Issue 5: October 2011

UIJ Volume 4 Issue 5 2011

Letter from the Editor - October 2011

Dear Colleagues,

Welcome to the October issue of UroToday International Journal. As the global economy continues its shift into uncharted territory burdened with challenges, it may appear that anxiety remains on the horizon. The truth is that although there are hurdles, there is always hope and eventual progress. We at UIJ remain at the forefront of progress, showcasing the most up-to-date advances in the field and sharing them with our ever-thriving community. Serving that community with a wealth of support is our newest editor, Jennifer Bennett, who works out of our offices in California. I know you will find her as helpful as she is friendly.

In this issue, an original study by Sallami brings up the very same socio-economic encounters expressed by many, detailing the current state of urology and urology training in Tunisia, its various limitations in education and equipment availability, and a lack of sub-specialty recognition prevalent in other countries. The author concludes with optimism, outlining ways to overcome these limitations while emphasizing review of economic and health care policies.

Khan and Baig review the successful results of ultrasound-guided lymphocele surgery following kidney transplantation. They stress meticulous surgical techniques where all lymphatics are carefully ligated, along with the reduction of known risk factors, in order to avoid recurrence.

Denewer et al. explore the minimally invasive techniques of hand-assisted cystectomy on forty patients with bladder carcinoma. The authors conclude that hand-assisted cystectomy combines the merits of open radical cystectomy with a decrease in blood loss, hospital stay, and complications. It also results in fewer treatment costs for the patient.

In an article by Soliman et al., the authors investigate obesity as an important risk factor for stress urinary incontinence in women. By comparing a group of 100 obese women with a control group of 100 normal-weight women, the authors discovered a significant difference in urinary bladder control in the two groups. They present a possible explanation of this relationship via ultrasound of the urethrovesical angle and bladder neck descent.

Daneshmand et al. express the importance of photodocumentation in bladder cancer surveillance based on fifteen patients who underwent flexible cystoscopy. During the fifteen-month surveillance period, photodocumentation proved a supportive and cost-effective tool for the observation and eventual biopsy of lesions in six patients.

We also present a series of case reports that provide various insights into multiple urologic complications, including giant bladder calculi and squamous cell carcinoma of multiple types.

As always, we offer free manuscript submission, peer review, and publication to our authors. Finally, without the continued loyalty of our authors and readers, UIJ would cease to be the success it is. Thank you for your continued support in all that we provide for the urology community. 



Karl-Erik Andersson


Challenges for a Resident in Urology in Tunisia in 2011


This article presents the actual state of urology and highlights some of the most significant challenges facing resident urological training in Tunisia. These include a specifically limited number of trained urologists, limited training capacity, limited availability of some modern equipment, and non-recognition of subspecialties related to urology. Brief suggestions to overcome these problems are made, and the need for a wholesome review of the economic and health care policies is emphasized.

Sallami Satáa

Submitted January 24, 2011 - Accepted for Publication July 3, 2011

KEYWORDS: Urology; Training; Residency; Education; Clinical competence; Motivation; Evaluation; Curriculum; Medical; Surgery; Endourology; Endoscopy; Laparoscopy

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

CITATION: UroToday Int J. 2011 Oct;4(5):art 59. doi:10.3834/uij.1944-5784.2011.10.01


Page Kidney - Rare but Correctable Cause of Hypertension


A case of Page kidney as a result of injury followed by hypertension is presented. An abdominal ultrasound revealed soft tissue mass suggestive of a hematoma, resulting in a nephrectomy during which there were dense adhesions on the posterior surface of the kidney due to a large sucapsular hematoma. This presentation aims to bring attention to Page kidney’s causes associated with hypertension and its correctable treatment.

Kapil Singla, Ashish K. Sharma, Sistla B. Viswaroop, Myilswamy Arul, Ganesh Gopalakrishnan, Sangam V Kandasamy

Submitted April 25, 2011 - Accepted for Publication May 19, 2011 

KEYWORDS: Page kidney; Subcapsular hematoma; Hypertension

CORRESPONDENCE: Kapil Singla, Department of Urology, Vedanayagam Hospital, 52 East Bashykaralu Road, Coimbatore 641002, Tamil Nadu, India ().

CITATION: Urotoday Int J. 2011 Oct;4(5):art54. doi:10.3834/uij.1944-5784.2011.10.10


The Role of Photodocumentation in Surveillance Cystoscopy for Bladder Cancer


PURPOSE: To determine if the combination of photodocumentation and electronic medical record keeping led to changes in the management of suspicious lesions in patients with bladder cancer undergoing surveillance cystoscopy.

METHODS: We reviewed the charts of all patients undergoing surveillance cystoscopy for bladder cancer during a 15-month period. We evaluated patients who had photodocumentation of bladder lesions in our electronic medical record (EPIC). Baseline demographics, surveillance data, and biopsy results were collected, and the outcome of photodocumentation was analyzed. A cost base analysis was performed using figures obtained from the billing department.

RESULTS: During the study period, 50 patients underwent flexible cystoscopy for bladder cancer surveillance at our institution. Fifteen were identified who met the study criteria. Using photodocumentation in EPIC, nine patients had well documented lesions that had no change during the surveillance period with negative urine cytology and therefore did not undergo biopsy. Six patients, however, did undergo biopsy based on a change in the appearance of the lesion. Biopsies demonstrated 3 benign lesions, 2 low-grade transitional cell carcinomas, and 1 muscle-invasive lesion. An economic base analysis demonstrated a cost reduction of 27% and 55% compared with office-based biopsy and transurethral resection of bladder tumor, respectively, by using photodocumentation.

CONCLUSIONS:  Photodocumentation of lesions during flexible cystoscopy is a useful tool in bladder cancer surveillance. It provides support for clinical decisions and is a cost effective way to monitor patients undergoing frequent interventions.

Eric S. Reid, Hooman Djaladat, Siamak Daneshmand

Submitted April 1, 2011 - Accepted for Publication June 16, 2011

KEYWORDS: Bladder neoplasm; Cystoscopy; Biopsy; Economic

CORRESPONDENCE: Siamak Daneshmand, M.D., Associate Professor of Urology, Norris Comprehensive Cancer Center, USC Institute of Urology, Los Angeles, CA 90033, USA ().

CITATION: Urotoday Int J. 2010 Oct;4(5):art 58. doi:10.3834/uij.1944-5784.2011.08.14



Spontaneous Rupture of Adrenal Myelolipoma


Adrenal myelolipoma is a benign tumor composed of adipose tissue and hematopoietic lesions. It is usually diagnosed incidentally in imaging tests such as computed tomogram (CT) or by patient symptoms such as retroperitoneal hemorrhage due to tumor rupture. We present a patient with retroperitoneal hemorrhage due to spontaneous rupture of a myelolipoma with enlargement of the mass and hemorrhage during the follow-up regimen of watchful waiting.

Minori Matsumoto, Katsumi Shigemura, Masato Fujisawa

Submitted March 22, 2011 - Accepted for Publication June 1, 2011

KEYWORDS: Rupture of Adrenal Myelolipoma; Enlargement of the mass and hemorrhage; Watchful waiting

CORRESPONDENCE: Katsumi Shigemura MD, PhD, Division of Urology, Department of Organs Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo 650-0017, Japan ().

CITATION: UroToday Int J. 2011 Oct;4(5):art 55. doi:10.3834/uij.1944-5784.2011.08.11



Myeloid Sarcoma of the Bladder: Case Presentation and Review of the Literature


Myeloid sarcoma, an uncommon proliferative hematological entity associated with leukemia, can present in various extramedullary soft tissues in the body and its outcome is generally undesirable. Due to its rarity, the diagnosis can be challenging and commonly missed. A search through PubMed revealed only 8 cases in English literature. We would like to present a case of myeloid sarcoma in the bladder and briefly discuss this disease.

Eng Hong Goh, Akhavan Adel, Praveen Singam, Christopher Chee Kong Ho, Guan Hee Tan, Badrulhisham Bahadzor, Zulkifli Md Zainuddin, Fauzah Abdul Ghani, Noraidah Masir

Submitted April 12, 2011 - Accepted for Publication May 11, 2011

KEYWORDS: Myeloid sarcoma; Chloroma; Bladder

CORRESPONDENCE: Eng Hong Goh, Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia ().

CITATION: Urotoday Int J. 2011 Oct;4(5):art 48. doi:10.3834/uij.1944-5784.2011.08.13


Pheochromocytoma with the Renovascular Hyperreninemia Attendant on Renal Artery Stenosis


A 68-year-old female, diagnosed with essential hypertension, demonstrated a muscular depression caused by hypokalemia. Endocrinological data revealed elevated plasma rennin activity (PRA), plasma aldosterone concentration (PAC), and cathecholamine, and the computed tomography (CT) presented a 6 cm mass above the left kidney. I-metaiodobenzylguanidine (MIBG) scintigraphy showed an uptake in accord with the tumor and I-adosterol scintigraphy showed no abnormal accumulation. Magnetic resonance angiography (MRA) demonstrated left renal artery stenosis (RAS). Peak systolic velocity in the left renal artery measured by a duplex ultrasound was elevated. We considered that the left RAS accompanied by compression caused hyperreninemia. A tumor strongly adhered to the left renal artery and vein, so we performed a laparoscopic left nephroadrenalectomy. Two weeks after the operation, PRA, PAC, and cathecholamine were almost normalized. We present a rare case of pheochromocytoma with the renovascular hyperreninemia attendant on RAS diagnosed by MRA and a duplex ultrasound.

Fumitaka Shimizu, Kazuhiko Fujita, Takeshi Ieda, Kentaro Imaizumi, Taiki Mizuno, Kazuo Suzuki

Submitted March 21, 2011 - Accepted for Publication May 25, 2011

KEYWORDS: Pheochromocytoma; Renovascular hyperreninemia; Renal artery stenosis

CORRESPONDENCE: Fumitaka Shimizu, M.D., Department of Urology, Juntendo Shizuoka Hospital, 1129 Nagaoka, Izunokunishi, Shizuoka 410-2295, Japan ().

CITATION: UroToday Int J. 2011 Oct;4(5):art 56. doi:10.3834/uij.1944-5784.2011.08.12


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