Issue 1: February 2011

UIJ Volume 4 Issue 1 2011

Letter from the Editor - February 2011

Dear Colleagues:

This, our first issue of 2011 is being published on the new UroToday International Journal on-line portal, which connects the global urology community to one of the most extensive urological collections freely available and always accessible on line. This proprietary platform creates an easy user interface, developed in consultation with UroToday readers, providing intuitive navigation and fast access to our on-line content.

In the current issue, Kollmeier and Bochner present results of a study that was conducted at Memorial Sloan-Kettering Cancer Center. They placed Visicoil linear fiducial markers (Core Oncology; Santa Barbara, CA, USA) into the bladder wall to counteract the effects of organ motion during radiation therapy for patients with bladder cancer. Their positive results indicate that such markers may help to improve the accuracy of radiation therapy.

Vijay et al investigated the effects of intraperitoneal or extraperitoneal carbon dioxide insufflation on 13 measures of cardiopulmonary and immunological response during urological laparoscopic surgery (N = 40). Although the mean intraoperative pO2 was significantly reduced from baseline, the results showed that CO2 insufflation had minimal effect on these otherwise-healthy patients.

Two of the current studies assess male infertility. Hussein et al compared the semen of 50 smokers with 50 nonsmokers and found that smoking had significant negative effects on some semen parameters, particularly sperm motility. Mohamed et al studied the impact of inguinal varicocele ligation on testicular volume, sperm parameters, and pregnancy rates before and after varicocelectomy in 50 infertile men. Three- and 6-months after varicocele ligation, ipsilateral mean sperm concentration and motility were significantly increased and mean testicular volume was significantly decreased. The partners of 24 patients (48%) were pregnant 6 months following surgery.

Trospium chloride has been studied for use in pediatric patients with idiopathic or neurogenic detrusor overactivity. Bürst and Wolf provide a synopsis of studies that have been reported in the literature.

Finally, Wu et al describe their experience using laparoscopic surgery for a patient with paraganglioma. Open partial cystectomy is typically used to treat these uncommon neoplasms because there is multilayer involvement of the bladder wall and concern about intraoperative hypertensive crisis. The authors describe their treatment procedure and share the outcomes.

With this issue, we announce the 2011 Editorial Board. I offer my sincere thanks to the previous and current board members and to all of the reviewers who share their expertise and assist us in publishing this journal. We welcome your continued submission of manuscripts and look forward to a productive new year.

Karl-Erik Andersson

Uropathogens Causing Urinary Tract Infections in Females and Their Susceptibility to Antibiotics


INTRODUCTION: Understanding the uropathogens causing urinary tract infection (UTI) and their susceptibility to antibiotics is important to physicians who are choosing antibiotic therapy. The purpose of the study was to evaluate the uropathogens causing UTI and their antibiotic susceptibility in females residing in Saudi Arabia.

METHODS: The participants were 150 females with UTI that was proven by culture and sensitivity tests. Their mean age was 32 years (SD, 2.4; range, 6-55). There were 8 children and 142 adults. Of the adults, 92 patients were not pregnant and 50 were pregnant. All patients were treated with antimicrobials; the most common was fluoroquinolone for patients who were not pregnant and third-generation cephalosporin for patients who were pregnant. The distribution of uropathogens was compiled. Antimicrobial sensitivity testing was completed for each antibiotic administered.

RESULTS: The majority of UTIs occurred in the lower urinary tract for all patients. Escherichia coli was the most common pathogen, occurring in 52% of the patients who were pregnant and 53% of the patients who were not pregnant. Klebsiella was the second most commonly occurring pathogen, occurring in 15% and 16% of the patients who were not pregnant and pregnant, respectively. In females who were not pregnant, Pseudomonas and Staphylococcus aureus were also relatively common; in females who were pregnant, Staphylococcus epidermidis and nonhemolytic Streptococcus were more frequently found. The antibiotic susceptibility for E. coli ranged from 97% for fluoroquinolone to 48% for cefaclor; nitrofurantion was also high at 96%. Klebsiella had the highest response to gentamicin (80%).

CONCLUSION: E. coli was the most frequently isolated uropathogen in females with UTI, followed by other Gram-negative bacteria. There were some differences in the types of pathogens when compared with previous literature. These may be due to variations in geographic location, patient characteristics, or treatment methodology. Susceptibility rates are essential for determining the most sensitive antimicrobial for the causative organism.

Tarek A Salem,1 Mohamed H El-Azab2

1 Urology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Submitted November 13, 2010 - Accepted for Publication December 17, 2010

KEYWORDS: Urinary Tract infection; Uropathogen; Antimicrobial.

CORRESPONDENCE: Dr. Tarek Salem, Department of Urology, Suez Canal University, Faculty of Medicine, Ismailia 31911, Egypt ().

CITATION: UroToday Int J. 2011 Feb;4(1):art15. doi:10.3834/uij.1944-5784.2011.02.15

ABBREVIATIONS AND ACRONYMS: AMC, amoxicillin-clavulanic acid; E. coli, Escherichia coli; IV, intravenous; TMX, trimethoprim-sulfamethoxazole; UTI, urinary tract infection.



Effect of Tobacco Smoking on Semen Quality in Men With Subfertility


INTRODUCTION: Smoking is considered a risk factor for male infertility, but studies have not shown a conclusive reduction in fertility associated with paternal smoking. The aim of the present study was to investigate the effects of smoking cigarette or shisha tobacco on semen parameters in men with subfertility.

METHODS: This was a prospective study of 100 patients with subfertility. There were 50 smokers with mean (SD) age of 37.1 (8.3) years and 50 nonsmokers with a mean age of 39.5 (9.0) years. The outcome measures were sperm abnormal forms (%), sperm count (M/mL), semen volume (mL), sperm motility (%), duration of infertility, and type, amount, and duration of smoking. Group differences (smoker vs nonsmoker and cigarette vs shisha) in semen volume and sperm parameters were analyzed with t tests. Pearson correlations were calculated to determine the association between smoking index and smoking duration and the semen parameters.

RESULTS: When compared with nonsmokers, the smokers had a significantly higher mean percentage of abnormal sperm forms (92.3 % vs 89.4%) (P < .01), a significantly lower mean sperm count (20.6 M/mL vs 44.9 M/mL), a significantly lower mean semen volume (2.01 mL vs 2.52 mL), and a significantly lower mean percentage of sperm motility (25.7 vs 37.9) (all with P < .01). There were no statistically significant differences in semen parameters between men smoking cigarettes or shisha. There were statistically significant negative correlations between smoking index and the percentage of sperm motility(r = -0.38; P = .006) and between smoking duration and the percentage of sperm motility(r = -0.32; P = .026). There was also a marginally significant positive correlation between smoking index and the percentage of abnormal sperm forms(r =0.28; P = .046). Correlations with other semen parameters were not significant.

CONCLUSION: Results showed significant deleterious effects of tobacco smoking on semen parameters. The correlation analysis placed special emphasis on the negative impact of smoking on sperm motility. Evidence from this and other studies seems sufficient to recommend that male smokers with subfertility should stop smoking to prevent detrimental effects on semen quality.

Alaa Hussein,1 Ayman AlGadaa,2 Mohamed ElFaras,1 Medhat ElFiky1

1 In Vitro Fertilization Center, King Fahd Specialized Hospital, Buridah, Kingdom of Saudi Arabia

2 Department of Surgery, Faculty of Medicine, Qassim University, Qassim Province, Kingdom of Saudi Arabia

Submitted November 10, 2010 - Accepted for Publication December 14, 2010

KEYWORDS: Smoking; Subfertily; Semen quality.

CORRESPONDENCE: Dr. Alaa Hussein, King Fahd Specialized Hospital, IVF Center, PO Box 2290, Buridah, Qassium Region, Kingdom of Saudi Arabia ().

CITATION: Urotoday Int J. 2011 Feb;4(1):art11. doi:10.3834/uij.1944-5784.2011.02.11

ABBREVIATIONS AND ACRONYMS: DNA, deoxyribonucleic acid; ROS, reactive oxygen species.



Efficacy and Safety of Trospium Chloride Use in Children With Idiopathic and Neurogenic Detrusor Overactivity: An Overview of Available Data


INTRODUCTION: There are limited data regarding treatment of idiopathic and neurogenic detrusor overactivity with anticholinergic drugs in children. Although oxybutynin and propiverine are authorized for use with children, treatment of this subgroup of patients is not officially approved for the newer anticholinergic drugs that have some advantages in tolerability. In particular, the quaternary drug trospium chloride (TC) has the benefit of not passing the blood-brain barrier (in contrast to the other anticholinergics, which are tertiary amines). The purpose of this article is to evaluate published data regarding the efficacy, safety, and dosage of TC in pediatric patients.

METHODS: Major computerized database indexes were analyzed for studies between 1960-2010 that involved treatment of children with TC and other anticholinergics. Key words used for searching were: trospium chloride, anticholinergic, oral application, incontinence, urgency, pollakiuria, and children. Variables compared across studies were the age of the patients, daily dose, duration of treatment, efficacy parameters, and safety aspects.

RESULTS: One randomized controlled trial with 58 participants and 3 uncontrolled studies with various inclusion criteria were identified in the literature. TC has been investigated in children aged between 3 and 14 years for a number of indications including bladder instability, neurogenic bladder dysfunction, and nocturnal enuresis. The reported studies ranged in length from 5 days to 12 weeks. In all studies, results showed improvement in symptoms for the majority of the patients. The occurrence of side-effects was low and none of the side-effects was severe.

CONCLUSIONS: A definite recommendation for the use of TC in children cannot be given due to insufficient data. Preliminary results indicate that its use may have potential advantages in children, but additional studies are needed.

Maria Bürst1, Anna Wolf2

1 Bereich Urologie, MVZ Klinikum Deggendorf GmbH, Deggendorf, AFG
2 Department of Medical Science/Clinical Research, Dr. R. Pfleger GmbH, Bamberg, DEU

Accepted December 23, 2010 - Published February 12, 2011

KEYWORDS: Trospium chloride; Children; Incontinence; Anticholinergic; Dosage.

CORRESPONDENCE: Anna Wolf, Dept. Medical Science/Clinical Research, Dr. R. Pfleger GmbH, 96045 Bamberg, Germany ().

CITATION: Urotoday Int J. 2011 Feb;4(1):art17. doi:10.3834/uij.1944-5784.2011.02.17




Hemodynamic, Respiratory, and Immunological Effects of Urological Laparoscopic Surgery: A Prospective Study


INTRODUCTION: Numerous physiological responses as a result of carbon dioxide (CO2) insufflation occur in almost every organ system. The present study investigated the impact of intraperitoneal or extraperitoneal CO2 insufflation on cardiopulmonary and immunological variables during urological laparoscopic surgery.

METHODS: From August 2007 to April 2009, we performed 40 laparoscopic urological surgeries (36 transperitoneal; 4 retroperitoneal) on otherwise healthy patients. There were 16 males and 24 females. Their mean age was 39 years. All patients underwent peripheral venous blood sampling preoperatively and 24 hours postoperatively. These were analyzed for C-reactive protein (CRP), white blood cell count, and differential leukocyte count. Arterial blood gas was sampled preoperatively and intraoperatively. Measurements were started when the patient was placed in the lateral decubitus position and continued at 2-minute regular intervals until the time of emergence. End-tidal CO2 (ETCO2) was measured every 15 minutes during the entire procedure. Outcome measures were surgery duration and mean pH level, partial pressure of oxygen (pO2), ETCO2, peak airway pressure (PAP), respiratory rate (RR), oxygen (O2) saturation, mean arterial pressure (MAP), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), C-reactive protein (CRP), and leukocyte levels. Measures before and after CO2 insufflation were compared with paired t tests.

RESULTS: Mean operative time was 3.6 hours. The mean (SD) preoperative pO2 was 140.28 (25.61) mmHg, which was significantly higher than the mean intraoperative pO2 of 133.9 (24.43) mmHg (P < .05). There was no significant difference in the mean ETCO2 before and after insufflation. However, the mean change in ETCO2 at 15-minute intervals was significantly higher than the ETCO2 before insufflation. There were no significant changes in mean pH, O2 saturation, MAP, RR, ETCO2, PAP, HR, SBP, DBP, or RR. Inflammatory markers CRP and white blood cell count were statistically similar.

CONCLUSIONS: Physiological changes incurred as a result of CO2 insufflation have minimal adverse effects in healthy individuals undergoing urological laparoscopic surgery.

Mukesh Kumar Vijay, Preeti Vijay, Punit Tiwari, Suresh Kumar, Pramod Kumar Sharma, Amit Goel, Pratim Sengupta, Malay Kumar Bera

Department of Urology, Institute of Post Graduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India

Submitted November 29, 2010 - Accepted for Publication December 19, 2010

KEYWORDS: Intra-abdominal pressure; Mean arterial pressure; Heart rate; pO2; End-tidal CO2.

CORRESPONDENCE: Mukesh Kumar Vijay, Department of Urology, Institute of Post Graduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, 682 A Newalipore O Block, Kolkata, West Bengal 700020, India ().

CITATION: UroToday Int J. 2011 Feb;4(1):art18. doi:10.3834/uij.1944-5784.2011.02.18

ABBREVIATIONS AND ACRONYMS: CO2, carbon dioxide; CRP, C-reactive protein; DBP, diastolic blood pressure; ETCO2, end-tidal CO2; HR, heart rate; IAP, intraabdominal pressure; IL-6, interleukin-6; MAP, mean arterial pressure; O2, oxygen; PAP, peak airway pressure; pCO2, partial pressure of carbon dioxide; pO2, partial pressure of oxygen; RR, respiratory rate; SBP, systolic blood pressure.



Intravesical Fiducial Marker Placement to Facilitate Image-Guided Radiation Therapy for Patients With Muscle-Invasive Bladder Cancer


INTRODUCTION: Recent development of image-guided techniques facilitates the monitoring of organ motion during radiation therapy. The purposes of this study were to: (1) describe the technique of intravesical fiducial marker placement using Visicoil linear fiducial markers (Core Oncology; Santa Barbara, CA, USA) for treatment planning and delivery of radiation therapy for invasive bladder cancer, and (2) describe the feasibility of this program and initial results.

METHODS: Participants were 10 male patients with a mean age of 74 years (range, 58-87 years). They underwent placement of Visicoil fiducial markers into the bladder wall under endoscopic guidance for the purpose of facilitating treatment planning and delivery for external beam radiotherapy for bladder cancer. We assessed the feasibility of marker placement and stability of the marker using daily on-board imaging during a standard course of therapy. We assessed acute procedure-related complications and related toxicity using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0.

RESULTS: All 10 patients had successful implantation of Visicoil fiducial markers without procedure-related acute complications. No patient developed acute toxicity related to the procedure or markers. All markers remained stable during radiation therapy using daily on-board imaging.

CONCLUSION: The use of Visicoil fiducial markers for the guidance of radiation therapy for bladder cancer is safe and feasible. The procedure is associated with minimal toxicity. The use of fiducial markers may enhance the accuracy and efficacy of radiotherapy for bladder cancer.

Marisa A Kollmeier, Bernard Bochner

Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York USA.

Accepted December 23, 2010 - Published February 07, 2011

KEYWORDS: Bladder cancer; Fiducial markers; Image-guided radiotherapy; Radiation therapy.

CORRESPONDENCE: Marisa A. Kollmeier, M.D., Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021 USA ().

CITATION: UroToday Int J. 2011 Feb;4(1):art16. doi:10.3834/uij.1944-5784.2011.02.16

ABBREVIATIONS AND ACRONYMS: 2-dimensional, 2D; CT, computed tomography; kV, kilovoltage; TUR, transurethral resection.



Laparoscopic Partial Cystectomy for Symptomatic Paraganglioma of the Urinary Bladder: A Case Report


Paragangliomas of the bladder are uncommon neuroendocrine neoplasms. Open partial cystectomy is usually performed because all layers of the bladder are involved. In this case, we used laparoscopic partial cystectomy to minimize surgical morbidity of the transabdominal approach. A 43-year-old female presented with symptomatic paraganglioma of the bladder. The patient was pretreated with alpha- and beta-adrenergic blockers before surgery. A 4-port technique was performed with the patient in the Trendelenburg lithotomy position. The bladder mass was excised with a rim of normal mucosa under both cystoscopic and laparoscopic vision. Total operative time was 170 minutes and blood loss was < 100 mL. The patient’s intraoperative blood pressure remained stable. The final histology showed a 6 cm paraganglioma with clear resection margins. Laparoscopic partial cystectomy is feasible for excising a symptomatic paraganglioma with adequate preoperative adrenergic blockage to prevent a hypertensive crisis during resection.

Fiona Mei Wen Wu,1 Shih Ling Kao,2 Thomas Paul Thamboo,3 Woo Chau Tsang,1 Chin Tiong Heng,1 Ho Yee Tiong1

1 Department of Urology, National University Hospital, Singapore

2 Department of Endocrinology, National University Hospital, Singapore

3 Department of Pathology, National University Hospital, Singapore

Submitted November 14, 2010 - Accepted for Publication December 17, 2010

KEYWORDS: Paraganglioma; Symptomatic; Laparoscopic partial cystectomy

CORRESPONDENCE: Dr Tiong Ho Yee, Consultant, Department of Urology, National University Health System, NUHS Tower Block Level 8, 1E Kent Ridge Road, Singapore 119228 ().

CITATION: Urotoday Int J. 2011 Feb;4(1):art3. doi:10.3834/uij.1944-5784.2011.02.03

ABBREVIATIONS AND ACRONYMS: CT, computed tomography; MIBG, metaiodobenzylguanidine scintigraphy.



Outcomes of the Urogenital Distress Inventory (UDI-6) for 20- to 50-Year-Old Females With Lower Urinary Tract Dysfunction in Qalubia Governorate, Egypt


INTRODUCTION: The 6-item Urogenital Distress Inventory (UDI-6) was recently validated on 68 women with lower urinary tract symptoms. The purpose of the present investigation was to use the UDI-6 to determine the types of lower urinary tract dysfunction across different age groups, as described by women from Qalubia Governorate, Egypt.

METHODS: The study group was recruited from females attending hospitals for urological consultation between February and August, 2009. There were 378 participants who were 20-50 years old. They had lower urinary tract symptoms for 3 months and a negative dipstick test. Each had a medical history, clinical evaluation, urine culture, and pelvic-abdominal ultrasound. All participants completed the Arabic version of the UDI-6. They were divided into 3 groups according to age: (1) 20-30 years (n = 144), (2) 31-40 years (n = 94), (3) 41-50 years (n = 140). Results were compared by age group using t tests; a Bonferroni adjustment was applied and significant differences were noted at P < .001.

RESULTS: The most common symptoms of lower urinary tract dysfunction were stress urinary incontinence and lower abdominal or genital pain. Stress urinary incontinence was present in 182 (48.1%) of the 378 patients. It occurred in 4.8% of patients age 20-30 years, 8.1% of patients age 31-40 years, and 17.2% of patients age 41-50 years. Urge incontinence was present in 84 patients (22.2%). The presence of mild and moderate stress incontinence and mild urge incontinence increased significantly in patients who were 41-50 years old (all with P < .001). Micturition difficulty and micturition frequency occurred in < 7% of patients. Lower abdominal or genital pain was described by 204 patients (53.9%). Micturition difficulty, micturition frequency, and lower abdominal or genital pain did not have significantly different distributions across age.

CONCLUSION: The most common symptoms of lower urinary tract dysfunction were stress urinary incontinence and lower abdominal or genital pain. The presence of mild and moderate stress incontinence and mild urge incontinence increased significantly in patients who were 41-50 years old. These patterns are similar to those reported by authors from other countries.

Osama Abdelwahab, Ashraf Mohamed, Tarek Mohamed, Mohamed Abdelzaher

Urology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt

Accepted November 17, 2010 - Published February 07, 2011

KEYWORDS: Stress urinary incontinence; Voiding dysfunction; Lower urinary tract symptoms.

CORRESPONDENCE: Osama Abdelwahab, Professor of Urology, Benha Faculty of Medicine, Benha University, 1st Gameel Street-Makkah Tower, Benha, Egypt ().

CITATION: UroToday Int J. 2011 Feb;4(1):art6. doi:10.3834/uij.1944-5784.2011.02.06

ABBREVIATIONS AND ACRONYMS: LUTS, lower urinary tract symptoms; UDI, Urogenital Distress Inventory; UI, urinary incontinence.



Dysfunctional Voiding as a Presenting Feature of Marfan Syndrome: A Rare Case


Dysfunctional voiding is incontinence resulting from voiding-phase dysfunction. It has been associated with various disorders, but there are only 2 known reports of dysfunctional voiding as a presenting feature of Marfan syndrome in the literature. The present case is a 16-year-old boy with dysfunctional voiding who was diagnosed as having failure to void due to sphincter dyssynergy associated with an unsafe bladder, left-sided vesicoureteric reflux, and emerging Marfan syndrome. Diagnosis of Marfan syndrome was based on the number and type of his clinical features. Because of the prohibitive cost of regular botulinum toxin injections to the sphincter in India, the patient's dysfunctional elimination was managed with clean intermittent self-catheterization, anticholinergics, and stool softeners. Follow-up included monitoring the thorax for any signs of increasing aorta size. It is important to predict dysfunctional elimination in children born with any syndrome that has generalized hypermobility of the joints.

Gajanan Bhat, Girish Nelivigi, Maregowda Shivalingiah, Chandrashekhar Ratkal

Department of Urology, Institute of Nephrourology, Karnataka, India

Received November 09, 2010 - Accepted for Publication December 17, 2010

KEYWORDS: Marfan syndrome; Ghent criteria; Dysfunctional voiding.

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 Feb;4(1)art14. doi:10.3834/uij.1944-5784.2011.02.14

ABBREVIATIONS AND ACRONYMS: CIC, clean intermittent catheterization; CISC, clean intermittent self-catheterization; DSD, detrusor sphincter dyssynergia.



Occult Ileovesical Fistula in a Patient Presenting With Squamous Cell Carcinoma of the Bladder: An Unsual Intraoperative Diagnosis


Enterovesical fistulae are commonly caused by pathology related to the gastrointestinal tract such as colonic malignancy and inflammatory bowel disease. On rare occasions, an ileovesical fistula can develop due to a primary bladder neoplasm. Alternatively, a fistula may cause chronic bladder inflammation that leads to the development of squamous cell carcinoma. We report an unusual way of diagnosing an occult ileovesical fistula in a 61-year-old male. The patient presented with hematuria and urinary tract infection and histologically proven squamous cell carcinoma of the urinary bladder. Bladder irrigation-like fluid bypassing the endotracheal tube during transurethral resection of the bladder tumor was highly suspicious of an ileovesical fistula. A postoperative computed tomography scan confirmed the diagnosis. This is the first known case in the literature to report this type of intraoperative diagnosis of an ileovesical fistula.

Costin Chintea, Yuko Smith, Aniruddha Chakravarti

Department of Urology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Dudley, West Midlands, United Kingdom

Submitted November 7, 2010 - Accepted for Publication December 11, 2010

KEYWORDS: Ileovesical fistula; Bladder; Squamous cell carcinoma; Enterovesical fistula.

CORRESPONDENCE: Dr. Costin Chintea, Department of Urology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Dudley, West Midlands, United Kingdom, DY1 2HQ ().

CITATION: Urotoday Int J. 2011 Feb;4(1): art9. doi:10.3834/uij.1944-5784.2011.02.09




Spontaneous Bladder Perforation Due to Tuberculosis

(no abstract)

Christopher CK Ho

Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia

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

KEYWORDS: Spontaneous bladder perforation; Tuberculosis; Management.

CORRESPONDENCE: Dr. Christopher C.K. Ho, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia ().

CITATION: Urotoday Int J. 2011 Feb;4(1):art12. doi:10.3834/uij.1944-5784.2011.02.12



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.