Volume 5

UIJ Volume 5 2012

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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


Antegrade and Retrograde Endoscopic Manipulation of a Complete Posterior Urethral Stricture


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 


Primary Myeloid Sarcoma of the Urinary Bladder


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


Ureteric Endometriosis with Adenomyosis: A Rare Association Leading to the Death of a Kidney


A 34-year-old female presented with recurrent right flank pain with severe dysmenorrhoea. She was diagnosed with a right parametrial mass encasing the right ureter, leading to severe hydroureteronephrosis and non-functioning kidney. Initially she was managed with danazol and showed a positive response but there was a relapse following cessation of danazol. Finally, we performed a right nephroureterectomy with total abdominal hysterectomy and a bilateral salpingo-oophorectomy. The histopathological examination showed right ureteric wall involvement of endometrial tissue, adenomyosis, and chocolate ovarian cysts. The patient is doing well in the last 12 months of follow-up.

Dheeraj Kumar Gupta, Vishwajeet Singh, Rahul Janak Sinha, Pushp Lata Sankhwar

Submitted January 18, 2012 - Accepted for Publication February 17, 2012

KEYWORDS: Ureteric endometriosis, renal loss, chronic pelvic pain

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

CITATION: UroToday Int J. 2012 August;5(4):art 39.http://dx.doi.org/10.3834/uij.1944-5784.2012.08.12


Renal Cell Carcinoma Presenting with Inguinal Metastasis: A Rare Presentation


Renal cell carcinoma has myriad presentations. Inguinal metastasis at presentation is a rare finding in this tumor. Possible mechanisms of such metastasis may include retrograde lymphatic spread or spread via retrograde spermatic vein flow. Excision of the left inguinal nodal mass was done with a left radical nephrectomy. At a 1-year follow-up, there was no evidence of any locoregional or systemic recurrence, even in the absence of systemic adjuvant immunotherapy.

Amit Attam, Arun Kerketta, Sameer Trivedi, Udai Shankar Dwivedi

Submitted April 9, 2012 - Accepted for Publication May 17, 2012

 KEYWORDS: Renal cell carcinoma, inguinal metastasis, varicocele

CORRESPONDENCE: Sameer Trivedi, MCh, Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India ()

CITATION: UroToday Int J. 2012 August;5(4):art 41. http://dx.doi.org/10.3834/uij.1944-5784.2012.08.14


A Multi-institutional Study Demonstrating the Safety and Efficacy of Holmium Laser Ureterolithotripsy


Purpose: To present the results of a large multi-institutional series of patients treated with ureteroscopic holmium laser lithotripsy (UHLL) for ureteric stones; demonstrating its safety and efficacy in different age groups, stone locations, and other special situations.

Materials and Methods: The medical records of 239 patients with ureteral stones managed by UHLL were reviewed. Patients’ medical records were reviewed for age, sex, stone laterality, location, the number and size of stones, the need for ureteral dilation, stenting, and residual fragment extraction.

Results: The 239 patients included 199 males and 40 females. The mean age was 40.6 years (range: 5 to 93 years). Six patients had bilateral ureteric stones that were managed in 1 session. The average stone burden was 9.8 mm (range: 4 to 20 mm). The 239 patients harbored 272 ureteral stones and underwent 255 UHLL sessions. Acute ureteral dilation was performed just prior to ureteroscopy in 73 procedures (28.6%). Stone retrieval was done in 124 (48.6%) of the procedures. Twenty-six patients presented with renal insufficiency and were rendered stone-free with UHLL. Following ureteroscopy, minimal stone clearance was noted on the first postoperative day (20%) but improved to 96% after 3 months. The success rate after a single session was 96.3% and increased to 99% after 2 sessions.

Conclusion: This study demonstrates 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. Good stone clearance was also obtained in patients with renal impairment.

 Ahmed S Safwat, Nabil K Bissada, Udaya Kumar, Mahmoud M Osman, Toulupe Bakare, Ehab Eltahawy, Samy Heshmat

Submitted April 17, 2012 - Accepted for Publication June 17, 2012

 KEYWORDS: Urinary stones, ureteral calculi, lithotripsy, laser, anuria

CORRESPONDENCE: Mahmoud M Osman, MD, Department of Urology, Assiut University Hospital, Assiut 71516, Egypt ()

CITATION: UroToday Int J. 2012 August;5(4):art 34. http://dx.doi.org/10.3834/uij.1944-5784.2012.08.07


Retroperitoneum Beyond the Kidney: Retroperitoneal Sarcomas in a Urology Department


Primary adult soft tissue sarcomas represent 1% of all cancers and represent a treatment challenge for surgeons and oncologists. Of these sarcomas, 15% are located in the retroperitoneum. Randomized series that have examined both radiation therapy and chemotherapy have not shown a survival benefit. Conversely, radiotherapy may delay the time to local recurrence but not overall survival. Our review presents medical records of 5 consecutive patients undergoing retroperitoneal sarcoma excision from May 2004 through February 2006. Images were obtained from the patients’ exams and during their surgical procedures. Surgery is the only potential curative treatment as “retroperitoneal surgeons.” Urologists are completely able to approach these kinds of tumors.

BJ Pereira, R Borges, R Leão, V Grenha, H Coelho, A Brandão, P Temido

Submitted April 4, 2012 - Accepted for Publication April 23, 2012

KEYWORDS: Retroperitoneal sarcomas, liposarcoma, angiosarcoma, rhabdomyosarcoma, pararenal mass, retroperitoneal surgery

CORRESPONDENCE: Bruno Jorge Pereira, MD, Urology Department, Centro Hospitalar de Coimbra, Hospital dos Covões, Quinta dos Vales, São Martinho do Bispo, Coimbra, Protugal ()

CITATION: UroToday Int J. 2012 August;5(4):art 35. http://dx.doi.org/10.3834/uij.1944-5784.2012.08.08


Penile Fractures: Tertiary Center Experience and a Review of the Literature


Objectives: To analyze the clinical presentation, investigations, and outcome of the surgical treatment of penile fractures.

Methods: We present a retrospective study of 18 consecutive cases of penile fracture presented to our institution from March 2008 to August 2011. All patients were completely evaluated and emergency surgical repair was carried out. The outcome of the surgical repair was analyzed.

Results: Trauma during sexual intercourse was the most common cause of penile fracture. Ultrasonography was accurate in localizing tunical defect in 16 cases. Six patients presented 24 hours after injury. Following surgical repair, 2 patients had painful erection and 1 patient had mild chordee. None of the patients had erectile dysfunction.

Conclusion: Ultrasonography is a good adjunct to clinical examination in diagnosing penile fracture. The long-term outcome of surgical repair is good in all groups, including delayed presentation.

Avinash T Siddaiah, Madhumohan R Prabhudessai, Prashant R Lawande, Nilesh B Talwadker, Rajeev N Palvia, Elphiston Fernandes, Pravin Govardhane, Pankaj D Chari, Prashant TN Mandrekar

Submitted March 14, 2012 - Accepted for Publication April 9, 2012

KEYWORDS: Erectile dysfunction, rupture, ultrasonography, penis, urethra

CORRESPONDENCE: Avinash T Siddaiah, Department of Urology, Goa Medical College, Bambolim, Goa, 403202, India ()

CITATION: UroToday Int J. 2012 August;5(4):art 36. http://dx.doi.org/10.3834/uij.1944-5784.2012.08.09


Penile Carcinoma with Umbilical Metastasis: A Rare Case Report


Penile carcinoma with metastasis to umbilicus is a rare entity. We report a case of penile carcinoma with umbilical metastasis in a 46-year-old male. On initial presentation with penile growth over glans and shaft of the penis he was treated by total penectomy with perineal urethrostomy. Three months later, he developed a painful ulcerative mass over umbilicus. Biopsy from the ulcer confirmed metastasis from squamous cell carcinoma penis. Chemotherapy was given, but the patient succumbed to the disease after the first cycle. 

 Simanta Jyoti Nath, Rajeev T Puthenveetil, Saumar J Baruah, Sasanka K Barua, Puskal K Bagchi, Bikash Bawri

Submitted March 8, 2012 - Accepted for Publication April 9, 2012

 KEYWORDS: Carcinoma penis, penectomy, umbilical metastasis

CORRESPONDENCE: Simanta Jyoti Nath, MD, Department of Urology, Gauhati Medical College Hospital, Bhangagarh, Guwahati PIN-781032, Assam, India, ()

CITATION: UroToday Int J. 2012 August;5(4):art 37. http://dx.doi.org/10.3834/uij.1944-5784.2012.08.10


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