Issue 3: June 2012

Issue 3: June 2012

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


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.


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


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.


The Era of Tubeless Percutaneous Nephrolithotomy


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.


A Case of Recurrent Nephrocutaneous Fistula Treated with Partial Nephrectomy


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.


A Rare Feminizing Adrenocortical Carcinoma: A Case Report


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.


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


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.


Adult Wilms Tumor with Spinal Metastases


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.


Early Penile Prosthesis Insertion in the Delayed Presentation of Ischemic Priapism


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 (

CITATION: UroToday Int J. 2012 June;5(3):art 28.


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


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.


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


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.


Shock Wave Lithotripsy Re-treatment Rates Among 3 Different Lithotripters


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.

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


Ectopic Kidney


This rare case is an unusual form of ectopic kidney in an unusual site in a 4-year-old male child presenting with a history of a lump on the dorsal shaft of the penis since birth. He had a history of repeated UTI and failure of growth. Lump size was small at birth, as mentioned by his parents, and increased in size gradually until the last days when there was a noticable increase in size, with redness of the overlying skin and urine retention after complete investigations and full imaging studies. After a cystoscopy and surgical excision, the diagnosis of ectopic kidney on the penile shaft became clear.

Muhammad Abdullah Rahman Alshwani

Submitted December 7, 2011 - Accepted for Publication January 12, 2012

KEYWORDS: Ectopic kidney, congenital anomalies

CORRESPONDENCE: Muhammad Abdullah Rahman Alshwani, Department of Surgery, Medical College, Kirkuk University, Azadi Teaching Hospital, Kirkuk, Iraq ().

CITATION: UroToday Int J. 2012 June;5(3):art 22.


Hydatid Cyst of a Kidney in a Child: A Case Report


Hydatid disease of the kidney is rare and constitutes only 2 to 4% of all cases of hydatid. Its occurrence in children is even more rare. It ranks third after liver and lung. In the urinary tract, kidneys are generally affected, usually together with multiple organ involvement. An isolated renal hydatid cyst of the kidney without other organ involvement is very rare. We hereby present a case of pure hydatid cyst of the left kidney in a child presenting with left flank swelling and renal colic. She also had episodes of fever on and off for 2 months. On the basis of imaging studies, a diagnosis of hydatid cyst of the left kidney was established. The patient was successfully managed by simple nephrectomy. The patient is doing well at an 8-month follow-up.

Sanjay Kumar Gupta, Ranjit Kumar, Mahendra Singh, Vijoy Kumar, Rajesh K Tiwary, Atul Khandelwal, Vinod Priyadarshi

Submitted December 5, 2011 - Accepted for Publication January 9, 2012

KEYWORDS: Renal, hydatid cyst, simple nephrectomy, floating membrane

CORRESPONDENCE: Sanjay Kumar Gupta, Department of Urology, Indira Gandhi Institute of Medical Sciences, Bihar, India ().

CITATION: UroToday Int J. 2012 June;5(3):art 20.


A Survey on the Effect of Anticholinergic Therapy on Post-Void Dribbling


Purpose: Post-void dribbling (PVD) is a type of incontinence defined as the involuntary loss of urine immediately after passing urine and rising from the toilet. The purpose of this study was to evaluate whether anticholinergic therapy reduces symptoms of PVD in women placed on therapy for overactive bladder (OAB).

Methods: A survey was administered via telephone to patients being treated for OAB with anticholinergic medications who also carried a diagnosis of PVD. Patients were asked whether PVD symptoms had worsened, were unchanged, or had improved on anticholinergic therapy. Variables such as drug response to OAB symptoms, non-drug treatments for incontinence, and compensatory behaviors to avoid PVD symptoms were included. Other symptoms and variables of voiding dysfunction and medical comorbidities were collected from the medical record. Standard descriptive statistics, Wilcoxon rank sum, and Fisher’s exact tests were used to describe the data.

Results: Sixty participants completed the survey. Of the eligible patients, 82% consented to participate in the survey. Of those, 72% (95% CI: 59%-83%, p < 0.01) improved PVD symptoms on anticholinergic therapy. The response rate for OAB was also 72%. No difference was found between the response to PVD and OAB (p = 1). No other variable measured affected improvement in PVD symptoms on anticholinergic therapy.

Conclusions: In our survey, anticholinergic medications appeared to be effective in treating PVD with an efficacy similar to that of OAB. Additional studies are needed to confirm these findings.

Jessica Rasmussen, Songwon Seo, Tova Ablove

Submitted February 10, 2012 - Accepted for Publication April 17, 2012

KEYWORDS: Incontinence, overactive bladder, post-micturition dribble, survey, urge incontinence, women

CORRESPONDENCE: Tova Ablove, MD, MSc, Assistant Professor, Department of Obstetrics and Gynecology, University of Wisconsin at Madison, Wisconsin, United States ().

CITATION: UroToday Int J. 2012 June;5(3):art 14.


Robotic Partial Nephrectomy in a Morbidly Obese Patient: A Case Report


Laparoscopic surgical management of obese patients can be challenging. Data is limited on the use of robotic-assisted laparoscopic nephrectomy and partial nephrectomy in the management of renal masses in the obese population. We report a case of a morbidly obese white male with a BMI of 56.6 kg/m2 who underwent an uncomplicated robotic partial nephrectomy for 2 right-sided renal masses. We conclude that robotic partial nephrectomy is feasible for the management of renal masses in morbidly obese patients.

Adam B Althaus, Brad M Lake, Sam B Bhayani, R Sherburne Figenshau

Washington University School of Medicine, Department of Surgery, Division of Urologic Surgery, Missouri, United States

Submitted: January 24, 2012 - Accepted for Publication: April 12, 2012

KEYWORDS: Robotic partial nephrectomy, obese

CORRESPONDENCE: Adam Althaus, Washington University School of Medicine, Department of Surgery, Division of Urologic Surgery, 4960 Children’s Place, Campus Box 8242, St. Louis, MO 63110, United States ().

CITATION: UroToday Int J. 2012 June;5(3):art 15.