Issue 2: April 2011

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.

Sincerely,

 

Karl-Erik Andersson

Editor-in-Chief
UIJ

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

ABSTRACT

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.

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

ABSTRACT

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.

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

ABSTRACT

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.

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Urethral Leiomyoma in Females: Report of 3 Cases

ABSTRACT

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.

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

ABSTRACT

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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Laparoscopic Prostatectomy for Severely Symptomatic, Treatment-Refractory Chronic Prostatitis: Preliminary Observations from an Ongoing Phase II Clinical Trial

 ABSTRACT

INTRODUCTION: We report outcomes 1 year after surgery for the first 6 consecutive patients enrolled in an ongoing, prospective, Phase II clinical trial of laparoscopic radical prostatectomy (LRP) as a treatment for severely symptomatic, treatment-refractory chronic prostatitis. The protocol is approved by the Western Institutional Review Board and listed on the searchable National Institutes of Health clinical trials Web site.

METHODS: Patients met prespecified eligibility criteria, were fully counseled before treatment, gave written informed consent, had surgery, and were regularly monitored after treatment. The primary outcome measure was symptom severity, which was measured prior to LRP and at 1, 3, 6, and 12 months after treatment using the Chronic Prostatitis Symptom Index (CPSI). The exact Wilcoxon signed rank test was used to compare pretreatment and 6-month posttreatment scores, with statistical significance at P < .05. Patients also described symptoms that were not included on the CPSI. Intraoperative and postoperative complications were recorded.

RESULTS: Average patient age was 48.5 years (range, 31-61 years). The pretrial median disease duration was 6.5 years (range 3-31 years). Aside from their prostatitis, all patients were generally healthy. All patients had failed numerous medical, surgical, and complementary treatments. LRP was uncomplicated. All patients reported resolution of their prostatitis. Median CPSI scores were 35 before surgery and 26, 15.5, 10, and 7.5 at 1, 3, 6, and 12 months after surgery, respectively. The 6-month CPSI scores were significantly lower than the preoperative scores (P = .03).

CONCLUSIONS: Preliminary data suggest that LRP may offer a previously unavailable level of relief for carefully selected patients with severely symptomatic, treatment-refractory chronic prostatitis. This potential needs to be further validated and more thoroughly characterized.


Arnon Krongrad,1 Shenghan Lai2

1 The Krongrad Institute, Aventura, FL, USA

2 Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA

Submitted November 3, 2010 - Accepted for Publication February 23, 2011


KEYWORDS: Chronic prostatitis; Laparoscopic radical prostatectomy; Clinical trial.

CORRESPONDENCE: Arnon Krongrad, MD, The Krongrad Institute, 20900 NE 30th Ave, Suite 207, Aventura, FL 33180, USA ().

CITATION: Urotoday Int J. 2011 Apr;4(2):art30. doi:10.3834/uij.1944-5784.2011.04.12

ABBREVIATIONS AND ACRONYMS: CPPS, chronic pelvic pain syndrome; CPSI, Chronic Prostatitis Symptom Index; LRP, laparoscopic radical prostatectomy; NIH, National Institutes of Health.

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