Volume 5

UIJ Volume 5 2012

Pyeloplasty in Ureteropelvic Junction Obstruction: Laparoscopic or Open?

ABSTRACT

Introduction: Ureteropelvic junction obstruction (UPJO) can lead to symptoms such as hydronephrosis and progressive renal damage. We explain our primary experiences about laparoscopic pyeloplasty (LP) as the new probable gold standard in the treatment of UPJO in comparison with open pyeloplasty (OP).

Methods: Between March 2008 and August 2009, after confirming the diagnosis of UPJO, 21 patients underwent transperitoneal dismembered LP and 25 patients underwent dismembered OP. This selection was not randomized and was related to the surgeon’s experience. Success was assessed by IVU and diuretic renograghy 3 months after surgery. Important parameters were compared between 2 groups. P < 0.05 was considered statistically significant.

Results: No significant differences were seen in the mean age and gender between the 2 groups. LP (280 ± 95 minutes) had a significantly (p = 0.003) higher mean operating room time than OP (204 ± 59 minutes). The mean indwelling duration of drainage (LP: 2.5 ± 1.56 days; OP: 2.1 ± 1.14 days; p = 0.31) and the mean postoperative hospital stay (LP: 4.6 ± 1.76 days; OP: 4.3 ± 1.55 days; p = 0.934) were similar between the 2 groups. The mean dosage of postoperative analgesics and complication rates in LP (26.25 mg; 23.8%) were lower than OP (38.33 mg; 36%). But these differences were not significant. The mean duration of return to normal activity after discharge in LP was significantly lower than OP (3.9 versus 5.2 days; p = 0.002).

Conclusion: Despite a shorter operating room time of OP, LP is a gold substitute for OP even in primary experiences due to cosmetic advantages, faster returns to normal activity, and comparable results. Laparoscopic pyeloplasty can be the gold standard treatment for UPJO if LP is performed by experienced and skillful surgeons.


Siavash Falahatkar, Ali Roushani, Hamidreza Nasseh, Ehsan Kazemnezhad, Keivan Gholamjani Moghaddam, Seyedeh Mahboobe Raoofi, Mani Mohiti Asl, Ahmad Enshaei, Alireza Farzan

Submitted April 19, 2012 - Accepted for Publication June 1, 2012


KEYWORDS: Laparoscopic pyeloplasty, open pyeloplasty, ureteropelvic junction obstruction

CORRESPONDENCE: Keivan Gholamjani Moghaddam, MD, Urology Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Iran ()

CITATION: UroToday Int J. 2012 August;5(4):art 33. http://dx.doi.org/10.3834/uij.1944-5784.2012.08.06

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A Case Report of Foot Drop Following Visual Internal Uretherotomy In the Lithotomy Position: Is Prolonged Surgery In the Lithotomy Position the Only Important Risk Factor?

ABSTRACT

A 16-year-old boy underwent visual internal uretherotomy in the lithotomy position for short urethral stricture. The next day, the patient developed right foot drop and sensory loss over the right foot. Published literature describes a long surgery duration in the lithotomy position as the most significant risk factor. In our case, foot drop developed despite short surgical duration in the lithotomy position, signifying the importance of other, less-discussed factors.


 NH Nagaraja, Satyam Sharma, GB Manjuprasad

Submitted January 13, 2012 - Accepted for Publication February 28, 2012 


 KEYWORDS: Foot drop, VIU (visual internal urethrotomy), lithotomy, compartment syndrome

CORRESPONDENCE: Satyam Sharma, Mch, Department of Urology, Institute of Nephrourology, Bangalore, Karnataka, India ()

CITATION: UroToday Int J. 2012 August;5(4):art 38. http://dx.doi.org/10.3834/uij.1944-5784.2012.08.11

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Memokath 044 Stent for the Treatment of Recurrent Bulbar Urethral Strictures

ABSTRACT

Introduction: Urethral strictures are first described as causing bladder outlet obstruction in ancient literature dating back to the Greek and Egyptian period. The management of urethral stricture remains a challenge to all urologists, especially for those failing to respond to repeated dilatation or optical urethrotomy, and for strictures recurring after urethroplasty. So the idea is to use stents for preventing stricture recurrence based on mechanical interference, and to prevent the scarring process that ends in contraction.

Objective: In this study, we tried to assess the efficacy and safety of the Memokath 044 temporary stent in the treatment of recurrent bulbar urethral strictures.

Patients and Methods: Between April 2010 and May 2011, 16 patients presented with bladder outlet obstruction (BOO) due to recurrent bulbar urethral strictures. All underwent Memokath 044 stenting. The stents were inserted endoscopically under local or saddle-block anesthesia. Patients were followed up with Qmax , post-void residual urine (PVR), sexual function, and quality of life (QoL) scores at 2 weeks, 1 month, 3 months, 6 months, and 12 months, post-insertion.

Results: All the stents were successfully inserted. The operative time ranged from 20 to 40 minutes (30 ± 6.45) with no intraoperative complications. All patients achieved spontaneous voiding after insertion. The mean Qmax, PVR, and QoL scores significantly improved after the procedure and continued to improve throughtout the follow-up period. There were minimal postoperative complications; transient and treated conservatively. Stent migration took place in 6.25% of cases with easy endoscopic repositioning. Obstruction of the stent lumen occurred in 6.25%, which mandated stent removal.

Conclusion: The Memokath 044 stent is straightforward to insert and to remove, it can relieve the symptoms of BOO due to recurrent bulbar urethral strictures in surgically risky patients, maintaining urethral patency without affecting sexual intimacy and thereby improving the quality of life.


Magdy Ahmad Alsayed El-Tabey

Submitted April 2, 2012 - Accepted for Publication May 3, 2012


KEYWORDS: Uerthral stricture, Memokath 044, stent, bladder outlet obstruction

CORRESPONDENCE: Magdy Ahmad Alsayed EL-Tabey, MD, Department of Urology, Benha University Hospital, Benha, Egypt ().

CITATION: UroToday Int J. 2012 August;5(4):art 29. http://dx.doi.org/10.3834/uij.1944-5784.2012.08.02

Acronyms and Abbreviations

Qmax: Maximum flow rate UTI: Urinary tract infection

PVR: Post-void residual urine

QoL: Quality of life

BOO: Bladder outlet obstruction

VIU: Visual internal urethrotomy

AUR: Acute urinary retention

BPH: Benign prostatic hyperplasia

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Metastatic Breast Carcinoma Masquerading as Obstructive Uropathy: A Rare Clinical Presentation

ABSTRACT

Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in females worldwide, accounting for 23% of total new cancer cases and 14% of total cancer deaths in 2008. Common metastatic sites include the lungs, bones, liver, lymph nodes, and skin. Less frequently it involves the brain, adrenal glands, ovaries, spleen, pancreas, kidney, thyroid, and heart. There are reports of unusual sites of breast cancer metastases; the urinary bladder and retroperitoneum are considered some of these unusual sites. Metastasis usually occurs many years after diagnosis, and the prognosis is poor. Breast carcinoma metastatic to the retroperitoneum has been reported only sporadically. We report a rare presentation of occult breast carcinoma with obstructive uropathy.


Waleed Mansour Shabana, Tariq Tassadaq, Hosam Al-Oudah, Syed Gillani, Hisham Abu-Taha, Sameh Barayan

Submitted February 13, 2012 - Accepted for Publication February 28, 2012


KEYWORDS: Breast carcinoma, obstructive uropathy

CORRESPONDENCE: Waleed Mansour Shabana, PhD, Zagazig University, Zagazig, Sharkia, Egypt ()

CITATION: UroToday Int J. 2012 August;5(4):art 32. http://dx.doi.org/10.3834/uij.1944-5784.2012.08.05

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Ovarian Dermoid Cyst Perforating Into the Urinary Bladder

ABSTRACT

Ovarian dermoid cysts are common lesions accounting for up to 40% of all ovarian neoplasms. Most of the cases are asymptomatic. Symptoms develop once complications set in. Invasion into adjacent viscera such as the rectum, the small bowel, the peritoneum, and the urinary bladder is extremely rare. We present a rare case of ovarian dermoid cyst perforating into the urinary bladder presenting with irritative lower urinary tract symptoms characterized by urgency, frequency, dysuria, poor urine stream, and the passage of hairs and seborrhoeic gravels through the urethra for last 7 years.


Sanjay Kumar Gupta, Manoj Kumar, Mahendra Singh, Vijoy Kumar, Rajesh Kumar Tiwari, Sanjay Kumar Suman, Vijayanand Choudhary

Submitted January 6, 2012 - Accepted for Publication January 26, 2012


KEYWORDS: Dermoid cyst, urinary bladder, ovary, perforation, teratoma

CORRESPONDENCE: Sanjay Kumar Gupta, MS, General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India ()

CITATION: UroToday Int J. 2012 August;5(4):art 31. http://dx.doi.org/10.3834/uij.1944-5784.2012.08.04

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A Rare Case of Fungus Balls of the Urinary Bladder Due to Candida Tropicalis

 

ABSTRACT

A fungus ball of the urinary bladder is unusual and it is even more so in cases in which the causative agent is candida tropicalis. We present such a case and briefly discuss the management of a fungus ball of the urinary tract caused by candida tropicalis.


Sivaneswaran Lechmiannandan, Eng Hong Goh, Boon Wei Teoh, Kah Ann Git

Submitted March 5, 2012 - Accepted for Publication April 4, 2012


KEYWORDS: Fungus ball, bladder

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 August;5(4):art 30. http://dx.doi.org/10.3834/uij.1944-5784.2012.08.03

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Post-cesarean Vesicouterine Fistulae: A Report on a Case and an Update of the Literature

ABSTRACT

Vesicouterine fistula (VUF) is an abnormal communication between the posterior wall of the bladder and the anterior wall of the uterus. Although it represents only 1 to 4% of all urogenital fistulae, its prevalence is increasing all over the world because of the large indications of cesarean section. VUF usually presents with urine leak, amenorrhoea, and cyclic hematuria. It has a considerable marital and social impact and may cause serious urogenital infections. Herein we report on one more case of VUF following cesarean section with review and update of the recent literature regarding the aetiological, diagnostic, and therapeutic aspects of this entity. Some suggestions are mentioned concerning surgical repair and how to minimize their occurrence.


Benatta Mahmoud, Sallami Satáa

Submitted October 24, 2011 - Accepted for Publication March 14, 2012


KEYWORDS: Vesicouterine fistula, cesarean section, surgery, prevention

CORRESPONDENCE: Benatta Mahmoud, MD, Department of Urology, Ehu Oran, Oran, Algeria ().

CITATION: UroToday Int J. 2012 August;5(4):art 28. http://dx.doi.org/10.3834/uij.1944-5784.2012.08.01

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Letter from the Editor - June 2012

Dear Colleagues, 

UroToday International Journal has seen a lot of changes over the years, and as we have grown and evolved with the times, we have continued to focus on accessible, informative content catering to our extensive urology readership. That being said, we knew it was time for some enhancement.

We recently debuted the improved UIJ website, with superior search functionality, an easy-to-navigate archive, and a host of other enhanced options to make each visit to the journal not just productive but enjoyable. We hope that once you’ve browsed our most recent issue, you’ll take a tour of the site to see our fresh, new face. 

In this issue, Siami et al. discuss an effective and generally well-tolerated alternative administration method for intra-abdominal histrelin acetate implants in patients with advanced prostate cancer.

Rasmussen and team determine the results of a 60-person survey regarding the results of anticholinergic therapy on post-void dribbling. Their results suggest anticholinergic medications appear effective in treating PVD with efficacy similar to that of OAB.

Presented in their URO-RISK study, Mendive et al. investigate the epidemiological significance of urinary incontinence and overactive bladder in a primary care setting. They conclude that a higher level of health care be made available.

Elkoushy et al. compare and contrast three different lithotripters and their results during shock wave lithotripsy re-treatment. The big three—Storz, Siemens, and Philips—provide some interesting outcomes.

Al-Ba’adani and colleagues present their expertise in performing tubeless percutaneous nephrolithotomy as well as their diagnoses for indications, safety, and effectiveness.

We also present a variety of case reports, including acute penile prosthesis, ectopic kidney, and robotic partial nephrectomy.

With our new makeover comes a host of possibilities, and we hope that our dedicated readers, writers, and researchers get the most out of each and every article, CME, and case diagnosis available. 

Warm Regards, 

Karl-Erik Andersson

A Retrospective Study Evaluating the Efficacy and Tolerability of Intra-abdominal, Once-yearly Histrelin Acetate Subcutaneous Implants in Patients with Advanced Prostate Cancer

ABSTRACT

Introduction: Luteinizing hormone-releasing hormone (LHRH) agonists are an androgen deprivation therapy used in advanced prostate cancer. The LHRH agonist histrelin is available as an implant of histrelin acetate for once-yearly subcutaneous administration into the upper arm. A single-center, clinical retrospective chart review was performed to characterize the safety and efficacy of abdominal insertion of the histrelin acetate implant.

Methods: Data were collected retrospectively from the charts of 64 patients aged > 45 years with prostate cancer who received the histrelin acetate implant subcutaneously inserted into the abdomen at a single center. Of these, 37 patients received a second implant after 1 year.

Results: Following the first implant, mean serum testosterone levels were 0.38 nmol/L (10.89 ng/dL) at 6 months (n = 19) and 0.52 nmol/L (14.96 ng/dL) at 12 months (n = 33); serum testosterone level was < 1.04 nmol/L (< 30 ng/dL) in 94.7 and 90.9% of patients at 6 and 12 months, respectively. Mean serum prostate-specific antigen levels were 6.56 μg/L (6.56 ng/mL) at 6 months (n = 23) and 4.58 μg/L (4.58 ng/mL) at 12 months (n = 40). Efficacy was maintained in patients who received a second implant. Adverse events occurred in 3 patients. Eleven patients died during the chart review period; these deaths were deemed unrelated to histrelin acetate implant use.

Conclusion: Insertion of the histrelin acetate implant into the abdomen appears to be an effective and generally well-tolerated alternative administration method.


Paul F Siami, Knox Beasley, Sean Woolen, Joseph Zahn

Submitted December 9, 2011 - Accepted for Publication April 4, 2012


KEYWORDS: histrelin acetate, implant, prostate cancer, subcutaneous

CORRESPONDENCE: Paul F Siami, MD, Department of Urology, Deaconess Clinic, 421 Chestnut Street, Evansville, Indiana, 47713, United States ().

CITATION:UroToday Int J. 2012 June;5(3):art 26. http://dx.doi.org/10.3834/uij.1944-5784.2012.06.13

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Scrotal Swelling and Penile Fistula in a Patient with Crohn’s Disease

ABSTRACT

Crohn’s disease often is detected in adolescents with nonspecific gastrointestinal complaints. Extraintestinal complications are common but usually follow the onset of the bowel complaints. We present an unusual case in which scrotal swelling was the first symptom in a patient discovered to have Crohn’s disease. This is particularly unusual in that the patient presented as a case of urethral fistula.


Houda Boussourra, Sallami Satáa, Yosra Said, Hatem Rajhi, Najla Menif

Submitted October 1, 2011 - Accepted for Publication October 24, 2011


KEYWORDS: Crohn’s disease, diagnostic, fistula, complication, penis, MRI, treatment

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

CITATION: UroToday Int J. 2012 June;5(3):art 25. http://dx.doi.org/10.3834/uij.1944-5784.2012.06.12

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The Era of Tubeless Percutaneous Nephrolithotomy

ABSTRACT

Objective: To prescribe our experience in performing tubeless percutaneous nephrolithotomy and how we diagnose its indication, safety, and effectiveness.

Methods: Two hundred and fifty-three patients with renal stones were enrolled for a tubeless percutaneous nephrolithotomy with an externalized ureteric catheter. Their ages ranged between 4 to 80 years old, and of the sample, 168 were male and 85 were female. The stones ranged from 15 to 80 mm in size and were located in different areas of the pelvicalceal system. The majority of the procedures were conducted in the prone position while 24 cases were supine. The majority of the patients were treated with a single puncture, 20 patients were treated with double punctures, and 2 patients required 3 punctures. Haemostatic substances were used in only 50 of the patients, with no significant differences when compared to 50 who were treated without. In addition, 40 patients had a history of previous ipsilateral renal surgery, 20 had renal impairments, and 15 had a solitary kidney.

Results: The mean operative time was 44.34 minutes, the mean stent time was 1.1 days, and the mean hospital stay was 1.6 days. The mean drop in Hb levels was 1.67gm/dl, with 3.95% of the patients needing blood transfusions and 12.65% needing postoperative analgesia. The stone-free rate was 91.76% while the overall success rate was 97.25%. Complications were encountered in 7.9% of the patients, most of which were minor and were managed conservatively. One patient suffered from a colonic injury and 2 patients suffered from hydrothorax.

Conclusion: In the era of tubeless percutaneous nephrolithotomy, nephrostomy tube insertion should only be used for large residuals that need a second look. Tubeless percutaneous nephrolithotomy should be extended to include large stones, multiple numbers, multiple punctures, prone or supine positions, sub- or supracostal approaches, recurrent cases, solitary kidneys, renal impairment, extended time, and bilateral simultaneous cases. It’s safe and effective, and it decreases postoperative pain, discomfort, the need for analgesia, and the length of hospital stay.


Tawfik H Al-Ba’adani, Khaled Telha, Shihab Al-Gormozi, Khalid Al-Badwey, Gamil Al-Alimi, Mohammed Alwan, Nabil Al-Gonaid, Ibraheim H El-Nono

Submitted April 2, 2012 - Accepted for Publication May 1, 2012


KEYWORDS: Percutaneous, nephrolithotomy, tubeless, ureteric, catheter

CORRESPONDENCE: Tawfik H Al-Ba’adani, MD, Urology Department, Urology and Nephrology Center, Al-Thawra Modern General/Teaching Hospital, Medical College-Sana’a University, Sana’a, Yemen ().

CITATION: UroToday Int J. 2012 June;5(3):art 17. http://dx.doi.org/10.3834/uij.1944-5784.2012.06.04

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A Case of Recurrent Nephrocutaneous Fistula Treated with Partial Nephrectomy

ABSTRACT

Nephrocutaneous fistula is a distressing clinical condition. The fistula can be very difficult to treat and has a high chance of recurrence. The standard treatment of a recurrent fistula is nephrectomy along with the excision of the fistula. We present a case with recurrent nephrocutaneous fistula along with a hypofunctional contralateral kidney. This was a difficult clinical scenario as any compromise of the affected kidney could have resulted in renal failure. The patient was treated with a left upper polar partial nephrectomy and excision of the fistulous tract.


Tarun Jindal, Satyadip Mukherjee, Soumendra Nath Mandal, Dilip Karmakar

Submitted January 17, 2011 - Accepted for Publication February 22, 2012


KEYWORDS: Fistula, kidney, cutaneous

CORRESPONDENCE: Tarun Jindal, MS, Calcutta National Medical College, Kolkata, West Bengal, India ().

CITATION: UroToday Int J. 2012 June;5(3):art 21. http://dx.doi.org/10.3834/uij.1944-5784.2012.06.08

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A Rare Feminizing Adrenocortical Carcinoma: A Case Report

ABSTRACT

Adrenocortical carcinoma (ACC) is a rare tumor that accounts for only 0.02% of all cancers. About 60% of patients present with symptoms of excessive hormone production. However, ACC is usually nonfunctional when it occurs in adults. Its presentation with only virilizing symptoms is extremely rare. We report a case of a huge functional, virilizing ACC of the right adrenal gland that measured 14 cm by 9 cm by 6 cm and weighed 600 gm, which was successfully extirpated.


Bikash Bawri, Rajeev Thekumpadam Puthenveetil, Saumar Jyoti Baruah, Sasanka Kumar Barua, Puskal Kumar Bagchi

Submitted: November 23, 2011 - Accepted for Publication: January 31, 2012


KEYWORDS: Adrenocortical carcinoma, functional, virilizing

CORRESPONDENCE: Bikash Bawri, MD, Gauhati Medical College Hospital, Guwahati, Assam, India ().

CITATION: UroToday Int J. 2012 June;5(3):art 16. http://dx.doi.org/10.3834/uij.1944-5784.2012.06.03

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Encrusted Hairball in the Urethra: An Uncommon Complication of Hypospadias Repair

ABSTRACT

We present an uncommon case of an encrusted urethral hairball in an adult patient who had hypospadias repair during childhood. The management of such a case is discussed briefly and suggestions are made to overcome this issue.


Eng Hong Goh, Omar Syed, Boon Wei Teoh, Kah Ann Git

Submitted December 21, 2011 - Accepted for Publication January 23, 2012 


 KEYWORDS: Urethra, stone, hair

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 June;5(3):art 19. http://dx.doi.org/10.3834/uij.1944-5784.2012.06.06

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Adult Wilms Tumor with Spinal Metastases

ABSTRACT

Wilms tumor is rare in adulthood. The prognosis is poor when compared with children. Adults more frequently present with advanced disease stages, and chemotherapy has a moderate effect. The various protocols of chemotherapy and indications for surgery and radiotherapy are not yet precisely defined, mainly due to the rarity of the disease. Here we report a case of adult Wilms tumor with spinal metastases who remains disease free for 3 years after undergoing multimodality treatment.


Vedamurthy Pogula Reddy, Madhurima Pothula, Ravi Shankar Ganji, Surya Prakash Vaddi

Submitted October 24, 2011 - Accepted for Publication November 7, 2011


KEYWORDS: Adult Wilms Tumor, spinal metastases

CORRESPONDENCE: Vedamurthy Pogula Reddy, MS, MCh, Department of Urology & Renal Transplantation, Narayana Medical College, Nellore, Andhra Pradesh, India ().

CITATION: UroToday Int J. 2012 June;5(3):art 24. http://dx.doi.org/10.3834/uij.1944-5784.2012.06.11

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Early Penile Prosthesis Insertion in the Delayed Presentation of Ischemic Priapism

ABSTRACT

Ischemic priapism is an organ-threatening event. It presents as a rigid and painful erection despite the absence of any sexual stimulation. In up to 60% of cases of ischemic priapism no precipitating factor is identified. However, medications such as intra-cavernosal agents, anti-psychotics, anti-hypertensives, as well as illicit drug use and hematological disorders have been implicated in ischemic priapism. Management of a prolonged priapism is challenging. It is usually refractory to aspiration, intra-carvenosal phenylephrine, and even surgical shunting. The corpora carvenosa can be irreversibly replaced by dense fibrosis after 6 hours of ischemia. This may result in a shortened, indurated, non-erectile penis. We present and describe the surgical technique of a case of prolonged ischemic priapism treated with early implantation of penile prosthesis.


Yeng Kwang Tay, Dan Spernat, Sree Appu, Christopher Love

Submitted Septebmer 30, 2011 - Accepted for Publication March 9, 2012


KEYWORDS: Priapism, penile prosthesis, early insertion

CORRESPONDENCE: Yeng Kwang Tay, MBBS, Department of Urology, Monash Medical Centre, 865 Centre Road, East Bentleigh, Victoria, 3165, Australia (yktay2@gmail.com).

CITATION: UroToday Int J. 2012 June;5(3):art 28. http://dx.doi.org/10.3834/uij.1944-5784.2012.06.15

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Retrocaval Ureter with Contralateral Renal Agenesis with Renal Failure: A Rare, Reversible Surgical Cause of Renal Failure

ABSTRACT

Retrocaval ureter is a rare anomaly causing upper urinary tract obstruction, usually presented later in life as recurrent flank or abdominal pain and recurrent urinary tract infection. There may be associated abnormalities of other organ systems as well. We present a rare case of retrocaval ureter with contralateral renal agenesis with renal failure. Surgical correction with ureteropyelostomy was successful.


Dheeraj Kumar Gupta, Vishwajeet Singh, Rahul Janak Sinha

Submitted January 3, 2012 - Accepted for Publication February 10, 2012


KEYWORDS: Retrocaval ureter, ureteropyelostomy, surgical cause of renal failure

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

CITATION: UroToday Int J. 2012 June;5(3):art 27. http://dx.doi.org/10.3834/uij.1944-5784.2012.06.14

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Epidemiological Study on Urinary Incontinence and Overactive Bladder in Primary Care, and the Prevalence of Risk Factors (URO-RISK Study)

ABSTRACT

Introduction: The assessment of risk factors for urinary incontinence (UI) can help the physician detect patients with UI. Apart from traditional risk factors, specifically related to stress UI, other factors such as medications and drinking habits can influence urge micturition. The present study analyzed the prevalence of risk factors for UI in a population treated in primary care centers, with at least 2 urinary symptoms.

Methods: This is an epidemiological, cross-sectional, multicenter, nonprobabilistic study with a consecutive inclusion of cases. For our case, 2 276 physicians recruited primary care patients over 18 years old with at least 2 urinary symptoms, excluding those with urethral catheters.

Results: In the 4 674 patients, with a mean age of 64.7 years, most were women (72.6%), and the most prevalent urinary symptoms were frequent urination, urgency, and nocturia. More than 90% of patients had 3 or more symptoms of UI. The most important risk habits were the intake of coffee or tea (32.3%), followed by liquid intake such as water, juice, or soft drinks (29.9%). Of our patients, 73% were taking medication, which could affect micturition. The most prevalent pathological antecedents were those linked to gender, followed by recurrent urinary infections, and diabetes.

Conclusion: Despite a high prevalence of UI in the adult population, there’s a low demand for health care. Moreover, the majority of these patients have habits and risk pathologies that could be solved or at least eased with medical advice that could result in improved quality of life.


Juan Manuel Mendive, Pablo Rebollo, Maite Pérez

Submitted February 21, 2012 - Accepted for Publication April 4, 2012


KEYWORDS: Epidemiological study, health care demand, overactive bladder, quality of life, urinary incontinence

CORRESPONDENCE: Juan Manuel Mendive Arbeloa, MD, Centro de Atención Primaria La Mina, Institut Català de la Salut, Sant Adrià de Besòs, Barcelona, Spain ().

CITATION:UroToday Int J. 2012 June;5(3):art 23. http://dx.doi.org/10.3834/uij.1944-5784.2012.06.10

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Shock Wave Lithotripsy Re-treatment Rates Among 3 Different Lithotripters

ABSTRACT

Purpose: There is controversy as to whether electromagnetic (EM) lithotripters are associated with higher fragmentation and lower re-treatment rates when compared with electrohydraulic (EH) lithotripters. Therefore, the aim of the present study was to compare SWL re-treatment rates of two EH lithotripters (the Siemens LITHOSTAR and Philips Litho Diagnost M) together with an EM mobile lithotripter (the Storz MODULITH SLX-F2) at a single center.

Methods: A retrospective review of a SWL database was performed for patients with radio-opaque stones between July 2001 and February 2010. A total of 6 434 SWL treatments were included (2 824 with Siemens, 3 136 with Philips, and 474 with Storz). Patients presenting for SWL re-treatment of the same stone were considered SWL failures. Clinical follow-up information was available only for patients treated by the Storz lithotripter.

Results: The Storz lithotripter had a significantly lower re-treatment rate (14.7%) when compared with the Siemens (18.8%, OR = 1.34, p = 0.04) and the Philips (19.6%, OR = 1.41, p = 0.01). However, on multivariate analysis, the Storz significantly differed only from the Philips (OR = 1.36, p = 0.02). When compared with renal pelvic stones, stones in the upper calyx were associated with significantly lower re-treatment rates (OR = 0.65, p = 0.02), whereas distal ureteral stones were associated with significantly higher re-treatment rates (OR = 1.30, p = 0.01). The Storz lithotripter was associated with higher fluoroscopy time (2.4 ± 1.3 min) when compared with the Siemens (1.74 ± 0.8 min) and the Philips (2.13 ± 1.1 min, p = 0.001).

Conclusion: In the present retrospective study, the EM Storz SLX-F2 lithotripter was associated with significantly lower re-treatment rates compared with the Philips EH lithotripter, but not the Siemens.


Mohamed A Elkoushy, Konrad M Szymanski, Douglas D Morehouse, Maurice Anidjar, Sero Andonian

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


KEYWORDS: Shock wave lithotripsy, lithotripters, re-treatment rate

CORRESPONDENCE: Sero Andonian, MD, MSc, FRCS(C), Assistant Professor of Urology, Royal Victoria Hospital, McGill University Health Centre, 687 Avenue des Pins Ouest, Suite S6.92, Montreal, Quebec, Canada H3A 1A1 ().

CITATION: UroToday Int J. 2012 June;5(3):art 18. http://dx.doi.org/10.3834/uij.1944-5784.2012.06.05

ACRONYMS AND ABBREVIATIONS: EH: Electrohydraulic; N/A: Not applicable; EM: Electromagnetic; OR: Odds ratio; SWL: Shock wave lithotripsy

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Letter from the Editor - April 2012

Dear Colleagues,

The year is off to a wonderfully productive start for UroToday International Journal, and the inflow of interesting contributions is steadily increasing. We all look ahead to the upcoming 2012 AUA Annual Meeting in May with anticipation and excitement. Many of the topics generated from the meeting will inevitably fill our pages as the year progresses, and the changes and influences these presentations produce will be nothing less than inspirational and worthwhile for our readers.

There are also many new upcoming developments with the UIJ, and we look forward to growing and expanding with our current readership and the new bibliophiles and researchers we gather along the way.

In this issue, Abraham et al. demonstrate laparoscopic live donor nephrectomy experience in donors with multiple arteries and then compare the results with single artery donors on a case-matched basis, finding no significant difference in operative complications.

In an effort to promote transrectal sectional sonography as a more reliable method, Elwagdy et al. assess the effectiveness of TSS in the diagnosis and treatment of prostatic abscesses, eventually demonstrating successful transperineal needle aspiration in all cases.

Falahatkar et al. determine whether body mass index can influence the outcomes of percutaneous nephrolithotripsy in the prone and the supine position, demonstrating that both positions in obese and morbidly obese patients were safe and effective.

The first report of its kind, Kuykendall et al. evaluate a xenographic urethral replacement model utilizing porcine-derived, decellularized blood vessel matrices in rabbits. Their article suggests further investigation of a potentially off-the-shelf product for single-stage urethral reconstruction without stem cell technology.

Satâa et al. compare the clinicopathological characteristics and the prognosis of bladder transitional cell carcinoma according to age in young adults and the results this study yields, including tumor size and location, recurrence, and survival rates among the young.

Westermann et al. assess whether the concomitant use of a tension-free sling with minimally invasive sacrocolpopexy for the treatment of pelvic organ prolapse decreases postoperative stress urinary incontinence in women with and without preoperative symptoms of stress incontinence. They determine that a full or mini-sling significantly reduced postoperative symptoms.

Finally, in a review by Klaassen et al., resection of cancer metastasis to the brain is questioned, suggesting the indications for surgical resection in the nonemergent setting are less clear. Through their labor, they conclude that surgical therapy is reserved for patients with a good Karnofsky Performance Status, minimal-to-no systemic disease, solitary large lesions, and those with a life expectancy of more than 3 months.

We also present a series of case studies that include various topics, including Puigvert disease, pleomorphic sarcoma of the scrotum, and isolated renal hydatid cysts.

I hope the upcoming issue proves constructive and fruitful for our entire urologic community, no matter your purpose or focus, and thank you for your continued support as we forge ahead.

Kind regards,

Karl-Erik Andersson

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