Volume 5

UIJ Volume 5 2012

Ureteral Diverticulum in Adults: Diagnostic Problems and Therapeutic Implications


Ureteral diverticulum is a rare anomaly and often gives rise to urinary complications. We report a case of a woman with bifid renal pelvis. She had a stone in the lower pelvis with cystic dilation of the upper ureter.

Sallami Satáa, Sami Ben Rhouma, Ali Horchani

Department of Urology, La Rabta Hospital-University, Tunis, Tunisia

Submitted: September 1, 2011

Accepted for Publication: October 4, 2011

KEYWORDS: Diverticulum; Ureter; Abnormalities; Stone

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

CITATION: UroToday Int J. 2011 Feb;5(1):art 86. http://dx.doi.org/10.3834/uij.1944-5784.2012.02.04



A Rare Cause of Acute Urinary Retention in a Young Female: Leiomyoma Bladder


Leiomyoma represents the largest subgroup of benign mesenchymal tumors that may arise anywhere within the genitourinary tract. Usual presenting symptoms include voiding symptoms such as obstruction and irritation. It can be diagnosed by careful physical examination assisted with ultrasound and endoscopic evaluation, but the confirmatory diagnosis is always histological. Bladder-conservative surgery is usually contemplated as the treatment of choice, be it transurethral resection or open surgery. This can include partial cystectomy due to the benign nature of the disease. Although the occurrence of this tumor is rare, it should be suspected with any urinary bladder tumor presenting with benign features. The prognosis is good with bladder preservative protocols.

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

Submitted: September 9, 2011

Accepted for Publication: November 9, 2011

KEYWORDS: Leiomyoma; Genitourinary tract; Obstruction; Partial cystectomy

CORRESPONDENCE: Bikash Bawri, MD, RK Singh Apartment, House No 54, Ashram Road, Kasturba Nagar, Ulubari, Guwahati-781007, Assam, India ().

CITATION: UroToday Int J. 2012 Feb;5(1):art 83. http://dx.doi.org/10.3834/uij.1944-5784.2012.02.01


Retroperitoneal Textiloma Mimicking an Adrenal Tumor


We describe a case with a perirenal-retained sponge presenting as an adrenal tumor in a patient who had undergone surgery for urolithiasis 10 years prior to presentment. It was incidentally diagnosed during an evaluation of left flank pain.

Rahul Devraj, Vedamurthy Pogula Reddy, Surya Prakash Vaddi, Ajit Vikram, Sreedhar D

Dept of Urology and Renal Transplantation, Narayana Medical College, Nellore, India

Submitted: May 9, 2011

Accepted for Publication: July 25, 2011

KEYWORDS: Retained sponge; Textiloma; Adrenal tumor

CORRESPONDENCE: Vedamurthy Pogula Reddy, MCh, Dept of Urology and Renal Transplantation, Narayana Medical College, Nellore, Andhra Pradesh, India, 524 002 ().

CITATION: UroToday Int J. 2012 Feb;5(1):art 85. http://dx.doi.org/10.3834/uij.1944-5784.2012.02.03





Percutaneous Nephrolithotomy in the Supine Position with Ultrasound-Guided Renal Access


Aim: To evaluate PCNL in the supine position under ultrasound-guided puncture regarding its technical aspects, success rate, and complications.

Patients and Methods: The study included 47 patients. All patients with renal and or upper ureteral stones were included in this study, while patients with uncorrectable coagulopathy congenital anomalies in the kidney were excluded. PCNL in the supine position was done under ultrasound-guided puncture while dilatation was done under fluoroscopy.

Results: Twenty cases (42.5%) had pelvic stones, 18 cases (38.3%) had calyceal stones, 5 cases (10.6%) had multiple stones, 1 case (2.1%) had upper ureteic stones, and 3 cases (6.4%) had stagehorn stones. Twenty-five cases (53.2%) were right sided and 22 cases (46.8%) were left sided. Stone size was 2.9 ±1.029. Forty-two cases had radiopaque stones (89.4%), while 5 cases had radiolucent stones (10.6%). Upper calyceal puncture was done in 2 cases, middle calyceal puncture in 6 cases, lower calyceal puncture in 32 cases (68.1%), and multiple punctures in 9 cases. Stone disintigration using pneumatic lithoclast was done in 31 cases (66%), and in toto stone extraction was done in 16 cases (34%). The mean operative time was 70 minutes (60 to 120 minutes). The intraoperative complications were dilatation difficulties in 5 cases (10.6%) and bleeding requiring transfusion in 2 cases (4.2%). The stone-free rate was achieved in 44 cases (93.6%) and residual stones more than 4 mm were detected in 3 cases (6.4%). The mean hospital stay was 3.2 days (2 to 5 days). There was fever in 4 cases (8.5%) and urinary leakage in 3 cases (6.4%).

Conclusion: PCNL in the supine position under ultrasound-guided puncture is feasible, safe, and successful, with minimal complications.

Hammouda Sherif, Osama Abdelwahab, Abdelaziz Omar, Ibrahim Eraky

Submitted: November 4, 2011 Accepted for Publication: December 6, 2011

KEYWORDS: Supine position; PCNL; Stones

CORRESPONDENCE: Hammouda Waheeb Sherif, MD, Benha University, Benha Elgdeeda, Benha,11513, Egypt ().

CITATION: UroToday Int J. 2012 Feb;5(1):art 89. http://dx.doi.org/10.3834/uij.1944-5784.2012.02.07


CT: Computed tomography

DJ: Double J

ESWL: Electrohydrolic lithotripsy

IVU: Intravenous urography

PCS: Pelvicaliceal system

PCNL: Percutaneous nephrolithotomy

URS: Ureteroscopy

US: Ultrasonography


Clinical Epidemiologic Study of Penile Cancer in the State of Pernambuco, Brazil


Introduction: Penile cancer is a malignant disease that has an uneven geographical distribution. Brazil is one of the countries with the highest incidence of penile cancer, although epidemiological studies are rare. Poor hygiene, the presence of phimosis, HPV infection, and low socioeconomic status seem to be some important risk factors. The objective of this study is to know the clinical and epidemiological data on new cases of penile cancer in the state of Pernambuco, located in the northeast region of Brazil, and contribute to the national study of the Brazilian Society of Urology.

Methods: We selected from a plethora of new penile cancer cases diagnosed from August 2008 to June 2009, at the department of urology of 5 referral hospitals of the National Health System. Interviews were conducted with a clinical, epidemiological questionnaire adapted from the questionnaire used by the SBU in the first epidemiological study of penile cancer. All patients gave written, informed consent for inclusion in the sample. This study was approved by the ethics committees of the institutions involved.

Results: In 11 months of the study, 32 new cases of penile cancer were enrolled and analyzed in 5 referral hospitals in Pernambuco. The average age of lesion diagnosis was 59.2 years (SD ± 14.3 years), with 50% of cases diagnosed in patients over 60 years. Regarding schooling, 92% were illiterate or had only a primary level of schooling, and none advanced beyond the second grade. Assessing the antecedents and habits, it was found that 8 patients (32%) had at least 1 case of a lifelong STD, 14 patients (56%) reported a history of phimosis, and only 4 (16%) underwent circumcision, 3 of which during adulthood. Smoking was an addiction reported by 56.2% of patients. The average time between the appearance of the lesion and the diagnosis of penile cancer was higher than 10 months.

Conclusion: Penile cancer in referral hospitals of Pernambuco usually involves men older than 60 years, with low education, a history of smoking, uncircumcised genitalia, and with delayed access to specialized medical care. It is necessary to create campaigns for the prevention and guidance of this most affected population.

KEYWORDS: Circumcision; Epidemiology; Penile cancer; Phimosis; Risk factors

CORRESPONDENCE: Marina de Andrade Lima Arcoverde, Federal University of Pernambuco, Recife, Brazil ().

CITATION: UroToday Int J. 2012 Feb;5(1):art 91. http://dx.doi.org/10.3834/uij.1944-5784.2012.02.09



Prevalence and Risk Factors Associated with Overactive Bladder


Introduction: The pathophysiology and management of overactive bladder (OAB) has been the subject of intensive research, but the prevalence of OAB in the community has not been well documented. This study aims to determine the prevalence of OAB among men and women attending the Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This study also shows the impact of OAB on daily life activities and associated risk factors.

Methods: Four hundred respondents, aged between 18 to 70 years and visiting UKMMC, were interviewed and scored using the validated OAB screener. Information on sociodemographic data, the effects of OAB on daily living activities, and possible risk factors were included in the questionnaire.

Results: The prevalence of overactive bladder in the study population was 42%. The most common symptom complaint was nocturia (94%). Gender (p = 0.004) and family history (p = 0.016) were related to a higher prevalence of overactive bladder. Males were significantly affected with the odd ratio of 1.792 compared to females. Race, age, monthly income, occupation, family, and smoking history were not associated with OAB. The most commonly affected activity of daily living in OAB patients is sleep disturbance (43.5%).

Conclusion: The study has shown that the prevalence of OAB is relatively high in the Malaysian community, especially among males, and those with a positive family history. This has warranted closer attention to the issue. Preemptive measures should be taken by health care givers, the government, and the community to raise OAB awareness among society.

Christopher Chee Kong Ho, Teo Chee Yang, Phang Lay Fang, Nur Aziyana Noor Azizi, Farah Lyna Darwin, Nur Afifah Mohd Ghazi, Guan Hee Tan, Eng Hong Goh, Praveen Singam, Badrulhisham Bahadzor, Zulkifli Md Zainuddin

Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia

Date Received: November 07, 2011

Accepted on: November 23, 2011

Original Publication Date: January 05, 2012

KEYWORDS: Prevalence; Overactive bladder; Daily living activities; Risk factors

CORRESPONDENCE: Christopher CK Ho, Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia ().

CITATION: UroToday Int J. 2012 Feb;5(1):art 88. http://dx.doi.org/10.3834/uij.1944-5784.2012.02.06





Inflammatory Pseudotumor of the Urachus


Urachal diseases often create serious diagnostic dilemmas owing to their uncommon occurrences and the diversity of their presentations. We present a rare case of inflammatory pseudotumor of the urachus. The rarity and confusing nature of this condition prompted us to submit the present information.

Raj Kumar Sharma, Vir Kumar Jain, S Mukherjee, SN Mondal, D Karmakar

Submitted: November 5, 2011 Accepted for Publication: December 9, 2011

KEYWORDS: Inflammatory pseudotumor; Urachus

CORRESPONDENCE: Raj Kumar Sharma, MBBS, MS, MCh, Department of Urology, Calcutta National Medical College, Kolkata, West Bengal, India 700046 ().

CITATION: UroToday Int J. 2012 Feb;5(1):art 94. http://dx.doi.org/10.3834/uij.1944-5784.2012.02.12



Treatment of Post, High-Intensity-Focused Ultrasound Urethral Stricture with Novel Long-term Stent


Urethral strictures (US) can be recurrent chronic illnesses leading to severe side effects and poor quality of life. Several options to treat US exist, including repeated dilatations, stents, and open surgery. A urethral stent is a good, minimally invasive option but has major limitations, such as stent migration, mucosal growth, and incontinence, especially for bladder-neck strictures. Herein, we describe a new stent that, due to its design, may solve some of the above-mentioned problems, enabling long-term use and safe removal.

Omri Nativ, Sarel Halachmi, Boaz Moskovitz, Ofer Nativ

Department of Urology, Bnei-Zion Medical Center, Haifa, Israel

Submitted: November 4, 2011

Accepted for Publication: December 13, 2011

KEYWORDS: High-intensity-focused ultrasound; Urethral stricture; Long-term urethral stent

CORRESPONDENCE: Sarel Halachmi, MD, Department of Urology, Bnai-Zion Medical Center, Haifa, Israel ().

CITATION: UroToday Int J. 2012 Feb;5(1):art 92. http://dx.doi.org/10.3834/uij.1944-5784.2012.02.10



Teratoid Wilms Tumor in a Child: A Case Report


Teratoid Wilms is a very rare histopathological variant of Wilms tumors that is characterized by the predominance of heterologous components, and is described by many to be a nonaggressive, nonmetastatic tumor with a favorable prognosis. We report a case of a 4-year-old boy with a rare, aggressive metastatic variant of teratoid Wilms tumor. The boy presented with abdominal pain and a palpable abdominal mass. The computed tomography scan demonstrated a large, cystic, multiloculated left renal mass and a single left pulmonary metastasis. The patient had a 5-week course of neoadjuvant chemotherapy. As a result, the size of the metastatic lesion decreased, but there was no change in the size of the renal mass. Subsequently, a left radical nephrectomy and left pulmonary metastectomy were performed where the pathology report showed metastatic teratoid Wilms tumor. The patient received adjuvant chemotherapy and radiotherapy. One year following the initial surgery, the child developed bilateral pulmonary metastases where he is currently having an aggressive regimen of chemotherapy. Although teratoid Wilms has been described as a nonaggressive tumor with a favorable prognosis, it can present with more aggressive forms, with a tendency for metastasis.

KEYWORDS: Wilms tumor; Teratoid Wilms; Rare Wilms

CORRESPONDENCE: Jameel Hisham Bardesi, King Abdulaziz University, Jeddah 21589, Saudi Arabia ().

CITATION: UroToday Int J. 2012 Feb;5(1):art 90. http://dx.doi.org/10.3834/uij.1944-5784.2012.02.08



Dutasteride with As-Needed Tamsulosin in Men at Risk of Benign Prostatic Hypertrophy Progression


Purpose: The primary aim of this study was to investigate whether initial therapy with dutasteride followed by dutasteride with as-needed tamsulosin can prevent symptom progression in patients at a high risk of clinical progression of benign prostatic hyperplasia (BPH).

Patients and Methods: This study was an open-label, single-site pilot study of 63 patients. Patients were men > 50 years of age, with a clinical diagnosis of BPH based on medical history, symptom scores, and medical exams. Each patient was prescribed 0.5 mg once daily of dutasteride for 1 year, at which time 0.4 mg once daily of tamsulosin was added. After 3 months of combination therapy, subjects were counseled to taper or discontinue tamsulosin and to restart only on an as-needed basis. Patients returned to the clinic at 6, 9, and 12 months when they were evaluated and drug compliance was measured.

Results: Adding tamsulosin to dutasteride resulted in a 41% improvement in IPSS and a 62% improvement in Qmax after 3 and 6 months, respectively, which were maintained regardless of subsequent tamsulosin use.

Conclusion: The partial or total withdrawal of tamsulosin after 1 year of 5-ARI, followed by combination therapy for 3 months, resulted in little or no deterioration of LUTS in men with BPH in the final 12 months of the study.

Paul F Siami, Knox Beasley

Submitted: October 24, 2011 Accepted for Publication: December 15, 2011

KEYWORDS: Dutasteride; Tamsulosin; Benign prostatic hyperplasia

CORRESPONDENCE: Paul F Siami, MD, 3521 Lincoln Ave, Evansville, IN 47714 USA ().

CITATION: UroToday Int J. 2012 Feb;5(1):art 93. http://dx.doi.org/10.3834/uij.1944-5784.2012.02.11



Lower Urinary Tract Management in Patients with Neurological Disease


Lower urinary tract dysfunction is common in patients with neurological disease. Storage and/or voiding function can be affected, leading to bothersome symptoms. However, preventing upper urinary tract deterioration is a greater clinical priority, requiring identification of patients at risk, early intervention where indicated, and ongoing surveillance. An initial assessment requires a comprehensive evaluation, including wider issues such as aspirations for independent living, cognitive function, manual dexterity, and mobility. Measures to improve urine storage include antimuscarinic drugs, botulinum injections, or surgical procedures. For voiding dysfunction, intermittent catheterization is by far the most effective and most widely applicable approach, with additional benefits for urinary storage. The assessment of urinary tract function and treatment selection requires a multidisciplinary approach in the context of full rehabilitation or support.

Marcus J Drake, Francisco MJ Cruz

Date Received: April 26, 2011 Accepted on: January 17, 2012

KEYWORDS: Neurourology; Detrusor overactivity; Urodynamics; Antimuscarinics; Botulinum toxin A

CORRESPONDENCE: Marcus J Drake, MA, DM, FRCS (Urology), University of Bristol, Bristol Urological Institute, Southmead Hospital, Bristol, BS10 5NB, United Kingdom ().

CITATION:UroToday Int J. 2012 Feb;5(1):art 95. http://dx.doi.org/10.3834/uij.1944-5784.2012.02.13

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