Issue 4: August 2012

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

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.


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.


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.


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.


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.


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.


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.


Pyeloplasty in Ureteropelvic Junction Obstruction: Laparoscopic or Open?


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.


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?


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.


Memokath 044 Stent for the Treatment of Recurrent Bulbar Urethral Strictures


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.

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


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


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.


Ovarian Dermoid Cyst Perforating Into the Urinary Bladder


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.


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



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.


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


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.