Issue 5: October 2012

Letter from the Editor - October 2012

Dear Colleagues,

Since the inception of UroToday International Journal, our primary concern has been to provide our readers with articles focusing on topics of interest to the urology community as well as a platform to share innovation, experimentation, and discovery. It’s these very tenets that continue to propel us forward, and as our readership continues to grow, we are proud to remain a dependable resource for all of the up-to-date advances and breakthroughs that reflect the challenging and ever-changing field.

In this issue, a review by Carnevale et al. investigates prostatic artery embolization (PAE) as a new benign prostatic hyperplasia treatment. PAE, a minimally invasive outpatient procedure, is performed under local anesthesia, and it has been widely reported since 2008. They are encouraged by the data demonstrating PAE as a safe and effective treatment for patients.

Al-Ba’adani et al. present their experience with antegrade-retrograde maneuver in the form of cut-to-light or cut-to-sound in treating complete posterior urethral strictures. They determine this procedure is safe under supervision, and it markedly decreased operative time, hospital stay, and cost.

Galal et al. assess the value of non-contrast computed tomography as a possible predictor of renal stone disintegration by shock-wave lithotripsy. Through this process, they discover that increased stone density is a significant predictor of failure to fragment renal stones.

Seeking to correlate various factors affecting the male population with benign prostatic hyperplasia, Baruah et al. observe statistically significant correlations within age, prostate volume, and serum prostate-specific antigen level. However, contradictory data suggests further evaluation in a large cohort of the aging population is needed to establish further influence.

Singham et al. compare prostate cancer detection using the Vienna nomogram versus laterally directed sextant and octant biopsy methods on 371 patients with qualified inclusion criteria. Based on their findings, they discover that the use of a Vienna nomogram did not offer significant advantages in cancer detection.

Khaled et al. explore the specificity and sensitivity of increased bladder wall thickness as measured by transabdominal ultrasonography for diagnosing detrusor overactivity in patients with lower urinary tract symptoms. This non-invasive, easily performed technique offers negligible risks. However, further studies are required to validate findings before this technique can be recommended as a primary diagnostic tool.

Priyadarshi et al. present a prospective study that compares the results of sonourethrography with that of retrograde urethrography and probe the effects. Their determination is that sonourethrography is more accurate in providing a better assessment of a diseased urethra. It is best if used as an extension of the physical examination.

We also present a series of case studies on several topics, including isolated renal hydatid cysts, adrenal oncocytomas, and chronic ketamine abuse and its effects.

As always, we thank our readers for their continued support of UIJ and its goals. We are also grateful to the authors who shared their work in this issue and to the reviewers who ensured its publication. 

Warm regards, 

Karl-Erik Andersson

Isolated Renal Hydatid Cyst: A Rare Occurrence


A 20-year-old female presented with upper abdominal pain. The renal function tests and liver function tests were within normal range. The abdominal ultrasound revealed a complex cystic mass in the left kidney. The contrast-enhanced CT scan showed a hypoattenuating, left-sided cystic renal mass at the upper pole with a well-defined margin and fine areas of calcification. Immunological tests for hydatid disease were positive. The patient was pre- and postoperatively managed with 10 mg/kg per day of albendazole for 2 weeks, and the hydatid cyst was excised through the retroperitoneal route. The cut section and histopathological examination were consistent with a hydatid cyst. Follow-up with a renal ultrasound showed normal findings and no evidence of new cyst reappearance. The patient is doing well in follow-up care.

 Vishwajeet Singh, Rahul Janak Sinha, Dheeraj Kumar Gupta, Ajay Singh, Mohit Pandey, Sanjay Bhat

Submitted July 13, 2012 - Accepted for Publication July 23, 2012

KEYWORDS: Hydatid cyst, renal hydatid, isolated renal hydatid, echinococcus cyst, cystic renal mass

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

CITATION: UroToday Int J. 2012 October;5(5):art 55.


Labial Nodular Fasciitis: A Rarity with Benignity


A middle-aged woman presented with a right labial mass that had been gradually increasing for 2 years. There were no other associated symptoms. The local examination of swelling showed a right labial mass of approximately 10 cm x 10 cm, which was not tender, firm, and had side-to-side mobility. Fine-needle aspiration cytology was negative for malignant cells. The contrast computed tomography (CT) scan of the pelvis showed a large, well-encapsulated homogenously enhancing mass. The patient was planned for excision of the mass through the transvaginal route. The histopathological examination was consistent with nodular fasciitis.

Nodular fasciitis is a common reactive mesenchymal proliferation that mimics some of the benign and malignant soft-tissue masses. The labium is the preferred location for a number of mesenchymal tumors and tumor-like lesions, including the postoperative spindle cell nodule, aggressive angiomyxoma, angiomyofibroblastoma, and nodular fasciitis. The urologist/gynecologist must have awareness about this rare lesion, and it must be differentiated from other mesenchymal lesions because of its benign nature.

Herein, we present a case of labial nodular fasciitis that was large, in comparison to those reported in English literature. The patient is asymptomatic and doing well in 1 year of follow-up care.

Vishwajeet Singh, Dheeraj Kumar Gupta, Rahul Janak Sinha

Submitted June 11, 2012 - Accepted for Publication July 23, 2012

KEYWORDS: Nodular fasciitis, benign vulvar lesion, labial mass

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

CITATION: UroToday Int J. 2012 October;5(5):art 56.



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


Blunt abdominal trauma with an isolated abnormal kidney rupture is a rare clinical entity. The correct preoperative diagnosis may be difficult and challenging because of the insidious onset, lack of obvious bleeding, and, frequently, lack of urinary symptoms.

We present a case of a 22-year-old female with isolated pelvic rupture of a hydronephrotic left kidney secondary to a strong punch in the flank. She underwent a computerized tomography that showed a large retroperitoneal collection, with a poor functioning left kidney. Surgical exploration revealed a large rupture of the renal pelvis. She underwent nephrectomy.

Hydronephrosis may be a fortuitous discovery after blunt trauma. The diagnostic features at presentation and the decision-making of surgical management are discussed. The medicolegal aspects of the case are evaluated.

Sallami Satáa, Ben Rhouma Sami, Hmidi Mohamed, Chtourou Meher

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

KEYWORDS: Kidney, congenital, renal pelvis, rupture, abdominal trauma, hemorrhage, retroperitoneal space

CORRESPONDENCE: Sallami Satáa, MD, La Rabta Hospital-University, Tunis, Tunisia ()

CITATION: UroToday Int J. 2012 October;5(5):art 53.


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


Ureteric injury is a potential complication in various surgical procedures. The incidence varies between 0.5 and 10%. The risk of such complications is mainly related to the complexity of the surgical procedure and the presence of eventual periureteric pathology.

The most effective measure to prevent iatrogenic injury is to have a sound knowledge of abdominal and pelvic anatomy, meticulous surgical technique, and an identification of factors that increase the likelihood of developing such complications. As soon as the injury is identified, prompt urological referral is recommended.

We present a case of unusual ureteric stenosis and fistula after an open appendectomy.

Sallami Satáa

Submitted July 13, 2012 - Accepted for Publication July 23, 2012

KEYWORDS: Appendicitis, appendectomy, ureteric injury, stenosis, fistula

CORRESPONDENCE: Sallami Satáa, MD, La Rabta Hospital-University, Tunis, Tunisia ()

CITATION:UroToday Int J. 2012 October;5(5):art 54.


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


Purpose: To report our findings on urothelial lesions diagnosed as nephrogenic adenomas and determine the importance of a correct clinical and anatomopathological interpretation.

Materials and Methods: We report the surgical and anatomopathological findings for 3 cases involving nephrogenic adenoma into the urothelium. One case was in the prostatic urethra of an 84-year-old male who underwent suprapubic prostatectomy due to benign prostatic hyperplasia. Another one was microscopic, and in the lumen of a 4 cm proximal ureteral stenosis of a 30-year-old man due to a ureteral perforation during an ultrasonic ureterolithotripsy 18 months prior. After repeated (6) transureteral endoscopic manipulations, always stented with a double-J ureteral catheter, we finally performed an excision of the ureteral stenotic segment and end-to-end ureteroureteral anastomosis. The final case was in a 5-year-old female, exhibiting recurrent urinary infections and renal lithiasis, who presented with a polypoid lesion in the proximal ureter that we detected and resected by ureteroscopy.

Results: In the older male patient, who underwent surgical manipulation with repeated vesical catheterizations and experienced recurrent urinary infections, the microscopic exam revealed benign prostatic hyperplasia and an incidental lesion 1 cm in diameter in the prostatic urethra with pathological characteristics of nephrogenic adenoma. In the younger male, the nephrogenic adenoma was incidentally found as a microscopic lesion in the ureteral fibrotic lumen. In the child’s case, she underwent an ultrasonic percutaneous nephrolithotripsy due to a voluminous renal calculus, which later resulted in residual obstructive renal calculi at the pyeloureteral junction that necessitated ureteroscopy for nephrocutaneous fistula. It was then that a 0.8 cm polypoid lesion was observed in the proximal ureter during implantation of a double-J ureteral catheter, which was resected and diagnosed as nephrogenic adenoma.

Conclusion: In areas of the urinary tract that have experienced recurrent urinary infections or traumas, or have undergone surgical manipulation, polypoid lesions can develop or appear microscopically. These lesions do not promote such chronic alterations but could result from them, likely due to cellular implants of renal tubules in areas of the urothelium in which the implantation is suitable and are recognized by microscopy as benign urothelial processes. Although such findings are rare, they likely occur more frequently than believed.

Ricardo LR Felts de La Roca, Guilherme B Lamacchia, Luiz Fernando G da Silva, Emilio M Pereira

Submitted May 31, 2012 - Accepted for Publication July 9, 2012

 KEYWORDS: Nephrogenic adenoma, urothelial lesion, recurrent urinary infections, ureter, prostatic urethra

CORRESPONDENCE: Ricardo Leo Roberto Felts de la Roca, MD, Jardim Paulista, São Paulo, SP, 01424-000, Brazil ()

CITATION: UroToday Int J. 2012 October;5(5):art 52.


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


Ketamine is an anesthetic drug that has been used in clinical settings since the 1960s. Unfortunately, this medication has been abused as a recreational drug among partygoers and youth over the last 30 years. Recently, mounting evidence has shown the association between chronic ketamine abuse and urinary tract complications. However, not many are aware that chronic ketamine abuse may also be responsible for cholestasis and cholangitis. We report a case of urinary tract complication from chronic ketamine abuse in combination with cholestasis, cholangitis, and early liver cirrhosis related to the drug. Public awareness about ketamine abuse and its complications should be communicated. Physicians should have a high index of suspicion for ketamine abuse in someone presenting with lower urinary tract symptoms along with jaundice, abdominal pain, and abnormal liver function.

Keat Seong Poh, Christopher Chee Kong Ho, Zulkifli Md Zainuddin

Submitted April 10, 2012 - Accepted for Publication April 30, 2012

KEYWORDS: Ketamine abuse, cholestasis, cholangitis, liver cirrhosis, urinary tract complication

CORRESPONDENCE: Keat Seong Poh, BSc, MD, MRCSEd, Universiti Kebangsaan Malaysia, Kuala Lumpur, Kuala Lumpur, Malaysia ()

CITATION: UroToday Int J. 2012 October;5(5):art 51.


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


Objective: To explore the specificity and sensitivity of increased bladder wall thickness as measured by transabdominal ultrasonography (TAU) for diagnosing detrusor overactivity (DO) in patients with lower urinary tract symptoms (LUTS) compared to the results of filling cystometry as a gold-standard diagnostic procedure.

Methods: This prospective study included 60 patients who were neurologically free with irritative LUTS. The study included 40 females and 20 males. Patients were divided into 2 groups. Group 1 included 40 patients with urodynamic evidence of DO and Group 2 (control) included 20 patients with normal urodynamic studies. All patients were submitted to a history, clinical examination, urine analysis and culture, blood chemistry, and pelviabdominal ultrasound.

Results: The mean age of Group 1 and Group 2 was 22.4 ± 2.4 and 27.6 ± 2.1 years, respectively. All patients had urgency. While 25% of patients in Group 1 had urge incontinence, no patients in Group 2 had urge incontinence. Those in Group 1 (65%) had nocturnal enuresis compared to 10% in Group 2; more than 1 patient had more than 1 complaint. The mean bladder-wall thickness as measured by TAU was significantly higher in Group 1 (5.2 ± 0.27 mm) than in Group 2 (2.8 ± 0.47 mm) (p < 0.001).

Conclusion: Transabdominal ultrasound is a sensitive diagnostic technique when predicting DO in patients with LUTS. This technique is noninvasive and easily performed in an office setting with negligible risks. Further studies are required to validate the findings of this study before this technique can be recommended as a primary diagnostic tool for DO.

Sabri M Khaled, Mahmoud M Ali, Bahaa Elmenshawy, Hamdy Abozeid, Mostafa E AbdelMagid

Submitted June 8, 2012 - Accepted for Publication July 31, 2012

KEYWORDS: Detrusor overactivity, bladder wall thickness, transabdominal ultrasound, urodynamics

CORRESPONDENCE: Sabri M Khaled, MD, Assistant Professor of Urology, Al-Azhar University, Eldarassa, Cairo, Egypt ()

CITATION: UroToday Int J. 2012 October;5(5):art 48.


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


Despite advances in endoscopic surgery, there is still a limited role of open surgery in clinical practice. We report a case of a patient with spina bifida presented with a huge ureteric stone. The management of this case is briefly discussed in this report.

Justius Kok Hui Teo, Eng Hong Goh, Boon Wei Teoh, Kah Ann Git

Submitted March 19, 2012 - Accepted for Publication April 12, 2012

KEYWORDS: Spina bifida, myelomeningocoele, ureteric stone, open ureterolithotomy

CORRESPONDENCE: Eng Hong Goh, Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, 56000, Malaysia ()

CITATION: UroToday Int J. 2012 October;5(5):art 49.


Prostate Cancer Detection via Transrectal Ultrasound Biopsy: Vienna Nomogram Versus Sextant/Octant Biopsy Methods


Introduction: The use of a Vienna nomogram for the initial transrectal ultrasound (TRUS) biopsy was shown to produce higher cancer detection rates. However, a recent prospective study has found no significant differences in its cancer detection compared to octant biopsy. The study objective was to compare prostate cancer detection using the Vienna nomogram versus laterally directed sextant and octant biopsy methods.

Methods and Materials: This retrospective study included all patients with prostate-specific antigen (PSA) of 2 to 40 ng/ml, grouped into the Vienna nomogram (VN) or the sextant/octant (S/O) group. Patients were further subdivided according to prostate volume (> or < 50 ml) and age group (< 60 years and > 70 years). Statistical analysis was performed using chi square, Fisher's exact test, and t test, where appropriate. A p value of < 0.05 was considered significant.

Results: A total of 371 patients qualified with inclusion criteria (VN, n = 190, S/O, n = 181). There were no significant differences in the mean PSA value, age, PSA density, and prostate volume between the 2 groups. Cancer detection rates were slightly higher in the VN group for PSA of 2 to 40 ng/ml (20.5% versus 17.6%), PSA of 2 to 10 ng/ml (16.6% versus 13.7%), younger age (16.1% versus 10%), and prostate volumes above 50 ml. These differences were not significant.

Conclusion: The use of a Vienna nomogram did not offer significant advantages in cancer detection on initial TRUS biopsy compared to sextant or octant methods. Strategies employing the standard 8 to 10 core biopsy incorporating the lateral and apical zones should be used regardless of age and prostate volume.

Praveen Singam, Badrulhisham Bahadzor, Azlina Abas, Tan Guan Hee, Christopher Ho, Goh Eng Hong, Zulkifli M Zainuddin

Submitted June 6, 2012 - Accepted for Publication July 31, 2012

KEYWORDS: Prostate cancer, biopsy, Vienna nomogram, sextant

CORRESPONDENCE: Praveen Singam, Urology Unit, Department of Surgery, UKM Medical Center, Jalan Yaacob Latif, 56100 Cheras, Kuala Lumpur, Malaysia ()

CITATION: UroToday Int J. 2012 October;5(5):art 47.


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


Objective: Retrograde urethrography (RGU) is the most commonly used imaging modality for the evaluation of the anterior urethra. Sonourethrography (SUG) is another modality that is not so frequently used, though several studies have suggested its higher degree of sensitivity and specificity in anterior urethral stricture evaluation. The present prospective study has been done to compare the results of SUG with that of RGU and to probe its effect in decision making.

Patients and Methods: A total of 50 patients with anterior urethral stricture disease were evaluated with both SUG and RGU for stricture length, site location, and associated urethral pathologies. Collected information was used as a guide for the choice of surgery, and it was compared with operative findings.

Results: The mean lengths of strictures on SUG, RGU, and surgery were 20.46 cm, 17.14 cm, and 20.35 cm, respectively. Overall sensitivity and accuracy of SUG in predicting correct stricture length was 95.55 and 97.33%, respectively, and overall sensitivity and accuracy of RGU in predicting correct stricture length was 77.22 and 85.33%, respectively. Spongiofibrosis was noted only with SUG in 78 to 88% accuracy. In 32% of cases, the surgical plan changed when SUG results were taken into consideration along with RGU.

Conclusion: SUG is more accurate in measuring stricture length, especially that of the bulbar urethra. It simultaneously provides a better assessment of a diseased urethra. It should be used as an extension of the physical examination by the treating urologist as it helps in better preoperative surgical planning of anterior urethral strictures.

Vinod Priyadarshi, Mahendra Singh, Vijoy Kumar, Rajesh Tiwari, Sanjay Kumar Gupta, Nidhi Sehgal

Submitted May 7, 2012 - Accepted for Publication June 27, 2012

KEYWORDS: Sonourethrography, retrograde urethrography, anterior urethral stricture

CORRESPONDENCE: Vinod Priyadarshi, MBBS, MS, Senior Resident, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India ()

CITATION: UroToday Int J. 2012 October;5(5):art 46.


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


The standard management of benign prostatic hyperplasia (BPH) is based on the overall health of the patient, on the severity of the lower urinary tract symptoms (LUTS), and on quality-of-life (QoL) considerations. Voiding difficulties attributable to BPH can be quantified with the American Urological Association Symptom Index score (AUA-SI) or International Prostate Symptom Score (IPSS). Various medications can decrease the severity of voiding symptoms secondary to BPH. Impotence, decreased libido, and ejaculatory disorders are known side effects.

The AUA guidelines indicate that patients with mild LUTS secondary to BPH (AUA-SI score < 8) and patients with moderate or severe symptoms who are not bothered by their LUTS should be managed using a strategy of watchful waiting. If the patient elects interventional therapy and there is sufficient evidence of obstruction, the patient and urologist should discuss the benefits and risks of the various interventions.

Transurethral resection of the prostate (TURP) is the most common interventional treatment, but it can be associated with bleeding, erectile dysfunction, and ejaculatory disorders in up to 10 to 65% of patients. The high prevalence rate of BPH has a tremendous impact on the health and quality of life of men. Increasingly, BPH therapy trends are moving away from the gold standard operation of TURP and toward less invasive pharmacological options and minimally invasive procedures provided in an outpatient setting.

Prostatic artery embolization (PAE) is a new BPH treatment under clinical investigation. PAE is a minimally invasive procedure that blocks the blood flow to the prostate, causing shrinkage of the gland. PAE is performed under local anesthesia as an outpatient procedure. A team of interventional radiologists, diagnostic radiologists, and urologists at the University of Sao Paulo Medical School are pioneers of the procedure, which has been widely reported since 2008. The multi-disciplinary team is encouraged by the data demonstrating PAE is a safe and effective minimally invasive treatment for patients with LUTS.

Francisco Cesar Carnevale, Alberto A Antunes, Joaquim M da Motta-Leal-Filho, Ronaldo H Baroni, Antonio SZ Marcelino, Luciana MO Cerri, Giovanni G Cerri, Miguel Srougi

Submitted March 29, 2012 - Accepted for Publication August 3, 2012

KEYWORDS: Benign prostate enlargement, benign prostatic hyperplasia, bladder outlet obstruction, transurethral resection of the prostate, prostatic artery embolization, lower urinary tract symptoms

CORRESPONDENCE: Francisco Cesar Carnevale, Chief, Interventional Radiology Section, Radiology Institute, Hospital das Clinicas, University of Sao Paulo Medical School, Rua Teodoro Sampaio, Sao Paulo, Sao Paulo, 05406-000, Brazil ()

CITATION: UroToday Int J. 2012 October;5(5):art 45.

ACRONYMS AND ABBREVIATIONS: BPE: benign prostate enlargement; BPH: benign prostatic hyperplasia; TURP: transurethral resection of the prostate; PAE: prostatic artery embolization; LUTS: lower urinary tract symptoms; PSA: prostate specific antigen; QoL: quality of life; IPSS: International Prostate Symptoms Score; IIEF: International Index of Erectile Function


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


Introduction and Objective: Benign prostatic hyperplasia is the most common neoplastic disorder affecting the aging male population worldwide. Various factors such as age, prostate volume, serum prostate-specific antigen, and testicular androgens determine the natural history and its progression. The objective of the study is to correlate the relationship between these factors in men with benign prostatic hyperplasia.

Methods: A total of 121 men aged above 50 years with benign prostatic hyperplasia were enrolled in this study. Patients were evaluated by history, digital rectal examination, focused neurological evaluation, uroflowmetry, transrectal ultrasonography of the prostate, serum prostate-specific antigen, serum testosterone (free and total), and prostate biopsy done in patients with prostate-specific antigen > 4 ng/ml to exclude prostatic carcinoma. Patients were divided by age, and a Spearman rank correlation test was done to compare variables.

Results: There was a positive correlation within age, prostate volume, and serum prostate-specific antigen level. Age negatively correlated with serum total and free testosterone level. A comparison among serum PSA, prostate volume, and serum testosterone level did not reveal any statistically significant relationship.

Conclusion: We observed statistically significant correlations within age, prostate volume, and serum prostate-specific antigen level. These variables bear no significant relationship with serum testosterone levels. Considering the contradictory data on the inter-relationship of various variables, further evaluation in a large cohort of the aging population with benign enlargement of the prostate is needed to establish the influence of one over the other.

Sasanka K Baruah, Simanta Jyoti Nath, Rajeev T Puthenveetil, Saumar J Baruah, Phanindra Mohan Deka, Bikash Bawri

Submitted May 21, 2012 - Accepted for Publication July 31, 2012

KEYWORDS: BPH, serum PSA, serum testosterone

CORRESPONDENCE: Sasanka K Baruah, Assistant Professor, Department of Urology, Gauhati Medical College Hospital, Guwahati, Assam, India ()

CITATION: UroToday Int J. 2012 October;5(5):art 43.


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


Purpose: We assess the value of non-contrast computed tomography (NCCT) as a possible predictor of renal stone disintegration by shock-wave lithotripsy (SWL), aiming for a better selection of patients.

Materials and Methods: Forty-five patients (27 males, 18 females) with a mean age of 39.1 ± 12.5 years were reviewed between August 2008 to September 2009. All patients had a solitary renal stone ranging in size from 5 to 25 mm. High-resolution NCCT was done and a bone window was used to measure stone attenuation values. SWL was performed with an electromagnetic lithotripter. Failure was defined as no stone fragmentation after 3 sessions. The impact of the patient’s sex, age, body mass index (BMI), stone location, volume, mean attenuation value, and the skin-to-stone distance on stone disintegration was statistically evaluated. The mean follow-up period was 3 months.

Results: The overall stone-free rate at 3 months was 84.4% (38 of 45 patients); 28 patients were stone free and 10 patients had residual fragments < 4 mm. The only significant predictor of residual fragments was stone density (p < 0.001). Failure of disintegration was observed in 7 patients (15.5%). Stone density > 1000 HU and BMI > 30 were the significant independent predictors of failure (p = 0.002 and 0.001, respectively).

Conclusion: Increased stone density as detected by NCCT is a significant predictor of failure to fragment renal stones by SWL. An alternate treatment should be devised for obese patients with a stone density > 1000 HU.

Ehab Mohamad Galal, Tarek Khalaf Fathelbab, Amr Mohamad Abdelhamid

Submitted June 4, 2012 - Accepted for Publication July 23, 2012

KEYWORDS: Stone density, shock-wave lithotripsy, non-contrast computed tomography

CORRESPONDENCE:Ehab Mohamad Galal, Urology Department, Minia University Hospital, Minia City, Egypt ()

CITATION: UroToday Int J. 2012 October;5(5):art 44.


Antegrade and Retrograde Endoscopic Manipulation of a Complete Posterior Urethral Stricture


Purpose: We present our experience in doing an antegrade-retrograde maneuver in the form of cut-to-light or cut-to-sound in treating complete posterior urethral strictures.

Patients and Methods: Between April 2005 and November 2011, 31 patients out of 99 with posterior urethral strictures underwent endoscopic urethral dilation using ureteroscopes (UR) through suprapubic cystostomy and internal urethrotome reterogradely through the urethra. Their ages ranged between 16 to 70 years (mean: 35) and strictures were caused by car accidents in 19 patients, falls astride in 4, gunshots in 3, iatrogenics in 4, and a bomb explosion in 1. The length of the stricture was 4 to 10 mm (mean: 7.6).

Result: Operative time ranged between 20 to 70 minutes (mean: 37.74) and blood transfusion was needed in 2 patients. Cut-to-light was performed in 20 while cut-to-sound was performed in 11. Hospital stay ranged between 1 to 3 days. Catheter stay time was 2 to 4 weeks (mean: 2.4). Twenty-seven patients passed urine smoothly after removal of the catheter, and during a period of observation (10 days), 2 needed transurethral resection of the prostate (TURP) to pass urine strongly, so the success rate is 93.5%. Within 3 to 6 months, another 4 patients needed dilation so the success rate decreased to 80.6%. Another 2 needed dilation after 2 years, so the success rate dropped to 74.2%. Complications were in the form of bleeding in 2 patients and rectal injury in 1. Follow-up ranged between 3 and 24 months.

Conclusion: Antegrade-retrograde visual-internal urethrotomy is safe under supervision of the procedure in complete urethral strictures, so it is more or less acceptable. It markedly decreased operative time, hospital stay, and cost.

Tawfik Al-Ba’adani, Salah Ahmed, Shukri I Alfalah, Khaled Telha, Shehab Al-Germozi, Ibrahim Al-Nadhari, Ismail Al-Meslemi, Nabil Al-Gonaid, Mohammed Al-Ezi, Ibraheim El-Nono

Submitted May 11, 2012 - Accepted for Publication July 9, 2012

KEYWORDS: Antegrade-retrograde, posterior urethral stricture, urteroscope

CORRESPONDENCE: Tawfik Al-Ba’adani, MD, Sana'a University, Thawra Hospital, Sana'a, Yemen ()

CITATION: UroToday Int J. 2012 October;5(5):art 42. 


email news signup