Volume 5

UIJ Volume 5 2012

Percutaneous Nephrolithotomy in Solitary Kidneys with or without Renal Failure: Does Nadir Serum Creatinine Predict Long-Term Renal Function?

ABSTRACT

Aim: To present our experience of performing percutaneous nephrolithotomy (PNL) in solitary kidneys with or without renal failure, and assessing the postoperative complications and importance of nadir serum creatinine as marker of long-term renal function.

Materials and Methods: In a retrospective study, the records of 28 patients with solitary functioning kidney (N = 12) or congenital solitary kidney (N = 16) underwent PNL between January 2004 to July 2012 were analyzed. Mild renal failure (creatinine: 1.6 to 3.0 mg %) was present in 4 patients and moderate renal failure (creatinine: 3.1 to 6.0 mg %) was present in 8 patients. Internal ureteral stenting was performed in renal failure cases, except in 4 patients who required percutaneous nephrostomy and had moderate renal failure with infected hydronephrosis. Diabetes mellitus and/or hypertension were present in 9 patients. Complete stone clearance was achieved in all except 2 cases, which had clinically significant residue (CSR) of 8 mm. Both these required shock-wave lithotripsy (SWL) and they were stone free at 4 weeks. The patients were followed up with serum creatinine and a renal ultrasound.

Results: Gross hematuria requiring blood transfusion was observed in 4 patients. All these patients initially presented with moderate renal failure, infected hydronephrosis, diabetes mellitus, and hypertension. The median follow-up was 42.5 months. The nadir serum creatinine followed internal stenting or nephrostomy if it remained above the baseline; it failed to touch the normal level following PNL.

Conclusion: PNL in solitary functioning or congenitally solitary kidneys is a safe and effective procedure. The bleeding is the commonest complication, and it can be managed conservatively. The nadir serum creatinine remains the most important predictor of long-term renal function.


Vishwajeet Singh, Rahul Janak Sinha, Manoj Kumar, Dheeraj Kumar Gupta, Deeapak Nagathan, Arvind Gupta

Submitted August 2, 2012 - Accepted for Publication October 3, 2012


 KEYWORDS: Percutaneous nephrolithotomy, solitary kidney, predictor of renal function

CORRESPONDENCE: Vishwajeet Singh, MS, MCh (Urology), Chhatrapati Shahuji Maharaj Medical University (Formerly KGMC), Lucknow, Uttar Pradesh, India ()

CITATION: UroToday Int J. 2012 December;5(6):art 60. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.05

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Enterovesical Fistulae in Crohn Disease: A Series of 7 Cases

ABSTRACT

Background: Crohn disease is a chronic inflammatory disease of the bowel that may affect the urinary system.

Objective: The authors review their experience, evaluating the incidence, and examining the various modalities employed in the diagnosis and treatment of patients with Crohn disease complicated by fistulae.

Methods: Of 541 patients with confirmed Crohn disease treated and followed in the Department of Gastroenterology in La Rabta University-Hospital in Tunisia between 1995 and 2010, 7 patients (1.3%) were found to have enterovesical fistulae.

Results: A fistula was diagnosed preoperatively in 6 patients. Six patients underwent resection of the diseased intestinal segment with bladder repair, and a temporary stoma in 1 case.

Conclusion: Enterovesical fistulae complicating Crohn disease is often clinically suspected preoperatively. Treatment, based on resection of the diseased bowel and extirpation of the fistula, can be accomplished with minimal morbidity and mortality.


Sallami Satáa, Nadia Ben Mustapha, Houda Boussorra, Meriam Serghini, Lamia Kallel, Jalel Boubaker, Monia Fekih, Azza Filali

Submitted June 14, 2012 - Accepted for Publication July 31, 2012


KEYWORDS: Enterovesical fistula, Crohn disease, bladder, inflammation

CORRESPONDENCE: Sallami Satáa, MD, La Rabta Hospital-University, Tunis, Tunis, Tunisia ()

CITATION: UroToday Int J. 2012 December;5(6):art 58. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.03

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Correlation Between Gleason Scores on Prostatic Biopsies and Prostatectomy Specimens in 40 Patients Undergoing More Than 12 Core Biopsies

ABSTRACT

Summary: The Gleason score obtained on prostatic biopsies is a key parameter in the management of localized prostate cancer.

Objectives: We conducted this study to evaluate the correlation between Gleason scores (GS) obtained on prostate biopsies and radical prostatectomy to establish the accuracy of biopsy grading in the prediction of final grades.

Materials and Methods: Forty patients with localized prostate cancer diagnosed between 2000 and 2010, and treated with radical prostatectomy, were included in this study. All patients underwent transrectal needle biopsies (TRNB) with at least 12 cores. Gleason scores on biopsies and radical prostatectomy specimens were determined and the concordance between the 2 scores was then evaluated. Histological grading using the conventional Gleason grading system (3 groups) and the modified Gleason grading system (5 groups) was also performed. The correlation between grades obtained on biopsies and radical prostatectomy specimens was also evaluated.

Results: The mean age of patients was 61.1 years, with a mean PSA value of 10 ng/ml. In 32.5% of cases, the biopsy’s Gleason score correlated with the one obtained on radical prostatectomy. Using the conventional Gleason grading system, the correlation highly improved, with 62.5% of patients remaining in the same group after radical prostatectomy. However, using modified Gleason grading, the correlation was slightly improved and estimated at 37%.

Conclusion: In this study we have noticed that the accuracy of Gleason scores determined by transrectal needle biopsy in patients with prostate cancer seems unreliable. The classification of patients into 3 distinct groups (well, moderately, and poorly differentiated tumors) increases the concordance between the biopsy GS and the definitive GS, but the modified Gleason grading system seems to be more precise and better reflects the Gleason score.


Sallami Satáa, Ines Chelly, Amira Ben Salem, Hanen Chorfi, Haifa Nfoussi, Nidhameddine Kchir

Submitted June 11, 2012 - Accepted for Publication July 9, 2012


KEYWORDS: Prostate carcinoma, prostate biopsy, radical prostatectomy, pathology, Gleason score

CORRESPONDENCE: Sallami Satáa, MD, La Rabta Hospital-University, Tunis, Tunis, Tunisia ()

CITATION: UroToday Int J. 2012 December;5(6):art 57. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.02

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Lower Urinary Tract Symptoms and Benign Prostate Hyperplasia

ABSTRACT

Objectives: This article’s purpose is to review and discuss the relationship between urinary tract symptoms (LUTS) and renal damage, bearing in mind the epidemiology and pathophysiology of benign prostatic hyperplasia (BPH) and potential association.

Methods: Concerning the increasing number of elderly patients in urology clinics and the incidence of LUTS, the relationship between renal damage and LUTS should be an important issue. The authors searched literature in PubMed in order to correctly identify the pathophysiology and clinical correlation connecting these 2 entities.

Results: BPH is a common disease in adult men and its incidence is age related. Clinical BHP usually refers to the palpable enlargement of the prostate, which can be detected by physical or imaging examination, or by the presence of urinary symptoms loosely defined as LUTS. Despite the many possible causes of obstructive kidney disease, in studies of elderly patients with acute renal failure, the most common cause among all patients was BPH. Considering the high prevalence of BPH in older men with chronic kidney disease (CKD) it is invaluable to take into consideration the relationship between these 2 clinical entities.

Conclusion: Clinical and scientific findings show a worrisome and undiagnosed number of silent urinary obstruction symptoms that can lead to renal damage. This paper emphasizes that renal damage secondary to BPH, clinically manifested by lower urinary tract symptoms, is a preventable disease and must be under the care of physicians.


Ricardo Leao, Bruno Pereira, Hugo Coelho

Submitted August 6, 2012 - Accepted for Publication September 12, 2012


KEYWORDS: Benign prostate hyperplasia (BPH), chronic kidney disease (CKD), lower tract urinary symptoms (LUTS), renal disease

CORRESPONDENCE: Ricardo Leao, MD, Department of Urology and Renal Transplantation, University Hospital Center, Quinta dos Vales, Sao Martinho do Bispo, Coimbra, Portugal ()

CITATION: UroToday Int J. 2012 December;5(6):art 56. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.01

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Isolated Renal Hydatid Cyst: A Rare Occurrence

ABSTRACT

A 20-year-old female presented with upper abdominal pain. The renal function tests and liver function tests were within normal range. The abdominal ultrasound revealed a complex cystic mass in the left kidney. The contrast-enhanced CT scan showed a hypoattenuating, left-sided cystic renal mass at the upper pole with a well-defined margin and fine areas of calcification. Immunological tests for hydatid disease were positive. The patient was pre- and postoperatively managed with 10 mg/kg per day of albendazole for 2 weeks, and the hydatid cyst was excised through the retroperitoneal route. The cut section and histopathological examination were consistent with a hydatid cyst. Follow-up with a renal ultrasound showed normal findings and no evidence of new cyst reappearance. The patient is doing well in follow-up care.


 Vishwajeet Singh, Rahul Janak Sinha, Dheeraj Kumar Gupta, Ajay Singh, Mohit Pandey, Sanjay Bhat

Submitted July 13, 2012 - Accepted for Publication July 23, 2012


KEYWORDS: Hydatid cyst, renal hydatid, isolated renal hydatid, echinococcus cyst, cystic renal mass

CORRESPONDENCE: Vishwajeet Singh, MS, MCh (Urology), Chhatrapati Shahuji Maharaj Medical University (Formerly KGMC), Lucknow, Uttar Pradesh, India ()

CITATION: UroToday Int J. 2012 October;5(5):art 55. http://dx.doi.org/10.3834/uij.1944-5784.2012.10.14

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Labial Nodular Fasciitis: A Rarity with Benignity

ABSTRACT

A middle-aged woman presented with a right labial mass that had been gradually increasing for 2 years. There were no other associated symptoms. The local examination of swelling showed a right labial mass of approximately 10 cm x 10 cm, which was not tender, firm, and had side-to-side mobility. Fine-needle aspiration cytology was negative for malignant cells. The contrast computed tomography (CT) scan of the pelvis showed a large, well-encapsulated homogenously enhancing mass. The patient was planned for excision of the mass through the transvaginal route. The histopathological examination was consistent with nodular fasciitis.

Nodular fasciitis is a common reactive mesenchymal proliferation that mimics some of the benign and malignant soft-tissue masses. The labium is the preferred location for a number of mesenchymal tumors and tumor-like lesions, including the postoperative spindle cell nodule, aggressive angiomyxoma, angiomyofibroblastoma, and nodular fasciitis. The urologist/gynecologist must have awareness about this rare lesion, and it must be differentiated from other mesenchymal lesions because of its benign nature.

Herein, we present a case of labial nodular fasciitis that was large, in comparison to those reported in English literature. The patient is asymptomatic and doing well in 1 year of follow-up care.


Vishwajeet Singh, Dheeraj Kumar Gupta, Rahul Janak Sinha

Submitted June 11, 2012 - Accepted for Publication July 23, 2012


KEYWORDS: Nodular fasciitis, benign vulvar lesion, labial mass

CORRESPONDENCE: Vishwajeet Singh, MS, MCh (Urology), Chhatrapati Shahuji Maharaj Medical University (Formerly KGMC), Lucknow, Uttar Pradesh, India ()

CITATION: UroToday Int J. 2012 October;5(5):art 56. http://dx.doi.org/10.3834/uij.1944-5784.2012.10.15

 

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Rupture of the Renal Pelvis of a Ureteropelvic Junction Hydronephrosis After Blunt Abdominal Trauma

ABSTRACT

Blunt abdominal trauma with an isolated abnormal kidney rupture is a rare clinical entity. The correct preoperative diagnosis may be difficult and challenging because of the insidious onset, lack of obvious bleeding, and, frequently, lack of urinary symptoms.

We present a case of a 22-year-old female with isolated pelvic rupture of a hydronephrotic left kidney secondary to a strong punch in the flank. She underwent a computerized tomography that showed a large retroperitoneal collection, with a poor functioning left kidney. Surgical exploration revealed a large rupture of the renal pelvis. She underwent nephrectomy.

Hydronephrosis may be a fortuitous discovery after blunt trauma. The diagnostic features at presentation and the decision-making of surgical management are discussed. The medicolegal aspects of the case are evaluated.


Sallami Satáa, Ben Rhouma Sami, Hmidi Mohamed, Chtourou Meher

Submitted March 20, 2012 - Accepted for Publication May 7, 2012


KEYWORDS: Kidney, congenital, renal pelvis, rupture, abdominal trauma, hemorrhage, retroperitoneal space

CORRESPONDENCE: Sallami Satáa, MD, La Rabta Hospital-University, Tunis, Tunisia ()

CITATION: UroToday Int J. 2012 October;5(5):art 53. http://dx.doi.org/10.3834/uij.1944-5784.2012.10.12

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A Rare and Late Complication of an Appendectomy: Distal Ureteral Fistula with Stenosis

ABSTRACT

Ureteric injury is a potential complication in various surgical procedures. The incidence varies between 0.5 and 10%. The risk of such complications is mainly related to the complexity of the surgical procedure and the presence of eventual periureteric pathology.

The most effective measure to prevent iatrogenic injury is to have a sound knowledge of abdominal and pelvic anatomy, meticulous surgical technique, and an identification of factors that increase the likelihood of developing such complications. As soon as the injury is identified, prompt urological referral is recommended.

We present a case of unusual ureteric stenosis and fistula after an open appendectomy.


Sallami Satáa

Submitted July 13, 2012 - Accepted for Publication July 23, 2012


KEYWORDS: Appendicitis, appendectomy, ureteric injury, stenosis, fistula

CORRESPONDENCE: Sallami Satáa, MD, La Rabta Hospital-University, Tunis, Tunisia ()

CITATION:UroToday Int J. 2012 October;5(5):art 54. http://dx.doi.org/10.3834/uij.1944-5784.2012.10.13

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Nephrogenic Adenoma In the Prostatic Urethra and In the Ureter: Urothelial Lesions Associated with Chronic Infections and Injuries In the Urinary Tract

ABSTRACT

Purpose: To report our findings on urothelial lesions diagnosed as nephrogenic adenomas and determine the importance of a correct clinical and anatomopathological interpretation.

Materials and Methods: We report the surgical and anatomopathological findings for 3 cases involving nephrogenic adenoma into the urothelium. One case was in the prostatic urethra of an 84-year-old male who underwent suprapubic prostatectomy due to benign prostatic hyperplasia. Another one was microscopic, and in the lumen of a 4 cm proximal ureteral stenosis of a 30-year-old man due to a ureteral perforation during an ultrasonic ureterolithotripsy 18 months prior. After repeated (6) transureteral endoscopic manipulations, always stented with a double-J ureteral catheter, we finally performed an excision of the ureteral stenotic segment and end-to-end ureteroureteral anastomosis. The final case was in a 5-year-old female, exhibiting recurrent urinary infections and renal lithiasis, who presented with a polypoid lesion in the proximal ureter that we detected and resected by ureteroscopy.

Results: In the older male patient, who underwent surgical manipulation with repeated vesical catheterizations and experienced recurrent urinary infections, the microscopic exam revealed benign prostatic hyperplasia and an incidental lesion 1 cm in diameter in the prostatic urethra with pathological characteristics of nephrogenic adenoma. In the younger male, the nephrogenic adenoma was incidentally found as a microscopic lesion in the ureteral fibrotic lumen. In the child’s case, she underwent an ultrasonic percutaneous nephrolithotripsy due to a voluminous renal calculus, which later resulted in residual obstructive renal calculi at the pyeloureteral junction that necessitated ureteroscopy for nephrocutaneous fistula. It was then that a 0.8 cm polypoid lesion was observed in the proximal ureter during implantation of a double-J ureteral catheter, which was resected and diagnosed as nephrogenic adenoma.

Conclusion: In areas of the urinary tract that have experienced recurrent urinary infections or traumas, or have undergone surgical manipulation, polypoid lesions can develop or appear microscopically. These lesions do not promote such chronic alterations but could result from them, likely due to cellular implants of renal tubules in areas of the urothelium in which the implantation is suitable and are recognized by microscopy as benign urothelial processes. Although such findings are rare, they likely occur more frequently than believed.


Ricardo LR Felts de La Roca, Guilherme B Lamacchia, Luiz Fernando G da Silva, Emilio M Pereira

Submitted May 31, 2012 - Accepted for Publication July 9, 2012


 KEYWORDS: Nephrogenic adenoma, urothelial lesion, recurrent urinary infections, ureter, prostatic urethra

CORRESPONDENCE: Ricardo Leo Roberto Felts de la Roca, MD, Jardim Paulista, São Paulo, SP, 01424-000, Brazil ()

CITATION: UroToday Int J. 2012 October;5(5):art 52. http://dx.doi.org/10.3834/uij.1944-5784.2012.10.11

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Chronic Ketamine Abuse Associated with Cholestasis and Cholangitis: A Case Report

ABSTRACT

Ketamine is an anesthetic drug that has been used in clinical settings since the 1960s. Unfortunately, this medication has been abused as a recreational drug among partygoers and youth over the last 30 years. Recently, mounting evidence has shown the association between chronic ketamine abuse and urinary tract complications. However, not many are aware that chronic ketamine abuse may also be responsible for cholestasis and cholangitis. We report a case of urinary tract complication from chronic ketamine abuse in combination with cholestasis, cholangitis, and early liver cirrhosis related to the drug. Public awareness about ketamine abuse and its complications should be communicated. Physicians should have a high index of suspicion for ketamine abuse in someone presenting with lower urinary tract symptoms along with jaundice, abdominal pain, and abnormal liver function.


Keat Seong Poh, Christopher Chee Kong Ho, Zulkifli Md Zainuddin

Submitted April 10, 2012 - Accepted for Publication April 30, 2012


KEYWORDS: Ketamine abuse, cholestasis, cholangitis, liver cirrhosis, urinary tract complication

CORRESPONDENCE: Keat Seong Poh, BSc, MD, MRCSEd, Universiti Kebangsaan Malaysia, Kuala Lumpur, Kuala Lumpur, Malaysia ()

CITATION: UroToday Int J. 2012 October;5(5):art 51. http://dx.doi.org/10.3834/uij.1944-5784.2012.10.10

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The Role of Ultrasound-Estimated Bladder-Wall Thickness In the Prediction of Detrusor Overactivity in Patients with Irritative Lower Urinary Tract Symptoms

ABSTRACT

Objective: To explore the specificity and sensitivity of increased bladder wall thickness as measured by transabdominal ultrasonography (TAU) for diagnosing detrusor overactivity (DO) in patients with lower urinary tract symptoms (LUTS) compared to the results of filling cystometry as a gold-standard diagnostic procedure.

Methods: This prospective study included 60 patients who were neurologically free with irritative LUTS. The study included 40 females and 20 males. Patients were divided into 2 groups. Group 1 included 40 patients with urodynamic evidence of DO and Group 2 (control) included 20 patients with normal urodynamic studies. All patients were submitted to a history, clinical examination, urine analysis and culture, blood chemistry, and pelviabdominal ultrasound.

Results: The mean age of Group 1 and Group 2 was 22.4 ± 2.4 and 27.6 ± 2.1 years, respectively. All patients had urgency. While 25% of patients in Group 1 had urge incontinence, no patients in Group 2 had urge incontinence. Those in Group 1 (65%) had nocturnal enuresis compared to 10% in Group 2; more than 1 patient had more than 1 complaint. The mean bladder-wall thickness as measured by TAU was significantly higher in Group 1 (5.2 ± 0.27 mm) than in Group 2 (2.8 ± 0.47 mm) (p < 0.001).

Conclusion: Transabdominal ultrasound is a sensitive diagnostic technique when predicting DO in patients with LUTS. This technique is noninvasive and easily performed in an office setting with negligible risks. Further studies are required to validate the findings of this study before this technique can be recommended as a primary diagnostic tool for DO.


Sabri M Khaled, Mahmoud M Ali, Bahaa Elmenshawy, Hamdy Abozeid, Mostafa E AbdelMagid

Submitted June 8, 2012 - Accepted for Publication July 31, 2012


KEYWORDS: Detrusor overactivity, bladder wall thickness, transabdominal ultrasound, urodynamics

CORRESPONDENCE: Sabri M Khaled, MD, Assistant Professor of Urology, Al-Azhar University, Eldarassa, Cairo, Egypt ()

CITATION: UroToday Int J. 2012 October;5(5):art 48. http://dx.doi.org/10.3834/uij.1944-5784.2012.10.07

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Open Ureterolithotomy In an Era of Endoscopic Surgery for a Patient with Spina Bifida: Was It an Appropriate Decision?

ABSTRACT

Despite advances in endoscopic surgery, there is still a limited role of open surgery in clinical practice. We report a case of a patient with spina bifida presented with a huge ureteric stone. The management of this case is briefly discussed in this report.


Justius Kok Hui Teo, Eng Hong Goh, Boon Wei Teoh, Kah Ann Git

Submitted March 19, 2012 - Accepted for Publication April 12, 2012


KEYWORDS: Spina bifida, myelomeningocoele, ureteric stone, open ureterolithotomy

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

CITATION: UroToday Int J. 2012 October;5(5):art 49. http://dx.doi.org/10.3834/uij.1944-5784.2012.10.08

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Letter from the Editor - August 2012

Dear Colleagues,

With new changes come new challenges and we at UroToday International Journal have seen our share. I want to thank our devoted readers and dedicated authors who continue to count on us for our broad content and urologic focus—the basis of which could not be possible without our many reviewers striving to make sure you get the information you need and the articles that matter most in the field. The future of UIJ is bright and we look forward to expanding our readership as the year progresses.

We would also like to encourage everyone to view the new social media outlets promoting the UIJ on both Facebook and Twitter. We hope you’ll take the time to visit our pages, like us, and follow our breaking news.

In this issue, Pereira et al. review medical records of five consecutive patients undergoing retroperitoneal sarcoma excision. Demonstrating that surgery is the only potential curative treatment, urologists can successfully approach these kinds of tumors.

By presenting the results of a large multi-institutional series of patients treated with ureteroscopic holmium laser lithotripsy (UHLL) for ureteric stones, Safwat et al. demonstrate that the use of holmium laser lithotripsy is a safe and effective modality in the treatment of ureteral stones regardless of sex, age, stone location, or stone size.

Siddaiah et al. analyze the clinical presentation, investigations, and outcome of the surgical treatment of penile fractures. Ultrasonography poses a positive adjunct to clinical examination, and the long-term outcome of surgical repair is good for all groups.

El-Tabey examines the management of urethral strictures utilizing the Memokath 044 stent, proving it is straightforward to insert and to remove, it can relieve the symptoms of bladder outlet obstruction due to recurrent bulbar urethral strictures in surgically risky patients. It maintains urethral patency without affecting sexual intimacy and improves quality of life.

Falahatkar et al. explain their primary experiences with laparoscopic pyeloplasty as the new probable gold standard in the treatment of ureteropelvic junction obstruction in comparison to open pyeloplasty. Through their research, they show that laparoscopic pyeloplasty is an excellent substitute due to its cosmetic advantages, faster returns to normal activity, and comparable results.

We also present a series of case studies that include various topics, including foot drop, ovarian dermoid cysts, and ureteric endometriosis with adenomyosis.

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 issue.

Warm Regards, 

Karl-Erik Andersson

Prostate Cancer Detection via Transrectal Ultrasound Biopsy: Vienna Nomogram Versus Sextant/Octant Biopsy Methods

ABSTRACT

Introduction: The use of a Vienna nomogram for the initial transrectal ultrasound (TRUS) biopsy was shown to produce higher cancer detection rates. However, a recent prospective study has found no significant differences in its cancer detection compared to octant biopsy. The study objective was to compare prostate cancer detection using the Vienna nomogram versus laterally directed sextant and octant biopsy methods.

Methods and Materials: This retrospective study included all patients with prostate-specific antigen (PSA) of 2 to 40 ng/ml, grouped into the Vienna nomogram (VN) or the sextant/octant (S/O) group. Patients were further subdivided according to prostate volume (> or < 50 ml) and age group (< 60 years and > 70 years). Statistical analysis was performed using chi square, Fisher's exact test, and t test, where appropriate. A p value of < 0.05 was considered significant.

Results: A total of 371 patients qualified with inclusion criteria (VN, n = 190, S/O, n = 181). There were no significant differences in the mean PSA value, age, PSA density, and prostate volume between the 2 groups. Cancer detection rates were slightly higher in the VN group for PSA of 2 to 40 ng/ml (20.5% versus 17.6%), PSA of 2 to 10 ng/ml (16.6% versus 13.7%), younger age (16.1% versus 10%), and prostate volumes above 50 ml. These differences were not significant.

Conclusion: The use of a Vienna nomogram did not offer significant advantages in cancer detection on initial TRUS biopsy compared to sextant or octant methods. Strategies employing the standard 8 to 10 core biopsy incorporating the lateral and apical zones should be used regardless of age and prostate volume.


Praveen Singam, Badrulhisham Bahadzor, Azlina Abas, Tan Guan Hee, Christopher Ho, Goh Eng Hong, Zulkifli M Zainuddin

Submitted June 6, 2012 - Accepted for Publication July 31, 2012


KEYWORDS: Prostate cancer, biopsy, Vienna nomogram, sextant

CORRESPONDENCE: Praveen Singam, Urology Unit, Department of Surgery, UKM Medical Center, Jalan Yaacob Latif, 56100 Cheras, Kuala Lumpur, Malaysia ()

CITATION: UroToday Int J. 2012 October;5(5):art 47. http://dx.doi.org/10.3834/uij.1944-5784.2012.10.06

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The Role of Sonourethrography In the Evaluation of Anterior Urethral Strictures: A Correlation with Retrograde Urethrography

ABSTRACT

Objective: Retrograde urethrography (RGU) is the most commonly used imaging modality for the evaluation of the anterior urethra. Sonourethrography (SUG) is another modality that is not so frequently used, though several studies have suggested its higher degree of sensitivity and specificity in anterior urethral stricture evaluation. The present prospective study has been done to compare the results of SUG with that of RGU and to probe its effect in decision making.

Patients and Methods: A total of 50 patients with anterior urethral stricture disease were evaluated with both SUG and RGU for stricture length, site location, and associated urethral pathologies. Collected information was used as a guide for the choice of surgery, and it was compared with operative findings.

Results: The mean lengths of strictures on SUG, RGU, and surgery were 20.46 cm, 17.14 cm, and 20.35 cm, respectively. Overall sensitivity and accuracy of SUG in predicting correct stricture length was 95.55 and 97.33%, respectively, and overall sensitivity and accuracy of RGU in predicting correct stricture length was 77.22 and 85.33%, respectively. Spongiofibrosis was noted only with SUG in 78 to 88% accuracy. In 32% of cases, the surgical plan changed when SUG results were taken into consideration along with RGU.

Conclusion: SUG is more accurate in measuring stricture length, especially that of the bulbar urethra. It simultaneously provides a better assessment of a diseased urethra. It should be used as an extension of the physical examination by the treating urologist as it helps in better preoperative surgical planning of anterior urethral strictures.


Vinod Priyadarshi, Mahendra Singh, Vijoy Kumar, Rajesh Tiwari, Sanjay Kumar Gupta, Nidhi Sehgal

Submitted May 7, 2012 - Accepted for Publication June 27, 2012


KEYWORDS: Sonourethrography, retrograde urethrography, anterior urethral stricture

CORRESPONDENCE: Vinod Priyadarshi, MBBS, MS, Senior Resident, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India ()

CITATION: UroToday Int J. 2012 October;5(5):art 46. http://dx.doi.org/10.3834/uij.1944-5784.2012.10.05

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Review of Current Outcomes of Prostate Artery Embolization to Treat Patients with Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia

ABSTRACT

The standard management of benign prostatic hyperplasia (BPH) is based on the overall health of the patient, on the severity of the lower urinary tract symptoms (LUTS), and on quality-of-life (QoL) considerations. Voiding difficulties attributable to BPH can be quantified with the American Urological Association Symptom Index score (AUA-SI) or International Prostate Symptom Score (IPSS). Various medications can decrease the severity of voiding symptoms secondary to BPH. Impotence, decreased libido, and ejaculatory disorders are known side effects.

The AUA guidelines indicate that patients with mild LUTS secondary to BPH (AUA-SI score < 8) and patients with moderate or severe symptoms who are not bothered by their LUTS should be managed using a strategy of watchful waiting. If the patient elects interventional therapy and there is sufficient evidence of obstruction, the patient and urologist should discuss the benefits and risks of the various interventions.

Transurethral resection of the prostate (TURP) is the most common interventional treatment, but it can be associated with bleeding, erectile dysfunction, and ejaculatory disorders in up to 10 to 65% of patients. The high prevalence rate of BPH has a tremendous impact on the health and quality of life of men. Increasingly, BPH therapy trends are moving away from the gold standard operation of TURP and toward less invasive pharmacological options and minimally invasive procedures provided in an outpatient setting.

Prostatic artery embolization (PAE) is a new BPH treatment under clinical investigation. PAE is a minimally invasive procedure that blocks the blood flow to the prostate, causing shrinkage of the gland. PAE is performed under local anesthesia as an outpatient procedure. A team of interventional radiologists, diagnostic radiologists, and urologists at the University of Sao Paulo Medical School are pioneers of the procedure, which has been widely reported since 2008. The multi-disciplinary team is encouraged by the data demonstrating PAE is a safe and effective minimally invasive treatment for patients with LUTS.


Francisco Cesar Carnevale, Alberto A Antunes, Joaquim M da Motta-Leal-Filho, Ronaldo H Baroni, Antonio SZ Marcelino, Luciana MO Cerri, Giovanni G Cerri, Miguel Srougi

Submitted March 29, 2012 - Accepted for Publication August 3, 2012


KEYWORDS: Benign prostate enlargement, benign prostatic hyperplasia, bladder outlet obstruction, transurethral resection of the prostate, prostatic artery embolization, lower urinary tract symptoms

CORRESPONDENCE: Francisco Cesar Carnevale, Chief, Interventional Radiology Section, Radiology Institute, Hospital das Clinicas, University of Sao Paulo Medical School, Rua Teodoro Sampaio, Sao Paulo, Sao Paulo, 05406-000, Brazil ()

CITATION: UroToday Int J. 2012 October;5(5):art 45. http://dx.doi.org/10.3834/uij.1944-5784.2012.10.04

ACRONYMS AND ABBREVIATIONS: BPE: benign prostate enlargement; BPH: benign prostatic hyperplasia; TURP: transurethral resection of the prostate; PAE: prostatic artery embolization; LUTS: lower urinary tract symptoms; PSA: prostate specific antigen; QoL: quality of life; IPSS: International Prostate Symptoms Score; IIEF: International Index of Erectile Function

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Correlation of Age, Prostate Volume, Serum Prostate-Specific Antigen, and Serum Testosterone in Indian, Benign Prostatic Hyperplasia Patients

ABSTRACT

Introduction and Objective: Benign prostatic hyperplasia is the most common neoplastic disorder affecting the aging male population worldwide. Various factors such as age, prostate volume, serum prostate-specific antigen, and testicular androgens determine the natural history and its progression. The objective of the study is to correlate the relationship between these factors in men with benign prostatic hyperplasia.

Methods: A total of 121 men aged above 50 years with benign prostatic hyperplasia were enrolled in this study. Patients were evaluated by history, digital rectal examination, focused neurological evaluation, uroflowmetry, transrectal ultrasonography of the prostate, serum prostate-specific antigen, serum testosterone (free and total), and prostate biopsy done in patients with prostate-specific antigen > 4 ng/ml to exclude prostatic carcinoma. Patients were divided by age, and a Spearman rank correlation test was done to compare variables.

Results: There was a positive correlation within age, prostate volume, and serum prostate-specific antigen level. Age negatively correlated with serum total and free testosterone level. A comparison among serum PSA, prostate volume, and serum testosterone level did not reveal any statistically significant relationship.

Conclusion: We observed statistically significant correlations within age, prostate volume, and serum prostate-specific antigen level. These variables bear no significant relationship with serum testosterone levels. Considering the contradictory data on the inter-relationship of various variables, further evaluation in a large cohort of the aging population with benign enlargement of the prostate is needed to establish the influence of one over the other.


Sasanka K Baruah, Simanta Jyoti Nath, Rajeev T Puthenveetil, Saumar J Baruah, Phanindra Mohan Deka, Bikash Bawri

Submitted May 21, 2012 - Accepted for Publication July 31, 2012


KEYWORDS: BPH, serum PSA, serum testosterone

CORRESPONDENCE: Sasanka K Baruah, Assistant Professor, Department of Urology, Gauhati Medical College Hospital, Guwahati, Assam, India ()

CITATION: UroToday Int J. 2012 October;5(5):art 43. http://dx.doi.org/10.3834/uij.1944-5784.2012.10.02

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Non-Contrast Computed Tomography Scan as a Predictor of Shock-Wave Lithotripsy Outcomes for the Treatment of Renal Stones

ABSTRACT

Purpose: We assess the value of non-contrast computed tomography (NCCT) as a possible predictor of renal stone disintegration by shock-wave lithotripsy (SWL), aiming for a better selection of patients.

Materials and Methods: Forty-five patients (27 males, 18 females) with a mean age of 39.1 ± 12.5 years were reviewed between August 2008 to September 2009. All patients had a solitary renal stone ranging in size from 5 to 25 mm. High-resolution NCCT was done and a bone window was used to measure stone attenuation values. SWL was performed with an electromagnetic lithotripter. Failure was defined as no stone fragmentation after 3 sessions. The impact of the patient’s sex, age, body mass index (BMI), stone location, volume, mean attenuation value, and the skin-to-stone distance on stone disintegration was statistically evaluated. The mean follow-up period was 3 months.

Results: The overall stone-free rate at 3 months was 84.4% (38 of 45 patients); 28 patients were stone free and 10 patients had residual fragments < 4 mm. The only significant predictor of residual fragments was stone density (p < 0.001). Failure of disintegration was observed in 7 patients (15.5%). Stone density > 1000 HU and BMI > 30 were the significant independent predictors of failure (p = 0.002 and 0.001, respectively).

Conclusion: Increased stone density as detected by NCCT is a significant predictor of failure to fragment renal stones by SWL. An alternate treatment should be devised for obese patients with a stone density > 1000 HU.


Ehab Mohamad Galal, Tarek Khalaf Fathelbab, Amr Mohamad Abdelhamid

Submitted June 4, 2012 - Accepted for Publication July 23, 2012


KEYWORDS: Stone density, shock-wave lithotripsy, non-contrast computed tomography

CORRESPONDENCE:Ehab Mohamad Galal, Urology Department, Minia University Hospital, Minia City, Egypt ()

CITATION: UroToday Int J. 2012 October;5(5):art 44. http://dx.doi.org/10.3834/uij.1944-5784.2012.10.03

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Antegrade and Retrograde Endoscopic Manipulation of a Complete Posterior Urethral Stricture

ABSTRACT

Purpose: We present our experience in doing an antegrade-retrograde maneuver in the form of cut-to-light or cut-to-sound in treating complete posterior urethral strictures.

Patients and Methods: Between April 2005 and November 2011, 31 patients out of 99 with posterior urethral strictures underwent endoscopic urethral dilation using ureteroscopes (UR) through suprapubic cystostomy and internal urethrotome reterogradely through the urethra. Their ages ranged between 16 to 70 years (mean: 35) and strictures were caused by car accidents in 19 patients, falls astride in 4, gunshots in 3, iatrogenics in 4, and a bomb explosion in 1. The length of the stricture was 4 to 10 mm (mean: 7.6).

Result: Operative time ranged between 20 to 70 minutes (mean: 37.74) and blood transfusion was needed in 2 patients. Cut-to-light was performed in 20 while cut-to-sound was performed in 11. Hospital stay ranged between 1 to 3 days. Catheter stay time was 2 to 4 weeks (mean: 2.4). Twenty-seven patients passed urine smoothly after removal of the catheter, and during a period of observation (10 days), 2 needed transurethral resection of the prostate (TURP) to pass urine strongly, so the success rate is 93.5%. Within 3 to 6 months, another 4 patients needed dilation so the success rate decreased to 80.6%. Another 2 needed dilation after 2 years, so the success rate dropped to 74.2%. Complications were in the form of bleeding in 2 patients and rectal injury in 1. Follow-up ranged between 3 and 24 months.

Conclusion: Antegrade-retrograde visual-internal urethrotomy is safe under supervision of the procedure in complete urethral strictures, so it is more or less acceptable. It markedly decreased operative time, hospital stay, and cost.


Tawfik Al-Ba’adani, Salah Ahmed, Shukri I Alfalah, Khaled Telha, Shehab Al-Germozi, Ibrahim Al-Nadhari, Ismail Al-Meslemi, Nabil Al-Gonaid, Mohammed Al-Ezi, Ibraheim El-Nono

Submitted May 11, 2012 - Accepted for Publication July 9, 2012


KEYWORDS: Antegrade-retrograde, posterior urethral stricture, urteroscope

CORRESPONDENCE: Tawfik Al-Ba’adani, MD, Sana'a University, Thawra Hospital, Sana'a, Yemen ()

CITATION: UroToday Int J. 2012 October;5(5):art 42. http://dx.doi.org/10.3834/uij.1944-5784.2012.10.01 

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Primary Myeloid Sarcoma of the Urinary Bladder

ABSTRACT

Leukemia is a systemic disease affecting both the hematological system and the extramedullary sites alike. Myeloid sarcoma has been defined as a localized tumor mass of immature cells of granulocytic lineage in extramedullary sites. Myeloid sarcoma usually occurs with or after the onset of systemic leukemia but rarely before it. Localized myeloid sarcoma presenting before the onset of systemic leukemic disease has been termed primary myeloid sarcoma. The most common extramedullary sites affected by myeloid sarcoma are the central neurological system and the testes. The kidneys are the most common genitourinary organ affected by myeloid sarcoma; however, the urinary bladder can be involved. Here we report a rare case of primary myeloid sarcoma of the urinary bladder.


Yeng Kwang Tay, David Pan, Sree Appu, Mark Frydenberg

Submitted March 12, 2012 - Accepted for Publication April 4, 2012


KEYWORDS: Primary myeloid sarcoma, bladder, granulomatous sarcoma

CORRESPONDENCE: Yeng Kwang Tay, MBBS, Monash Medical Centre, Melbourne, Victoria, Australia ()

CITATION: UroToday Int J. 2012 August;5(4):art 40. http://dx.doi.org/10.3834/uij.1944-5784.2012.08.13

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