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.



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