Volume 6

Commentary on “Parental Attitudes Toward Fertility Preservation in Boys with Cancer: Context of Different Risk Levels of Infertility and Success Rates of Fertility Restoration,” Sadri-Ardekani et al. (2013). Fertil Steril 99: 796-802

 ABSTRACT

Cancer survival rates have increased dramatically in recent decades. Until better cancer therapies emerge, infertility will remain a common side effect of cancer therapy. Infertility therapies have likewise flourished in recent decades, but unfortunately the science of infertility has been relatively slow to infiltrate the oncology world. Parents of children with cancer are interested in preventing and/or preserving their children’s fertility. But do they know what their options are? Do they even know infertility is a risk? The answer to both, sadly, is often no. However, now that we know the majority of parents would agree to fertility preservation techniques, we may confidently proceed with appropriate clinical trials.


Thomas W. McLean, Hooman Sadri-Ardekani, Anthony Atala

Submitted June 16, 2013 - Accepted for Publication July 21, 2013


KEYWORDS: Cancer survival, fertility preservation, pediatric cancer

CORRESPONDENCE: Thomas W. McLean, Department of Pediatrics, division of Hematology/Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA ()

CITATION: UroToday Int J. 2013 August;6(4):art 50. http://dx.doi.org/10.3834/uij.1944-5784.2013.08.09

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Prevalence of Prostate Carcinoma in the Indian Population: The Need to Revise Serum Prostate Specific Antigen (PSA)


ABSTRACT

Introduction: This prospective study is an attempt to revise the serum prostate specific antigen (PSA) cutoff level to suit the Asian population.

Materials and Methods: A prospective study was carried out on 172 male patients who underwent transrectal ultrasound (TRUS) prostate biopsies. Only those patients with a serum PSA level within the range of 4 to 10 mg/mL were included in this study. The decision to perform the biopsy was undertaken only after further evaluation using free:total PSA ratio.

Results: Of the 172 patients, 9 (5.23%) patients had adenocarcinoma prostate with a Gleason's score ranging from 4 to 7. In total, 163 (94.7%) patients had benign pathology. Serum PSA ranged from 4.2 to 9.8 ng/mL.

Conclusion: The cutoff level of serum PSA beyond which investigations are warranted in Asians is controversial at present, and further multicentric trials involving a larger number of patients must be carried out to arrive at a consensus.


Nandan R. Pujari

Submitted March 21, 2013 - Accepted for Publication July 22, 2013


KEYWORDS: Prostate carcinoma, serum PSA, Asian population, adenocarcinoma

CORRESPONDENCE: Nandan R. Pujari, MS, DNB (Urology), MGM Medical College, Mumbai, Maharashtra, India ()

CITATION: UroToday Int J. 2013 August;6(4):art 51. http://dx.doi.org/10.3834/uij.1944-5784.2013.08.10

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Squamous Cell Carcinoma Arising in Keratinizing Desquamative Squamous Metaplasia (KDSM) of the Renal Pelvis

ABSTRACT

Keratinizing desquamative squamous metaplasia (KDSM) of the upper urinary tract is a rare condition. We present a case of a 45-year-old male smoker of more than 20 years presenting with a 1-month history of recurrent, intermittent left flank pain of moderate intensity associated with dysuria and nausea. In this case the differential diagnosis included renal cell carcinoma, tuberculosis of the kidney, and KDSM. However, the pathological findings showed squamous cell carcinoma arising in KDSM. Hence we report this rare association of a squamous cell carcinoma of the renal pelvis arising in KDSM.


Mohammed S. Al-Marhoon, P. A. M. Saparamadu, Krishna P. Venkiteswaran, Omar Shareef, Joseph Mathewkunju

Submitted June 7, 2013 - Accepted for Publication July 17, 2013


KEYWORDS: Squamous cell carcinoma, metaplasia, kidney

CORRESPONDENCE: Mohammed S. Al-Marhoon, PhD, MD, MRCSEd, BSc, Sultan Qaboos University, Al-Khould, Muscat, Oman ()

CITATION: UroToday Int J. 2013 August;6(4):art 49. http://dx.doi.org/10.3834/uij.1944-5784.2013.08.08

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Isolated Ano-vaginal Fistulae without Associated Vesicovaginal Fistulae Following Prolonged Labor: A Rare Entity

ABSTRACT

Isolated ano-vaginal fistulae without associated vesicovaginal fistulae following prolonged labor have not been reported. They present with fecal discharge per vaginum. A two-layered fistulae closure with interposition flap is the treatment of choice. Herein, we report such a rare entity that deserves mention.


Vishwajeet Singh, Dheeraj Kumar Gupta, Rahul Janak Sinha

Submitted May 15, 2013 - Accepted for Publication June 30, 2013


KEYWORDS: Ano-vaginal fistulae, vesicovaginal fistulae, obstetric delivery, interposition flap

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

CITATION: UroToday Int J. 2013 August;6(4):art 48. http://dx.doi.org/10.3834/uij.1944-5784.2013.08.07

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Management of Overactive Bladder (OAB) in Elderly Men and Women with Combined, High-Dosed Antimuscarinics without Increased Side Effects

ABSTRACT

Objectives: Numerous elderly patients with overactive bladder (OAB) demonstrate insufficient treatment results under antimuscarinic monotherapy with dose increase. To reduce the OAB symptoms and to estimate safety and tolerability of non-invasive treatment, we evaluated the use of combined antimuscarinics as the alternatives.

Methods: Eighty-one patients older than 65 years, both male and female, who earlier received (for 6 months or more before our study) double-dose antimuscarinic monotherapy (trospium), whose initial symptoms did not resolve (or the improvement was short lived), and who experienced mild or no side effects, were included in this study. The patients demonstrated urodynamic-proven overactive bladder with daily incontinence, increased intravesical pressure, and reduced bladder capacity. Taking into account the strength of the initial study treatment, they were distributed into 3 groups and treated with 2 antimuscarinics. The patients underwent urodynamic examination before enrollment in the sixth week and in the fourth month. During the whole treatment period, they kept special bladder diaries where they, among other issues, described side effects during treatment.

Results: Significant changes were noted at the 6-week follow-up in all 3 groups. The average number of daily incontinence events decreased from 6 to 2 events. The average maximum bladder capacity (177 to 356 mL) and reflex volume (149 to 284 mL) increased; detrusor compliance also improved (average, 16 to 37 mL/cm H2O). Twenty-four patients reported side effects; 3 of them discontinued the successful treatment due to this reason. Seven other patients did not receive any noticeable improvement of detrusor dysfunction, although they did not report any side effects.

Conclusion: The majority of elderly patients, who previously demonstrated unsatisfactory results under dose-escalated monotherapy, were treated successfully with combined high-dosage antimuscarinics (87.6 %). The quantity of side effects was comparable to that of normal-dosed antimuscarinics.

Take-Home Message: The majority of elderly patients, who continued to suffer from symptoms of overactive bladder after dose-escalated antimuscarinic monotherapy, showed subjective and objective treatment success. The therapy used the combination of high-dosed antimuscarinics (87.6%). Obtained side effects were comparable to (did not exceed) the single-drug treatment.


Kirill Kosilov, Sergey Loparev, Marina Ivanovskaya, Lily Kosilova

Submitted April 16, 2013 - Accepted for Publication July 14, 2013


KEYWORDS: Overactive bladder, aging population, pharmacologic treatments, muscarinic antagonists, side effects, tolterodine, trospium, oxybutynin, solifenacin, combination antimuscarinics, urodynamic monitoring

CORRESPONDENCE: Kirill Kosilov, Far Eastern Federal University, Department of Neurourology-Urodynamics, Primorsky Regional Diagnostic Center, Vladivostok, Russian Federation ()

CITATION: UroToday Int J. 2013 August;6(4):art 47. http://dx.doi.org/10.3834/uij.1944-5784.2013.08.06

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Common Laboratory Values Are Unreliable in Identifying the Presence of Metastatic Renal Cell Carcinoma in the Liver and Bones

ABSTRACT

Introduction: Evaluation of patients with newly diagnosed renal cell carcinoma (RCC) often includes evaluating serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP). Traditional teaching is these laboratory values, if elevated, may indicate the presence of metastatic disease to the liver (AST and ALT) or bones (ALP). We analyzed our institutional RCC database to determine how consistently aberrations in these values were present when metastatic RCC was present.

Materials and Methods: A retrospective chart review was completed, identifying 315 patients diagnosed with RCC who had AST, ALT, and ALP values available for review. Overall rates of aberration, as well as rates of aberration in those patients presenting with metastatic RCC, were calculated.

Results: Of the 315 patients in the study cohort, 61 (19.4%) presented with an elevation in 1 or more of the laboratory values in question. Of these 61 patients, 58 (95%) presented with clinically localized disease. The remaining 3 patients (5%) presented with lung metastasis identified on imaging and had isolated elevations of ALP ranging from 130 IU/L to 278 IU/L; these 3 patients were of the 9 in the cohort who presented with lung metastasis. Five patients presented with metastatic lesions to the bone with no elevation of ALP present. Five patients presented with metastatic lesions to the liver, and none of these patients had any elevation of ALT or AST. However, 1 of these 5 patients did have minimal elevation in ALP, 130 IU/L, but also had a concomitant lung metastasis.

Conclusion: Elevation in ALP, while not seen in patients with bone metastasis in this cohort, was present in 33.3% of patients presenting with lung metastasis. Therefore, an identified aberration in ALP may be considered to direct closer pulmonary evaluation. Regarding AST and ALT, elevations of these laboratory values were not present in any patients with liver metastasis. These observations highlight that AST, ALT, and ALP are unreliable in suggesting the presence of metastatic RCC lesions in liver or bone, and underscore the importance of imaging.


Joshua E. Logan, David A. Staneck, Mary H. James, Jack W. Lambert, Robert W. Given, Raymond S. Lance, Michael D. Fabrizio, Stephen B. Riggs

Department of Urology, Eastern Virginia Medical School, Norfolk, Virginia, USA

Submitted April 18, 2013 - Accepted for Publication June 30, 2013


KEYWORDS: Renal cell carcinoma, metastases, laboratory values, AST, ALT, alkaline phosphatase

CORRESPONDENCE: Joshua E. Logan, MD, Fellow, Institute of Urologic Oncology, Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California, United States ()

CITATION: UroToday Int J. 2013 August;6(4):art 46. http://dx.doi.org/10.3834/uij.1944-5784.2013.08.05

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Successful En-Bloc Kidney Transplantation from a 7-Month-Old Donor Weighing 14.3 Pounds Into an Adult Recipient: A Case Report

 

ABSTRACT

We report a case of successful transplantation of en-bloc kidneys (EBK) from a 7-month-old male pediatric donor weighing 14.3 pounds into a 94.8-pound, 18-year-old female recipient. The cause of brain death in the infant was pseudomonas meningitis, and the donor and recipient received appropriate intravenous antibiotics. Both ureters were implanted separately and stented. The postoperative course was uneventful except for 2 episodes of acute cellular rejection. She remains well at more than 36 months post-transplantation, with a serum creatinine of 48 µmmol/L. We recommend en-bloc kidney transplantation into suitable adults if the pediatric donor weighs less than 33 pounds. 


Taqi F. Toufeeq Khan, Suhaib Kamal, Basem Koshaji, Faheem Akhtar

Submitted May 2, 2013 - Accepted for Publication June 16, 2013


KEYWORDS: 14.3-pound pediatric donor, bacterial meningitis, en-bloc kidneys, kidney transplantation, adult recipient

CORRESPONDENCE: Taqi F. Toufeeq Khan, Section of Kidney Transplantation, Department of Surgery, Riyadh Military Hospital, 11159 Riyadh, Kingdom of Saudi Arabia ()

CITATION: UroToday Int J. 2013 August;6(4):art 45. http://dx.doi.org/10.3834/uij.1944-5784.2013.08.04

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Analysis of the Feasibility and Efficacy of Ambulatory/Day Care Percutaneous Nephrolithotomy: An Initial Experience

ABSTRACT

Purpose: Tubeless percutaneous nephrolithotomy (PCNL) is a well-accepted procedure for uncomplicated renal calculi. We prospectively evaluated the safety, feasibility, and efficacy of day care/ambulatory PCNL (totally tubeless, discharge within 24 hours) for selected patients for which only few case series have been reported.

Materials and Methods: Total tubeless PCNL was planned in 40 easily accessible patients with uncomplicated renal calculi, with single infracostal punctures, normal intraoperative events, and acceptable postoperative parameters (visual analogue pain score, parenteral analgesic requirement, bleeding, urinary soakage, hemodynamic stability), allowing an early discharge within 24 hours. Parameters like pain score and analgesic requirement, any complications, and return date to normal work were evaluated at follow-up. Ultrasonography was performed after a week to document stone clearance.

Results: Mean patient age was 38.6 years (22 to 62), stone size was 21.4 mm (15.4 to 30), and operating time was 72 minutes (42 to 106) without blood transfusion. Regional anesthesia was used in 13 cases while general anesthesia was used in the rest of the patients. Average pain score after 6 hours of surgery was 2.3 (1.8 to 3.6) with vitals in the normal range, and hospital stay was 12.5 hours (5.5 to 23.5). Six patients were excluded due to peri- and postoperative events (2: multiple punctures, 1: hematuria, 1: urine leak, 2: pain). This data was taken with the intention to treat the analysis with a successful application of study protocol in 34 (85%) of preoperatively selected cases. Out of 34 patients that qualified for a complete study protocol, 11 were discharged on the same day of surgery while the rest were discharged the next morning. Postoperative USG confirmed no residual calculus, and all patients had uneventful recoveries. Three patients had minor complications (mild hematuria/urine leaks), which were managed conservatively.

Conclusion: Our experience with ambulatory PCNL in properly selected cases suggests it as a feasible and effective option that can safely be offered to patients, providing uncomplicated surgery and favorable postoperative parameters.


Adittya K. Sharma, M. Nagabhushan, G. N. Girish, A. J. Kamath, C. S. Ratkal, G. K. Venkatesh

Submitted May 20, 2013 - Accepted for Publication June 16, 2013


KEYWORDS: Percutaneous nephrolithotomy, nephrolithiasis, kidney calculi

CORRESPONDENCE: Adittya K. Sharma, MCh, Institute of Nephro-Urology, Victoria Hospital Campus, Bangalore, Karnataka, India (, )

CITATION: UroToday Int J. 2013 August;6(4):art 44. http://dx.doi.org/10.3834/uij.1944-5784.2013.08.03

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Predictors of Unsuccessful Trials without Catheters in Acute Urinary Retention Secondary to Benign Prostatic Hyperplasia

 

ABSTRACT

Introduction: Acute urinary retention (AUR) is the most important event in the natural history of benign prostatic hyperplasia (BPH) that calls for urinary catheterization. Trial without catheter (TWOC) is an ambulatory care protocol, failure of which requires re-catheterization, a follow-up visit, subsequent evaluation, and surgical intervention. The aim of the study was to identify independent predictors of unsuccessful TWOC.

Methods: The present study enrolled 83 patients with a first episode of AUR secondary to BPH. We have recorded details of various factors, including age, international prostate symptom score (IPSS), total prostate volume (TPV), transition zone volume (TZV), transition zone index (TZI), intravesical prostatic protrusion (IPP), and residual urine volume (RUV) drained following catheterization. Administration of 0.4 mg of tamsulosin once a day for 7 days was given to all following catheterization and TWOC performed on the eighth day. Our definition of unsuccessful trial was the inability to pass urine or post-void residual urine > 150 mL on ultrasound, with a maximum flow rate < 10 mL/sec. Statistical Package for the Social Sciences (SPSS) 16.0 was used for statistical analysis. Multivariate analysis was performed to identify independent predictors. Independent t-test and Fisher’s exact tests were used for other statistical analysis where a P value of < 0.05 was considered significant. Receiver operating characteristic curves (ROC) were constructed using cutoff values for independent predictors.

Results: TWOC was unsuccessful in 48 (57.83%) patients. Multivariate analyses revealed that age (odds ratio = 1.069; 95% CI = 1.002-1.140; P value = 0.042), TZV (odds ratio = 1.662; 95% CI = 1.035-2.670; P value = 0.035), TZI (odds ratio = 0.00; 95% CI = 0.00-0.150; P value = 0.032), and RUV (1.003, 1.000-1.007, 0.38) are independent predictors of a failed trial. The failure rates of the voiding trial based on grades I to III IPP were 2.08% (1 of 48 cases), 10.41% (5 of 48), and 18.75% (9 of 48).

Conclusion: Our data suggested that age, IPP, TZV, TZI, and RUV are significant risk factors for unsuccessful TWOC. Evaluation of a first episode of AUR secondary to BPH in respect to the previously mentioned factors may guide urologists during subsequent evaluation and treatment without giving a failed trial.


Bijit Lodh, Somarendra Khumukcham, Sandeep Gupta, Kaku Akoijam Singh, Rajendra Singh Sinam

Submitted May 4, 2013 - Accepted for Publication June 14, 2013


KEYWORDS: Acute urinary retention, benign prostatic hyperplasia, trial without catheter, intravesical prostatic protrusion, transition zone index

CORRESPONDENCE: Bijit Lodh, MS (General Surgery), MCh (Trainee in Urology), Regional Institute of Medical Sciences, Imphal, Manipur, India ()

CITATION: UroToday Int J. 2013 August;6(4):art 43. http://dx.doi.org/10.3834/uij.1944-5784.2013.08.02

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The Use of Tamsulosin in Voiding Cystourethrograms for Pelvic Floor Urethral Distraction Injuries

 

ABSTRACT

Purpose: To analyze the utility of tamsulosin in patients with pelvic floor urethral distraction injuries (PFUDD) undergoing voiding cystourethrograms (VCUG) to assess the posterior urethra for length of the distraction defect.

Materials and Methods: A prospective randomized analysis of 107 patients with PFUDD who underwent VCUG from August 2007 to September 2011 at our tertiary referral center for urethral stricture. Patients were randomized into 2 groups. A dosage of 0.4 mg of tamsulosin, a potent selective alpha-blocker, was administered orally to patients in the study group (N = 53) undergoing VCUG in whom the posterior urethra was not delineated due to competency of the bladder neck. A repeat voiding film was taken 10 to 12 hours after administering tamsulosin. The control group (N = 54) did not receive tamsulosin. Instead, they underwent further diagnostic techniques (magnetic resonance imaging [MRI], bougiogram, and antegrade cystourethroscopy) to assess the distraction defect.

Results: Out of the 53 patients in the study group all 53 patients responded to oral tamsulosin. In the control group 32 patients required MRI, 20 patients required antegrade cystourethroscopy, and 2 patients required bougiograms.

Conclusion: Tamsulosin effectively relaxed the bladder neck and allowed the delineation of the posterior urethra in patients of PFUDD with a competent bladder neck. This prevented the patients from undergoing further invasive diagnostic techniques (bougiogram and antegrade cystourethroscopy). Further prospective studies with a larger number of patients with multicenter experience will be required to validate these results.


Nandan R. Pujari, Sanjay B. Kulkarni

Submitted March 21, 2013 - Accepted for Publication May 19, 2013


KEYWORDS: Tamsulosin, VCUG, distraction defect

CORRESPONDENCE: Nandan R. Pujari, MS, DNB (Department of Urology), MGM Medical College, Mumbai, Maharashtra, India ()

CITATION: UroToday Int J. 2013 August;6(4):art 42. http://dx.doi.org/10.3834/uij.1944-5784.2013.08.01

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Letter from the Editor - June 2013

Dear Colleagues,

Like the spring weather, Urotoday International Journal boasts its own mix of interesting and unpredictable articles of note that are sure to engage and interest our readers. We are proud of the encouraging variety of submissions and the discussion they will create in the days, weeks, and months ahead.

Singh et al. assessed the effectiveness of using intravesical prostatic protrusion (IPP) in correctly predicting bladder outlet obstruction (BOO) in symptomatic patients with BPH. In these patients, they compared IPP with other parameters of BOO like prostate volume, bladder wall thickness, PVR, and uroflowmetry. They conclude that bladder wall thickness and post-void residue in conjunction with IPP are good predictors of clinically significant BOO due to BPH.

Khan and colleagues discuss the incidence of immediate graft function (IGF), identify events causing delayed graft function (DGF), slow graft function, and factors that promote IGF in our living donor transplant recipients using kidneys recovered exclusively by open donor nephrectomy (ODN). They conclude that ODN is associated with excellent IGF and recommend it.

Nath et al. aim at determining the role of testosterone as a lithogenic factor and its relation to urinary and stone components. They found higher serum-free and total testosterone, and 24 hours of urinary oxalate  in male stone formers compared to non-stone formers. A larger prospective study is necessary to establish testosterone as a lithogenic factor in male former-stone patients.

The team of Falahatkar et al. compares complications and outcomes of totally ultrasonic versus fluoroscopically guided complete supine percutaneous nephrolithotomy (csPCNL). Through their findings, they demonstrate that totally ultrasonic had similar outcomes to fluoroscopic csPCNL in selected cases and conclude that ultrasonography can be an alternative to fluoroscopy in csPCNL.

Al-Asali and team assess if the AJUST® SIS would be an effective alternative to the TOT in a cohort of patients who have urodynamic stress incontinence with concomitant detrusor overactivity, voiding difficulty, high BMI, or those with previous retropubic surgery. Mean postoperative pain scores were low with no de novo groin pain. All women had satisfactory postoperative voiding and a negative cough stress test at 6 weeks of follow-up. At the 2-year follow-up, 89% had still improved.

Finally, Draga et al. present a study that investigates the accuracy of reproducing bladder coordinates during transurethral resection using an optical navigation system, as a first step to assess the feasibility of accurate navigation-assisted resection of bladder tumors. They show that navigation-assisted mapping of the bladder is accurate with constant bladder volumes.

We also present a series of case studies on several topics, including idiopathic urethral strictures, late bladder erosion complications, and primary vulval tuberculosis.  

As always, we are grateful to our sustained readership, our devoted authors, and our hard-working editorial board that continues to work tirelessly to make UIJ a distinguished journal in the field. 

Sincerely,

Karl-Erik Andersson

Late Bladder Erosion Complications and Vesical Stone Formations of Synthetic Graft Materials Used in Mid-Urethral Sling Procedures

ABSTRACT

We present a case of 2 patients with late bladder erosion and vesical stone formation due to mesh erosion from mid-urethral polypropylene slings and their management. Patients presented 18 and 22 months after surgery with hematuria, recurrent urinary tract infections, and lower urinary tract symptoms. Stone fragmentation was done by pneumatic lithotripsy, and transurethral resection of the mesh was performed using a 26 Fr resectoscope. Postoperative control cystoscopy demonstrated complete healing of bladder mucosa after 3 months. The patients were satisfied with this result, and the patients reported significant improvement of symptoms. The patients remained completely continent at the follow-up period. The endoscopic management of the eroded mesh should be the first choice of bladder erosion therapy. Careful and comprehensive urethrocystoscopy is mandatory during a mid-urethral sling procedure. There is a need for long-term follow-up of patients with mid-urethral slings. We present a case of 2 patients with late bladder erosion and vesical stone formation due to mesh erosion from mid-urethral polypropylene slings and their management. Patients presented 18 and 22 months after surgery with hematuria, recurrent urinary tract infections, and lower urinary tract symptoms. Stone fragmentation was done by pneumatic lithotripsy, and transurethral resection of the mesh was performed using a 26 Fr resectoscope. Postoperative control cystoscopy demonstrated complete healing of bladder mucosa after 3 months. The patients were satisfied with this result, and the patients reported significant improvement of symptoms. The patients remained completely continent at the follow-up period. The endoscopic management of the eroded mesh should be the first choice of bladder erosion therapy. Careful and comprehensive urethrocystoscopy is mandatory during a mid-urethral sling procedure. There is a need for long-term follow-up of patients with mid-urethral slings. 


Emrah Okulu, Kemal Ener, Mustafa Aldemir, Onder Kayigil

Submitted March 21, 2013 - Accepted for Publication April 22, 2013


KEYWORDS: Bladder erosion, incontinence surgery, vesical stone

CORRESPONDENCE: Emrah Okulu, M.D., Umit Mh. Meksika Cd. 2463. sk. 4/32, Umitköy, Yenimahalle, Ankara, Turkey ()

CITATION: UroToday Int J. 2013 June;6(3):art 41. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.15

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The Role of Serum Testosterone as a Lithogenic Factor and Its Correlation with Stone and Urine Composition Amongst Male Stone Formers

ABSTRACT

Introduction: Urolithiasis typically affects adult men more commonly than women with a two- to threefold higher incidence. Stone disease has been found to have an inverse relationship as one ages. This gender and age differentiation invites the role of testosterone as a possible lithogenic factor. Our study aims at determining the role of testosterone as lithogenic factor and its relation to urinary and stone components.

Methods: A total of 87 men older than 18 years were enrolled in our study. Early morning free and total testosterone, serum level of the parathyroid hormone, calcium acid, and uric acid were estimated between the 2 groups. Twenty-four hours of urinary oxalate, uric acid, and calcium were estimated in all patients and the control. Stone analysis was done to determine stone composition for stones in the former group.

Results: Of the 87 patients, 48 patients had a history of urolithiasis and 39 patients had no history of urolithiasis. In comparison to non-stone formers, stone formers have higher serum-free and total testosterone, and 24-hour urinary oxalate. A positive and weak-positive correlation was found in relation to 24 hours of urinary oxalate for free and total testosterone, respectively. Calcium oxalate stones were found in 40 patients. Other differences between the 2 groups were not statistically significant.

Conclusions: A higher serum-free and total testosterone, and 24 hours of urinary oxalate were found in male stone formers compared to non-stone formers. Serum testosterone had a positive correlation to urinary oxalate. These findings have a similarity with animal and human studies. A larger prospective study is necessary to establish testosterone as a lithogenic factor in male former-stone patients.


Simanta Jyoti Nath, Debanga Sarma, Puskal K. Bagchi, Sasanka K. Baruah, Rajeev T. Puthenveetil, Saumar J. Baruah

Submitted February 25, 2013 - Accepted for Publication May 12, 2013


KEYWORDS: Serum testosterone, urinary oxalate, calcium oxalate stones

CORRESPONDENCE: Dr. Simanta Jyoti Nath, Department of Urology, Gauhati Medical College & Hospital, Bhangagarh, Guwahati, PIN-78100, Assam, India, ()

CITATION: UroToday Int J. 2013 June;6(3):art 37. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.11

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Primary Vulval Tuberculosis Presenting As Multiple Vulval Ulcers: A Rare Case Report

ABSTRACT

Primary tuberculosis (TB) of the vulva is very rare. Here we report a case of primary ulcerative vulvar TB. The diagnosis was made on the histopathological finding along with demonstration of acid-fast bacilli on tissue biopsy and managed with anti-tubercular drugs. So, tuberculosis should be suspected in cases of non-healing vulvar ulcers, particularly in developing countries.


Krishnendu Maiti, Shwetank Mishra, Malay Bera, Dilip Pal, Moumita Maiti, Partha Pratim Mondal

Submitted February 27, 2013 - Accepted for Publication May 10, 2013


KEYWORDS: Vulva, tuberculosis, non-healing, ulcers

CORRESPONDENCE: Shwetank Mishra, Department of Urology, Institute of Postgraduate Medical Education & Research, Kolkata, India ()

CITATION: UroToday Int J. 2013 June;6(3):art 39. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.13

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Does Intravesical Prostatic Protrusion Predict Bladder Outlet Obstruction in Patients with Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia?

ABSTRACT

Aim: To prospectively detect clinically significant bladder outlet obstruction (BOO) in all symptomatic patients presenting with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) by studying select parameters like prostate volume, bladder wall thickness (BWT), intravesical prostatic protrusion (IPP), post-void residue (PVR), and uroflowmetry. Our aim is also to determine the effectiveness of using IPP in correctly predicting BOO in symptomatic patients with BPH, and to compare IPP with other parameters of BOO like prostate volume, bladder wall thickness, PVR, and uroflowmetry in patients with symptomatic BPH.

Methods: After obtaining institutional ethical clearance for this study and administering an informed consent, history, focused urological examination, and International Prostate Symptom Score (IPSS), select ultrasonographic and uroflowmetry parameters were recorded and analyzed in 48 selected patients, as per our protocol.

Results: The mean BWT, PVR, and IPP were 6.26 mm, 91.27 cc, and 8.2 mm, respectively, and their mean maximal flow rate (MFR), average flow rate (AVR), voiding duration, acceleration, and hesitancy time in 44/48 evaluable patients (4 patients had AUR) were 13.68 (3 to 49) mL/min, 7.17 (2 to 25) mL/min, 49.12 (15 to 115) secs, 3.82 (0 to 70) secs, and 13.9 (1 to 242) secs, respectively. The paired sample test (2-tailed) analysis demonstrated that the relationship between BWT vs MFR, IPP (mm) vs MFR, PVR vs MFR, and AFR was highly significant (P < 0.001).

Conclusion: With increasing life expectancy, more men are destined to develop bothersome symptoms due to BPH. Bladder wall thickness and post-void residue in conjunction with intravesical prostatic protrusion are good predictors of clinically significant bladder outlet obstruction due to BPH. A search for more reliable, accurate, and non-invasive methods could substitute present methods of evaluating symptomatic BOO due to BPH.


Iqbal Singh, Shankar Kumar

Submitted February 27, 2013 - Accepted for Publication May 10, 2013


KEYWORDS: BPH, bladder outlet obstruction, bladder wall thickness, post-void residue, intravesical prostatic protrusion

CORRESPONDENCE: Dr. Iqbal Singh, MCh (Urology), DNB (GU Surgery), MS, DNB (Surgery), Professor & Senior Consultant Urologist, Department of Surgery (Urology), University College of Medical Sciences, New Delhi, India ()

CITATION: UroToday Int J. 2013 June;6(3):art 40. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.14

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Bladder Ganglioneuroma: A Rare Case Report

ABSTRACT

Ganglioneuromas are neurogenic tumors that often stem from sympathetic ganglion cells, and less frequently from the adrenal medulla and peripheral nerves. These tumors are slow-growing and have a more benign character compared to other cell types. Herein we present a pure ganglioneuroma of a 50-year-old male patient as the third case reported in the urinary bladder. At cystoscopy a 6 cm x 6 cm tumor was found on the posterior wall of the bladder and resected. Histologically, the tumor was composed of mature and immature ganglion cells and Schwann cells. Since the neuroblasts did not consist of an evident bundle structure, it was diagnosed as a ganglioneuroma. To our knowledge, 5 cases of composite paraganglioma-ganglioneuroma have been reported in the English literature. However, there are only 2 documented cases of bladder-located, pure ganglioneuromas. 


Kemal Ener, Mustafa Aldemir, Emrah Okulu, Aylin Kilic Yazgan, Murat Keske, Fatih Akdemir, Muhammet Fuat Özcan

Submitted April 1, 2013 - Accepted for Publication May 17, 2013


KEYWORDS: Ganglioneuroma, urinary bladder

CORRESPONDENCE: Dr. Kemal Ener, Ataturk Education and Research Hospital Urology Clinic, 06610, Ankara, Türkiye ()

CITATION: UroToday Int J. 2013 June;6(3):art 38. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.12

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A Prospective Evaluation of the AJUST® Single-Incision Sling in the Surgical Treatment of Stress Urinary Incontinence: Two Years of Follow-Up

ABSTRACT

Introduction: The mid-urethral sling has become the mainstay in the surgical management of stress urinary incontinence. Early meta-analyses suggested that the obturator approach (TOT) may be preferable in women with a high body mass index (BMI), concomitant voiding difficulties (VD), mixed urinary incontinence (MUI), or previous retropubic surgery. However, they are associated with increased and prolonged de novo groin pain. The AJUST® single-incision sling (SIS) was developed as an alternative to the retropubic and obturator slings and has been shown to be an effective treatment for urodynamic stress incontinence (USI) in the short term. We aim to assess if the AJUST® SIS would be an effective alternative to the TOT in a cohort of patients who have urodynamic stress incontinence (USI) with concomitant detrusor overactivity (DO), VD, high BMI, or those with previous retropubic surgery.

Methods: Women with USI and either concomitant DO, VD, previous failed TVT, or a BMI > 35 underwent treatment with the AJUST® SIS. Women were asked to complete the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) and an Urgency Perception Scale (UPS) preoperatively and then at 6 weeks, 6 months, 12 months, and 24 months postoperatively along with the PGI-I form. The numerical rating scale (NRS) was used to score pain 3 hours postoperatively and prior to discharge. Changes in ICIQ-UI-SF and UPS scores were measured.

Results: Twenty-five women were recruited. The mean age was 58 years. Of these, 28% had USI and 72% had mixed incontinence. There were no major perioperative complications. Mean postoperative pain scores were low with no de novo groin pain. All women had satisfactory postoperative voiding and a negative cough stress test at 6 weeks of follow-up. At the 2-year follow-up, 89% had still improved.

Conclusion: The AJUST® SIS appears to have promising medium-term efficacy in this challenging cohort of women. The long-term results are awaited.


Fida Al-Asali, Alexander Goodman, Ismaiel Abu Mahfouz, Christian Phillips

Submitted April 2, 2013 - Accepted for Publication April 24, 2013


KEYWORDS: Stress urinary incontinence, retropubic sling, transobturator sling, AJUST® sling

CORRESPONDENCE: Ismaiel Abu Mahfouz, Consultant Obstetrician and Gynecologist, Jordan Healthcare Center, Amman, Jordan ()

CITATION: UroToday Int J. 2013 June;6(3):art 36. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.10

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The Feasibility of Navigation-Assisted Mapping of Bladder Tumors During Transurethral Resection

ABSTRACT

Introduction: Surgical navigation systems have proven to support surgeons to localize and target anatomical structures. The aim of this study is to investigate the accuracy of reproducing bladder coordinates during transurethral resection using an optical navigation system, as a first step to assess the feasibility of accurate navigation-assisted resection of bladder tumors.

Methods: The coordinates of 21 bladder locations in 7 patients were collected using a Medtronic StealthStation Surgical Navigation System with infrared optical tracking. The coordinates of bladder lesions and ureteral orifices were recorded twice, independently, after filling the bladder with an arbitrary fixed volume of 390 mL of saline.

Results: The distance, in millimeters, between the coordinates of 2 consecutive measurements of the same bladder location was calculated. Bladder lesions and ureteral orifices could be retrieved with a mean accuracy of 8.2 mm (SD = 6.2; N = 21).

Conclusion: Navigation-assisted mapping of the bladder showed to be accurate at constant bladder volumes. Further development of the technology is needed to improve navigation efficiency and to implement augmented reality techniques to facilitate the retrieval of bladder tumors during transurethral resection.


Ronald O.P. Draga, Herke Jan Noordmans, Tycho M.T.W. Lock, Joris Jaspers, Arjen van Rhijn, J.L.H. Ruud Bosch

Submitted February 21, 2013 - Accepted for Publication April 24, 2013


KEYWORDS: Urinary bladder neoplasms, computer-assisted surgery, cystoscopy, residual neoplasm, recurrence

CORRESPONDENCE: Ronald Oskar Draga, M.D., Department of Urology, University Medical Center, Utrecht, Utrecht, Netherlands ()

CITATION: UroToday Int J. 2013 June;6(3):art 35. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.09

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Kidney and Prostatic Abscesses Secondary to Burkholderia Cepacia: A Unique Constellation in an HIV-Positive Male

ABSTRACT

We report the first case of Burkholderia cepacia infection leading to multiple kidney abscesses and concomitant prostatic abscess in a human immunodeficiency virus (HIV)-positive 21-year-old male. The patient initially presented with generalized abdominal pain, and computed tomography (CT) demonstrated left renal micro-abscesses. A follow-up CT scan demonstrated worsening of the kidney abscesses and a cystic lesion in the right prostate gland suggestive of an abscess. Transrectal ultrasound guided drainage of the abscess was followed by transurethral resection of the prostatic abscess. All clinicians need vigilance and an open-mind when investigating etiologies for infectious disease processes in HIV-positive patients. 


Zachary Klaassen, Young Kwak, Derrick L. Johnston, Jeffrey M. Donohoe, Martha K. Terris

Submitted January 28, 2013 - Accepted for Publication April 22, 2013


KEYWORDS: Burkholderia cepacia, granulomatous prostatitis, HIV, kidney abscess, prostate abscess

CORRESPONDENCE: Zachary Klaassen, M. D., Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, 1120 15th Street, Augusta, Georgia 30912 ()

CITATION: UroToday Int J. 2013 June;6(3):art 34. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.08

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Ultrasound versus Fluoroscopic Complete Supine Percutaneous Nephrolithotomy: A Randomized Clinical Trial

ABSTRACT

Introduction: To compare complications and outcomes of totally ultrasonic versus fluoroscopically guided complete supine percutaneous nephrolithotomy (csPCNL).

Materials and Methods: In this randomized clinical trial study from January 2009 to September 2010, 26 of 51 patients with renal stones underwent csPCNL with ultrasonographic guidance (group A), and the other 25 patients underwent fluoroscopically guided csPCNL (group B). Statistical analysis was performed with SPSS 16 software.

Results: The mean BMI was 28.14 in group A and 26.31 in group B (ρ = 0.30). The mean stone burden was 26.48 and 30.44 in groups A and B, respectively (ρ = 0.20). The stone-free rate was 88.5% and 75.5% in groups A and B, respectively (ρ = 0.16). Overall, 2 patients (7.7%) in group A and 6 patients (24%) in group B had complications (ρ = 0.11). The mean operative time in groups A and B were 88.46 and 79.58 minutes, respectively (ρ = 0.39). The mean hospital stay was 69.70 and 61.79 hours in groups A and B, respectively (ρ = 0.22).

Conclusion: Totally ultrasonic had similar outcomes to fluoroscopic csPCNL in selected cases. Ultrasonography can be an alternative to fluoroscopy in csPCNL.


Siavash Falahatkar, Aliakbar Allahkhah, Majid Kazemzadeh, Ahmad Enshaei, Maryam Shakiba, Fahimeh Moghaddas, Mohammad Allahkhah

Submitted March 27, 2013 - Accepted for Publication May 5, 2013 


KEYWORDS: Percutaneous nephrolithotomy, supine, ultrasound, fluoroscopy, complete supine, csPCNL

CORRESPONDENCE: Aliakbar Allahkhah, M.D., Urology Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Islamic Republic of Iran ()

CITATION: UroToday Int J. 2013 June;6(3):art 33. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.07

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