Issue 3: June 2011

UIJ Volume 4 Issue 3 2011

Letter from the Editor - June 2011

Dear Colleagues,

This issue marks the beginning of the fourth year for UroToday International Journal, and we have continued successfully to achieve our primary goal to elevate access to urology science for professionals around the world. This could not have been achieved without the dedication of both our authors and reviewers.

The current issue contains a variety of articles, many of which should be of high interest to the professional community. Hajebrahimi et al. evaluated the effect of changes in voiding position on uroflowmetric findings of young, healthy male vounteers, and found no statistically significant differences between the standing, sitting, or squatting voiding positions for any of the measured urodynamic outcome parameters: peak flow rate (Qmax), average flow rate, time to peak flow, flow time, and voided volume. Bhat et al. studied the effects of the transurethral catheter comparing free uroflow versus pressure-flow on their outcome measures: maximum flow (Qmax), average flow rate, voiding time, time to Qmax, and flow acceleration. With a small sample size they were able to show an obstructive effect of an in situ 5 Fr urethral catheter during pressure-flow studies, a finding that needs to be confirmed by a randomized prospective investigation. Karami et al studied prospectively the prevalence of acquired renal cystic disease (ARCD) in patients with end-stage renal disease receiving hemodialysis, and they conclude that patients who are on long-term hemodialysis should be monitored for the development of ARCD. Ahmed Shelbaia evaluated the results of early endoscopic management of posttraumatic posterior urethral stricture by visual internal urethrotomy (VIU), and conclude that early endoscopic urethral realignment surgery is a safe procedure with few complications. Miyaoka et al. report the first-year follow-up results on the safety and efficacy of the Ophira Mini-Sling System, which 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. They conclude that the system appears to be an effective, minimally invasive option for the treatment of stress urinary incontinence.

We are devoting a larger-than-normal portion of this issue to the publication of case reports. Such cases often provide insight into rare conditions, reminding us to be more vigilant during differential diagnosis or more open to alternative ways of managing a given disorder. de Leon et al. present the first known case of atraumatic bladder rupture in an adult with Ehlers-Danlos syndrome. The authors attribute the spontaneous rupture to a weakened bladder wall and caution against overextending the bladder during cystoscopic procedures with these types of patients. Bhat et al. describe a 24-year-old married, phenotypic female. She presented with an inability to conceive and no knowledge of having androgen insensitivity syndrome. The authors discuss the complex physical and psychological issues involved in the management of patients with this disorder. Khan et al. describe a 44-year-old patient with an appendicular mass that was discovered at the beginning of living-donor kidney transplant surgery. Traditionally, the transplant would be aborted and rescheduled following recovery from an appendectomy. However, the authors detail the sequence of events that enabled them to successfully perform both surgical procedures in the same session, and discuss the circumstances when this approach is unlikely to be feasible.

It is our primary goal to publish original studies, and we encourage you to submit the results of clinical or basic science research in all areas of urology. I personally thank the authors and reviewers for their valuable contributions to this journal issue. 




Karl-Erik Andersson


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.

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