ABSTRACT

Background & Objective: Open radical cystectomy is the standard procedure for the treatment of muscle-invasive bladder cancer. There has been a recent trend towards minimally invasive techniques aiming to decrease blood loss, hospital stay, and complications. Therefore, hand-assisted cystectomy (HAC) emerged as a rational choice, combining the merits of laparoscopic surgery with the feasibility of performing a continent urinary reservoir in a reasonable operative time and with reasonable treatment costs.

Patients & Methods: Forty patients with invasive bladder carcinoma were offered radical cystectomy with the HAC approach. Thirty-two men and 8 women underwent HAC. The mean age was 57.5 years. The mean operation time was 200 minutes for the extirpative part and 90 minutes for the reconstructive part of the procedure. Estimated blood loss was 450 ml. The mean hospitalization time was 17 days (range of 10 to 30). At a median follow-up of 2 years, no cases of port-site, incisional, or isolated pelvic recurrence was detected. The median DFS is 14.6 month (95%CI = 13.2-15.8).

Conclusions: HAC is a rational procedure that can be used to perform radical surgery of invasive bladder carcinoma and orthotopic urinary diversion.

Adel Denewer, Fayez Shahato, Osama Hussein, Sameh Roshdy, Omar Farouk, Ashraf Khater, Mohammed Hegazy, Waleed ElNahhas, Mahmoud Mosbah, Mahmoud Adel

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

KEYWORDS: Radical cystectomy; Ileal neobladder; Bladder carcinoma

CORRESPONDENCE: Adel Denewer, Surgical Oncology Center, Mansoura University, Egypt ().

CITATION: UroToday Int J. 2011 Oct;4(5):art 59. doi:10.3834/uij.1944-5784.2011.10.09

Objective: To determine the impact of our surgical techinique with the incidence of lymphoceles in all patients who underwent renal transplantation, and identify other risk factors responsible for the development of lymphoceles.

Materials and Methods: The records of all patients who underwent kidney transplantation at the Riyadh Military Hospital from March 2007 to March 2011 were retrospectively reviewed to determine the incidence of lymphocele. Demographic characteristics, risk factors, and surgical technique were outlined. All transplants were performed by a single surgeon and his team.

Results: A total of 273 patients underwent kidney transplantation; only 1 recipient was diagnosed with a lymphocele on ultrasound 6 weeks after transplantation. This patient underwent ultrasound-guided aspiration with complete resolution without recurrence at a 1-year follow-up. Our surgical technique is based on (1) ligation of all paravascular hilar tissue in the allograft, (2) ligation and division of all lymphatic vessels when dissecting the recipient iliac artery and vein, (3) ligation and division of all lymphatics if iliac lymph nodes require removal, and (4) routine use of suction drains. The known risk factors are comparable with other studies and include an acute rejection (AR) rate of 6.6%, a body mass index (BMI) >30 to 24%, diabetes at 22%, retransplants at 15%, zero de novo sirolimus therapy, and 14.6% recipients on a steroid-free regimen.

Discussion: Post-renal transplant lymphoceles are not uncommon and can result in unnecessary morbidity. These patients can present with a palpable mass, renal impairment from obstruction of the ureter, lower limb edema from iliac vein thrombosis, and sepsis in case of infection. Diagnosis and follow-up with an ultrasound (US) is simple and efficient. The prevention of lymphoceles may be possible with meticulous surgical techniques where all lymphatics are carefully ligated. The reduction of known risk factors can also help reduce its incidence and morbidity. Treatment options include aspiration, sclerosant instillation, and surgery, but lymphoceles can recur and every effort must be made to reduce its incidence.

Conclusion: We feel that a meticulous surgical technique with ligation of all lymphatics, both during dissection of the recipient vessels and the donor allograft, along with appropriate suction drainage, was significant in reducing the incidence of lymphoceles following kidney transplantation in our recipients.

Taqi F Toufeeq Khan, Mirza Anzar Baig

Submitted June 11, 2011 - Accepted for Publication Aug 12, 2011

KEYWORDS: Post-renal transplant lymphocele; Meticulous surgical technique; Ligation of lymphatics; Risk factors; Incidence

CORRESPONDENCE: Taqi F Toufeeq Khan, Division of Kidney Transplant Surgery, PO Box 7897/624N, Riyadh Military Hospital, Riyadh, 11159, Kingdom of Saudi Arabia ().

CITATION: Urotoday Int J. 2011 Oct;4(5):art 64. doi:10.3834/uij.1944-5784.2011.10.07

 ABSTRACT

We present a case of a 28-year-old male who presented with complaints of continous urinary incontinence and a lower abdominal lump over a few months. The X-ray KUB showed a large radio-opaque shadow occupying the entire urinary bladder, suggestive of a calculus. A suprapubic cystolithotomy was done. The calculus weighed 1064 grams and had a size of 13.2 cms x 10 cms x 9 cms. Giant bladder stones are an extreme rarity these days. This, we believe, is the largest bladder stone in terms of volume and weight reported in recent times.

Sanjay Kolte, Chandrashekhar Mahakalkar, Rucha Jajoo

Submitted April 7, 2011 - Accepted for Publication July 3, 2011

KEYWORDS: Bladder calculus; Giant stone

CORRESPONDENCE: Sanjay Kolte, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha 442004, Maharashtra, India ()

CITATION: UroToday Int J. 2011 Oct;4(5):art 61. doi:10.3834/uij.1944-5784.2011.10.03

 

Background: Stress urinary incontinence (SUI) has an observed prevalence of between 4 and 35%. Aging, obesity, and smoking have consistent causal relationships with the condition.

Objective: To elucidate the relationship between obesity and urinary incontinence in women and a possible explanation of this relationship by ultrasound of the urethrovesical angle and bladder neck descent.

Material and Methods: This prospective, comparative study was conducted in Tanta University Hospital from January 2006 to July 2010, and it included 100 obese women compared to 100 normal-weight control women regarding symptoms of SUI, ultrasonographic examination of the bladder neck, and bladder neck descent during straining for the detection of SUI.

Results: In the obese group, 70% of patients had symptoms of SUI, whereas in the normal-weight group, 17% of patients had symptoms of SUI, denoting a significant increase among the obese. Ultrasonographic examination revealed that in obese women, the urethrovesical angle is nearly at a right angle with an empty urinary bladder at rest and becomes obtuse at straining; but when the bladder was full, this angle became obtuse at rest and during straining. In normal-weight women, the urethrovesical angle was acute at rest and nearly at a right angle at straining while the bladder was empty, and it became a right angle with a full bladder at rest and slightly obtuse at straining with a full urinary bladder. In obese women, the average bladder neck descent during straining was 10 ±3.5 mm compared with a mean of 3±1.2 mm in the normal weight group, with a significant difference between the 2 groups.

Conclusion: Female obesity is an important risk factor for the occurrence of SUI.

HH Eltatawy, TM Elhawary, MG Soliman, MR Taha

Submitted May 27, 2011 - Accepted for Publication July 25, 2011

KEYWORDS: Obesity; Female stress incontinence

CORRESPONDENCE: M. G. Soliman, Lecturer of Urology, Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt ().

CITATION: UroToday Int J. 2011 Oct;4(5):art 63. doi:10.3834/uij.1944-5784.2011.10.05

Von Hippel-Lindau disease is a dominantly inherited familial cancer syndrome with variable expression. Here we are reporting a case of von Hippel-Lindau disease in a family.

Vedamurthy Pogula Reddy, Dandu Venkata Satya Rambabu, Surya Prakash Vaddi, Subramanian S

Submitted May 1, 2011 - Accepted for Publication July 3, 2011

KEYWORDS: Von Hippel-Lindau disease; Familial renal cancer

CORRESPONDENCE: Vedamurthy Pogula Reddy, Department of Urology and Renal Transplantation, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India 524002 ().

CITATION: UroToday Int J. 2011 Oct;4(5):art 64. doi:10.3834/uij.1944-5784.2011.10.06

ABBREVIATIONS AND ACRONYMS: RCC, renal cell carcinoma; VHL, von Hippel-Lindau; VEGF, vascular endothelial growth factor; HIF, hypoxia induced factor; PDGF, platelet derived growth factor

A 55-year-old-female Egyptian presented to us with severe dysuria. Laboratory investigations showed high serum creatinine of 3.4 mg/dl. A urinalysis revealed pyuria and hematuria. Liver enzymes were very high due to viral hepatitis and the daily usage of NSAIDs. A KUB showed a large, lamellated, radio-opaque shadow in the pelvis. A non-contrast CT revealed a contracted bladder with diffuse thickening of the bladder wall, and a single, large urinary bladder stone 5 x 6 cm, bilateral marked hydronephrosis, and hepatomegaly. A VCUG showed left reflux grade IV. A cystoscopy confirmed the presence of the stone with multiple biopsies from the erythematous bladder wall. A histopathology showed invasive squamous cell carcinoma. A right percutaneous nephrostomy was inserted with a urethral catheter. There was conservative management for liver disease till the liver functions returned to normal. A radical cystectomy and ileal conduit urinary diversion was performed successfully. The association between a large, neglected bladder stone and SCC should be considered.

Hamdy AbdelMawla Aboutaleb, Atef Badawy, Ahmed Gamal-eldin, Mohammed Badr-eldin

Submitted April 14, 2011 - Accepted for Publication June 13, 2011

KEYWORDS: Bladder stone; Squamous cell carcinoma

CORRESPONDENCE: Hamdy AbdelMawla Aboutaleb, Department of Urology, Minoufiya University Hospital, Shebin Elkom, Minoufiya, Egypt ()

CITATION: UroToday Int J. 2011 Oct;4(5):art 67. doi:10.3834/uij.1944-5784.2011.10.08

ABBREVIATIONS AND ACRONYMS: SCC, squamous cell carcinoma; CT, computerized tomography; KUB, kidney ureter bladder X-ray; VCUG, voiding cystourography; NSAIDs, Nonsteroidal anti-inflammatory drugs

A case of bladder rupture due to intravesical explosion during transurethral resection of prostate (TURP) is presented. Exploratory laparotomy done on clinical suspicion revealed a large inverted “V” shaped bladder tear that was sutured in 2 layers. An incidence of intravesical explosion during TURP is extremely rare. It occurs due to a mixture of explosive gases produced during TURP, with the air introduced into the bladder while activating the electrosurgical instrument. The presentation aims to bring attention to this rare complication once again with a literature review and emphasis on the necessary precautions needed to prevent it.

Rahul Kapoor, Hemant R. Pathak

Submitted April 8, 2011 - Accepted for Publication June 1, 2011

KEYWORDS: Transurethral resection of the prostate; Intravesical explosion; Bladder rupture

CORRESPONDENCE: Rahul Kapoor, Department of Urology, Apollo BSR Hospital, Junwani Road, Bhilai 242002, Chhattisgarh, India ().

CITATION: Urotoday Int J. 2011 Oct;4(5):art 60. doi:10.3834/uij.1944-5784.2011.10.02

Squamous cell carcinoma of the urinary tract is a very rare tumor associated with chronic renal calculi and infection. This tumor is highly aggressive and often detected at an advanced stage with a poor outcome. We hereby describe a case report of a 56-year-old male who presented with hydronephrosis and hydroureter in a non-functioning left kidney with ureteric calculi. Histopathology of the nephrectomy specimen revealed unexpected squamous cell carcinoma with chronic pyelonephritis. The pus culture came out positive for fungus—Geotrichum.

Hamdy AbdelMawla Aboutaleb, Atef Badawy, Ahmed Gamal-eldin, Mohammed Badr-eldin

Submitted April 14, 2011 - Accepted for Publication June 13, 2011

KEYWORDS: Non-functioning kidney; Fungal infection-Geotrichum; Squamous cell carcinoma

CORRESPONDENCE: Anubha Singh Yadav, Department of Urology, Pt. BDS PGIMS, University of Health Sciences, Rohtak ().

CITATION: UroToday Int J. 2011 Oct;4(5):art 62. doi:10.3834/uij.1944-5784.2011.10.04