, Zimbabwe ().

CITATION: UroToday Int J. 2011 Feb;4(1):art4. doi:10.3834/uij.1944-5784.2011.02.04

ABBREVIATIONS AND ACRONYMS: HIV, human immunodeficiency virus; IIEF, International Index of Erectile Function.



Safety and Efficacy of the Solyx Single-Incision Sling for the Treatment of Stress Urinary Incontinence: Preliminary Results


INTRODUCTION: The objective of this study was to assess the short-term safety and efficacy of the Solyx single-incision sling (Boston Scientific Corp; Natick, MA, USA).

METHODS: A prospective study of 21 women with stress urinary incontinence (SUI) and no evidence of detrusor instability was conducted at 2 medical centers between July 2009 and March 2010. All patients underwent preoperative urodynamic testing and had urethral hypermobility. Patients with recurrent SUI or fixed urethras were excluded. All participants had surgery with the Solyx sling. Outcome measures were device-related adverse events, sling efficacy (based on a standing cough stress test at a fill volume of 300 mL, measured at postoperative week 12), and sling tolerability (based on Urogenital Distress Inventory, version 6 [UDI-6] and Incontinence-Quality of Life [I-QOL] questionnaire results at postoperative weeks 6 and 12). Satisfaction with surgery was also assessed with a rating scale.

RESULTS: Mean patient age was 60.2 years (range, 39-82 years). All sling procedures took < 10 minutes to perform and had blood loss of < 60 mL. A total of 10 patients had concomitant procedures. Nineteen of the 21 patients completed the study with a mean follow-up of 13.68 weeks (range, 8.71-18.86 weeks). There were no intraoperative or postoperative complications. Twelve weeks after surgery, 18/19 patients had a negative standing cough stress test and were no longer wearing pads. One patient developed de novo urgency and had resolution of her symptoms with anticholinergic medication. There were no differences in the success rates of the patients who underwent slings alone versus those that had concomitant surgery. I-QOL and UDI-6 mean preoperative scores differed significantly from both the 6-week and 12-week mean postoperative scores (both with P <.0001); there was no significant difference in mean scores at 6 and 12 weeks. Nineteen patients reported satisfaction with their surgical outcomes 12 weeks after surgery (5/19 completely satisfied, 10/19 very satisfied, 3/19 satisfied, 1/19 somewhat satisfied, 0/19 not satisfied).

CONCLUSION: Preliminary evidence suggests that the Solyx SIS is a safe and effective treatment for SUI.

Scott Serels,1 Sandy B Nosseir,2 Lawrence R Lind,2 Harvey A Winkler2

1 Bladder Control Center of Norwalk and Section of Urogynecology, Norwalk Hospital, Norwalk, CT, USA

2 Division of Urogynecology: Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, North Shore-Long Island Jewish Hospital, Great Neck, NY, USA

Submitted November 20, 2010 - Accepted for Publication December 6, 2010

KEYWORDS: Single incision sling; Stress urinary incontinence.

CORRESPONDENCE: Scott Serels, MD, 12 Elmcrest Terrace, Norwalk, CT 06850 ().

CITATION: Urotoday Int J. 2011 Feb;4(1):art5. doi:110.3834/uij.1944-5784.2011.02.05

ABBREVIATIONS AND ACRONYMS: I-QOL, Incontinence-Quality of Life; SIS, single-incision sling; SUI, stress urinary incontinence; TFS, tissue fixation system; TVT, tension-free vaginal tape; UDI-6, Urogenital Distress Inventory, version 6.



Renal Artery Pseudoaneurysm After Open Partial Nephrectomy


Nephron-sparing surgery has become the standard of care for renal masses that are < 4 cm in size. A renal artery pseudoaneurysm (RAP) following nephron-sparing surgery is a rare but well-documented complication. The most common presenting symptom is hematuria, but bleeding is not universal and differential diagnosis is essential to successful treatment. A high index of suspicion and proper imaging tests aid diagnosis. The present 34-year-old male demonstrates an unusual presentation of RAP following nephron-sparing surgery with no evidence of hematuria. In recent years, percutaneous selective arterial embolization has emerged as a simple and effective modality for managing RAPs in hemodynamically stable patients.

Kapil Singla, Sistla B Viswaroop, Myilswamy Arul, Ganesh Gopalakrishnan, Sangam V Kandasami

Department of Urology, Vedanayagam Hospital and Postgraduate Institute, Coimbatore, India

Submitted November 6, 2010 - Accepted for Publication November 21, 2010

KEYWORDS: Pseudoaneurysm; Angioembolization; Partial nephrectomy.

CORRESPONDENCE: Dr. Ganesh Gopalakrishnan, Consultant Urologist, Vedanayagam Hospital, R S Puram, Coimbatore, India ().

CITATION: UroToday Int J. 2011 Feb;4(1):art1. doi:10.3834/uij.1944-5784.2011.02.01

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; RAP, renal artery pseudoaneurysm.



Impact of Inguinal Varicocele Ligation on Testicular Volume, Sperm Parameters, and Pregnancy Rates


INTRODUCTION: The purpose of this prospective investigation was to study the impact of inguinal varicocele ligation on testicular volume, sperm parameters, and pregnancy rates before and after varicocelectomy.

METHODS: Participants were an experimental group of 50 infertile men with a mean age of 29.6 years (range, 23-36 years) and a comparison group of 50 age-matched, healthy fertile men. All infertile men had a clinical left grade 2 or grade 3 varicocele. Each participant received the same baseline tests of clinical examination, semen analysis, and scrotal ultrasonography. Tests were repeated 3 and 6 months after inguinal varicocele repair for patients in the experimental group. Outcome measures were semen parameters, testicular volumes, percentage of volume difference between the right and left testicles, and pregnancy rates. The t test was used to compare the baseline measures of the 2 groups. A Freidman repeated measures analysis of variance was performed to compare the results of the experimental group at baseline and at 3 months and 6 months after surgery. Comparison group baseline data were also compared with the experimental group data at 6 months.

RESULTS: Participants in the experimental group had significantly lower baseline mean sperm concentration and sperm motility and higher mean testicular volume differences than the participants in the comparison group (all with P < .0001); there was no significant group difference in baseline mean semen volume. Varicocele ligation resulted in significantly increased mean sperm concentration and motility and significantly decreased mean testicular volumes 3 months and 6 months after surgery (all with P < .0001). There was no significant change in semen volume. Sperm concentration and sperm motility reached near-normal levels following surgery, but patients continued to have significantly larger mean testicular volume differences than those of the comparison group. Mean right and left testicular volume difference was significantly correlated with mean sperm motility 6 months postoperatively (Pearson r = -0.365; P = .009), but not significantly correlated with sperm concentration or semen volume. The partners of 24 patients (48%) were pregnant 6 months postoperatively.

CONCLUSION: Varicocele ligation improves ipsilateral testicular volume loss, semen profile, and pregnancy rates.

Mostafa A Mohamed, Mohamed G ElShiekh, Hany M ElFayoumy, Amr S Fayad, Ibrahim F Hussein, AbdelRahim E Hegazy

Department of Urology, Kasr AlAini Hospital, Cairo University, Cairo, Egypt

Submitted September 28, 2010 - Accepted for Publication November 19, 2010

KEYWORDS: Varicocele; Pregnancy rates; Semen parameters; Testicular volume.

CORRESPONDENCE: Dr. Hany M. ElFayoumy, MD, MRCS, FEBU, Lecturer of Urology, Kasr Al-Aini Hospitals, Cairo University, Egypt ().

CITATION: Urotoday Int J. 2011 Feb;4(1):art2. doi:10.3834/uij.1944-5784.2011.02.02

ABBREVIATIONS AND ACRONYMS: TV, testicular volume; WHO, World Health Organization.



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