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Gastric neobladders: surgical outcomes of 91 cases using different techniques
Vol. 44 (x): 2018 April 4.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0563
Aloysio Floriano de Toledo 1, Carlos Eduardo Bastian da Cunha 1, Christian Heinz Steppe 1, Daniel Weissbluth de Toledo 1, Jorge Antonio Pastro Noronha 1, Gustavo Carvalhal 1
1 Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul – PUC, Porto Alegre, RS, Brasil
Introduction: We report on the surgical results of a series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers.
Materials and Methods: We report on a retrospective case series of 91 patients who received gastric neobladders as urinary diversion after radical cystectomies performed for the treatment of muscle-invasive bladder cancers. Different techniques of gastric neobladders were employed from 1988 to 2013 at a university hospital in the South of Brazil.
Results: Initial outcomes utilizing Leong (Antral) and Nguyen-Mitchell (Wedge) technique were unsatisfactory, yielding high pressure, low capacity reservoirs. Further developments of these techniques, with the detubularized gastric neobladder and the "spherical" gastric neobladders resulted in low pressure, high capacity reservoirs, with better surgical and urodynamic outcomes. Complication and perioperative mortality rates of our series of gastric neobladders were significantly higher than historical results of techniques using ileum or colon.
Conclusions: Stomach is an exceptional option for the creation of neobladders after radical cystectomies, but due to the increased complication rates it should be reserved for specific situations (e.g., renal insufficiency, previous pelvic/abdominal radiotherapy, short bowel syndromes).
Keywords: Surgical Procedures, Operative; Urinary Diversion; Cystectomy
Is urotherapy alone as effective as a combination of urotherapy and biofeedback in children with dysfunctional voiding?
Vol. 44 (x): 2018 August 8.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0194
Adem Altunkol 1, Deniz Abat 2, Nevzat Can Sener 1, Mehmet Gulum 3, Halil Ciftci 4, Murat Savas 5, Ercan Yeni 6
1 Department of Urology, Adana City Teaching and Research Hospital, University of Healthy Sciences, Adana, Turkey; 2 Department of Urology, Ministry of Health, Iskenderun State Hospital, Hatay, Turkey; 3 Department of Urology, Ankara Keçiören Teaching and Research Hospital, University of Healthy Sciences, Ankara, Turkey; 4 Department of Urology, Faculty of Medicine, Harran University, Şanliurfa, Turkey; 5 Department of Urology, Antalya Teaching and Research Hospital, University of Healthy Sciences, Antalya, Turkey; 6 Department of Urology, Ankara Numune Teaching and Research Hospital, University of Healthy Sciences, Ankara, Turkey
Objective: To compare standard urotherapy with a combination of urotherapy and biofeedback sessions and to determine the changes that these therapies promote in children with dysfunctional voiding.
Patients and Methods: The data of 45 patients who participated in the study from January 2010 to March 2013 were evaluated. All patients underwent urinary system ultrasonography to determine post-void residual urine volumes and urinary system anomalies. All patients were diagnosed using uroflowmetry – electromyography (EMG). The flow pattern, maximum flow rate, and urethral sphincter activity were evaluated in all patients using uroflowmetry – EMG. Each patient underwent standard urotherapy, and the results were recorded. Subsequently, biofeedback sessions were added for all patients, and the changes in the results were recorded and statistically compared.
Results: A total of forty – five patients were included, of which 34 were female and 11 were male and the average age of the patients was 8.4 ± 2.44 years (range: 5 – 15 years). After the standard urotherapy plus biofeedback sessions, the post-void residual urine volumes, incontinence rates and infection rates of patients were significantly lower than those with the standard urotherapy (p < 0.05). A statistically significant improvement in voiding symptoms was observed after the addition of biofeedback sessions to the standard urotherapy compared with the standard urotherapy alone (p < 0.05).
Conclusions: Our study showed that a combination of urotherapy and biofeedback was more effective in decreasing urinary incontinence rates, infection rates and post – void residual urine volumes in children with dysfunctional voiding than standard urotherapy alone, and it also showed that this combination therapy corrected voiding patterns significantly and objectively.
Keywords: Biofeedback, Psychology; Child; Urinary Tract Infections
A rare case of spontaneous renal rupture caused by anca – associated vasculitides
Vol. 44 (x): 2018 August 8.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0119
Yongquan Yu 1, Jiatong Li 2, Hongjun Hou 1
1 Department of Radiology, WeiHai Central Hospital, Affiliated Hospital of Qingdao University, China; 2 Taishan Medical University, China
Not available
Impact of overactive bladder on retrograde ejaculation
Vol. 44 (x): 2018 August 8.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0225
Ahmet Salvarci 1, Mehmet Karabakan 2, Aliseydi Bozkurt 3, Erkan Hirik 3, Binhan Kagan Aktaş 4
1 Department of Urology, Novafertile IVF Centers and Konya Hospital, Konya, Turkey; 2 Department of Urology, Mersin Toros State Hospital, Mersin, Turkey; 3 Department of Urology, Erzincan University, Mengücek Gazi Research and Training Hospital, Erzincan, Turkey; 4 Department of Urology, Ankara Numune Research and Training Hospital, Ankara, Turkey
Purpose: To evaluate the impact of overactive bladder disorder on patients diagnosed with retrograde ejaculation.
Materials and Methods: Retrospective analysis of prospective collected database made.
Questionnaires conducted in urology polyclinics in five different centers. Main Outcome Measure(s): International Index of Erectile Function – 5 (IIEF – 5), Overactive Bladder 8 – Question Awareness Tool (OAB – V8), urodynamics, semen analysis. The participants of the study were n = 120 patients. There was retrograde ejaculation (RE) in only n = 47 patients (non / minimal symptomatic patients), n = 73 patients had RE and overactive (OAB) complaints (symptomatic patients) and received anticholinergic treatment (trospium), n = 37 control group patients who only had OAB and received an anticholinergic.
Results: While no difference was observed in overactive bladder examination and urodynamic values between the non / minimal symptomatic group and the symptomatic group (p > 0.05), sperm was detected and identified as fructose positive in post – ejaculation urine in the symptomatic group. Thus, it was possible to demonstrate the differences between symptomatic patients and non – symptomatic patients. Consequently, following three – month daily treatment with trospium 30 mg 2 x 1 in the control group and the symptomatic group, it was observed that an evident increase was observed in the sperm count and ejaculate volume in the symptomatic group and that no change was observed in the control group (p < 0.05).
Conclusion: This clinical study is the first of its kind in terms of revealing the coexistence of RE with OAB upon performing urodynamics and showing that treatment is possible in selected patients.
Keywords: Urinary Bladder, Overactive; Ejaculation; Urodynamics
Robot – assisted laparoscopic local recurrence resection after radical prostatectomy
Vol. 44 (x): 2018 August 8.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0503
Fabio C. M. Torricelli 1, Paulo Afonso de Carvalho 1, 2, Giuliano B. Guglielmetti 1,2, William C. Nahas 1, 2, Rafael F. Coelho 1, 2, 3
1 Serviço de Urologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil; 2 Instituto do Cancer do Estado de Sao Paulo (ICESP), São Paulo, SP, Brasil; 3 Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
Introduction and objective: Local prostate cancer recurrence is usually treated with salvage radiation (sRDT) with or without adjuvant therapy. However, surgical resection could be an option. We aim to present the surgical technique for robot – assisted laparoscopic resection prostate cancer local recurrence after radical prostatectomy (RP) and sRDT in 2 cases.
Patients and method: First case depicts a 70 year – old man who underwent RP in 2001 and sRDT in 2004. Following adjuvant therapy, patient had biochemical recurrence. MRI showed a solid mass in the prostatic fossa close to vesicourethral anastomosis, measuring 2.1 cm and PET / CT revealed hyper caption significant uptake in the prostatic fossa. Second case is a 59 year – old man who underwent RP in 2010 and sRDT in 2011. Again, patient presented with biochemical recurrence. PET / CT showed hyper caption in the prostatic fossa. Biopsy conformed a prostate adenocarcinoma. Both patients underwent robot – assisted extended pelvic lymph nodes dissection and local recurrence resection. A standard 4 robotic arms port placement was utilized.
Results: Both procedures were uneventfully performed in less than 3 hours and there were no complications. Pathological examination showed a prostate adenocarcinoma Gleason 7 and 8 in the first and second case, respectively; surgical margins and lymph nodes were negative. After 6 months of follow-up, continence was not affected and both patients presented with PSA < 0.15 ng / mL.
Conclusion: Robot – assisted laparoscopic resection of prostate cancer local recurrence after RP and sRDT detected by PSMA PET / CT seems to be safe in experienced hands. It may postpone adjuvant therapy in selected cases.
Available at: http://www.intbrazjurol.com.br/video-section/20170503_Torricelli_et_al
Int Braz J Urol. 2018; 44 (Video #X): XXX-X
A new surgical technique: transvesical resection of prostate – case series
Vol. 44 (x): 2018 August 8.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0113
Hakan Türk 1, Sıtkı Ün 2, Erkan Arslan 3
1 Department of Urology, Evliya Celebi Training and Research Hospital, Kutahya, Turkey; 2 Department of Urology, Sivas State of Hospital, Sivas, Turkey; 3 Department of Urology, Harran University Medical School, Sanliurfa, Turkey
Objective: To protect the urethra from instrumentation related urethra injures and stricture, we developed a new surgical technique which can be defined as transvesical resection of prostate without using urethra.
Materials and Methods: Our study included 12 consecutive bladder outlet obstruction patients treated with transvesical prostate resection in our clinic between March 2016 and May 2016. Detailed anamnesis, results of physical examination, digital rectal examination, routine lab tests, international prostate symptoms score, transrectal ultrasound, measurement of prostate-specific antigen levels and uroflowmetry was performed in all patients prior to surgery.
Results: Hospitalization period following surgery was 1 day. Foley catheter and suprapubic cystostomy catheters were removed in a median period of 3.6 days and 1 day. Median mass of resected adenomas was measured as 21.8 gr. Median maximum flow rate was measured as 6mL/s. Median postvoid residual urine volume was 70.6 cc and median international prostate symptoms score and quality of life scores were 9 and 1.4, respectively.
Conclusion: In this study, we would like to show the possible practicality of transvesical resection of prostate technique in this patient group. However, we think that this technique is very useful in special patient groups such as patients with bladder stones, priapism and penile prosthesis.
Keywords: Transurethral Resection of Prostate; Urethra; Urinary Bladder Neck Obstruction
Protective effects of Tadalafil and darbepoetin against ischemia – reperfusion injury in a rat testicular torsion model
Vol. 44 (x): 2018 August 8.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0200
Caglar Yildirim 1, Ozgur H. Yuksel 1, Ahmet Urkmez 2, Aytac Sahin 1, Adnan Somay 3, Ayhan Verit 1
1 Department of Urology, Fatih Sultan Mehmet Research & Training Hospital, University of Health Sciences, Istanbul, Turkey; 2 Department of Urology, Haydarpasa Numune Research & Training Hospital, University of Health Sciences, Istanbul, Turkey; 3 Department of Pathology, Fatih Sultan Mehmet Research & Training Hospital, University of Health Sciences, Istanbul, Turkey
Objectives: to evaluate protective effects of darbepoetin and tadalafil against ischemiareperfusion injury in ipsilateral and contralateral testicle.
Materials and Methods: Thirty 3-month-old adult male Wistar-Albino rats were randomly divided into 5 groups (A-E). Sham operation was performed in the first group.
In Group B, rats did not received any medication after creating 720 degrees torsion of the left testis. The rats in Group C, D and E received darbepoetin, tadalafil, and darbepoetin/ tadalafil combination 30 minutes after creating 720 degrees torsion of the left testis, respectively. The testes of rats in these three groups were detorsioned at 90 minutes after drug administration. Both testes were removed at 30 minutes after detorsion.
Results: There were significant differences between the groups in terms of the degree of histopathological damage, Johnsen score, fibrosis score and caspase-3 immunoreactivity in the torsioned testes (p: 0.000). The results for each parameter in the left testes were significantly better in the darbepoetin / tadalafil combination group. Similarly, there were also significant differences in the contralateral testes (p: 0.000).
Conclusion: The active substances darbepoetin and tadalafil that were used as a combination had protective effects on both testes and produced out better results in preserving testicular histology. Especially in cases where it is not possible to rescue the torsioned testis, this result was more noticeable in the contralateral testis.
Keywords: Darbepoetin alfa; Tadalafil; Reperfusion Injury
Beneficial effects of oltipraz, nuclear factor – erythroid – 2 – related factor 2 (Nrf2), on renal damage in unilateral ureteral obstruction rat model
Vol. 44 (x): 2018 August 8.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0232
Emre Can Polat 1, Huseyin Besiroglu 2, Levent Ozcan 3, Alper Otunctemur 1, Ahmet Tugrul Eruyar 4, Adnan Somay 5, Nurver Ozbay 5, Mustafa Cekmen 6, Ceyla Eraldemır 7, Emin Ozbek 8
1 Department of Urology, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul, Turkey; 2 Department of Urology, Catalca Ilyas Cokay State Hospital, Istanbul, Turkey; 3 Department of Urology, Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey; 4 Department of Pathology, Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey; 5 Department of Pathology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey; 6 Department of Biochemistry, Istanbul Medeniyet University, Istanbul, Turkey; 7 Department of Biochemistry, Kocaeli University, Kocaeli, Turkey; 8 Department of Urology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
Introduction: We investigated whether Oltipraz (OPZ) attenuated renal fibrosis in a unilateral ureteral obstruction (UUO) rat model.
Materials and Methods: We randomly divided 32 rats into four groups, each consisting of eight animals as follows: Rats in group 1 underwent a sham operation and received no treatment. Rats in group 2 underwent a sham operation and received OPZ. Rats in group 3 underwent unilateral ureteral ligation and received no treatment. Group 4 rats were subjected to unilateral ureteral ligation plus OPZ administration. Transforming growth factor beta-1 (TGF-β1), E-cadherin, nitric oxide (NO) and hydroxyproline levels were measured. Histopathological and immunohistochemical examinations were carried out.
Results: TGF-β1, NO and E-cadherin levels in the UUO group were significantly higher than the sham group and these values were significantly different in treated groups compared to the UUO group. In rats treated with UUO + OPZ, despite the presence of mild tubular degeneration and less severe tubular necrosis, glomeruli maintained a better morphology when compared to the UUO group. Expressions of α–SMA in immunohistochemistry showed that the staining positivity decreased in the tubules of the OPZ-treated group.
Conclusions: While the precise mechanism of action remains unknown, our results demonstrated that OPZ exerted a protective role in the UUO-mediated renal fibrosis rat model highlighting a promising therapeutic potency of Nrf2-activators for alleviating the detrimental effects of unilateral obstruction in kidneys.
Keywords: Oltipraz [Supplementary Concept]; Renal Insufficiency; Ureter
A severely encrusted forgotten double – J ureteral catheter with giant stone formation
Vol. 44 (x): 2018 August 8.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0330
Gaurav Garg 1, Deepanshu Sharma 1, Siddharth Pandey 1, Manoj Kumar 1
1 King George's Medical University, Lucknow, India
Not available
A novel "six stitches" procedures for pediatric and adult buried penis
Vol. 44 (x): 2018 July 7.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0688
Junhao Lei 1, Chunhua Luo 1, Xinghuan Wang 1,2, Xinjun Su 1
1 Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China; 2 Center for Evidence-based and Translational Medicine, Wuhan University, Wuhan, China
Introduction: The buried penis, if not treated before adolescence, will lead to psychological and physical disorders in adulthood. Therefore, early surgical intervention is necessary. At present, the common surgical methods include the penile corpus fixation, the Johnson's operation, the Devine's method, the modified Devine's method, Shiraki's method, etc. However, we found that these traditional surgeries showed various postoperative complications, such as long-term prepuce edema, avascular necrosis of skin flaps, stenotic prepuce, scarring, and poor appearance. This video shows the main technical steps of our innovative surgical procedure "Six Stitch" (SS) method for the buried penis.
Materials and Methods: The designation of the so-called SS method was based on the total knots made (six knots were made for the SS procedure).
After the crura penis was fully exposed via a longitudinal incision at the penoscrotal junction, at the 2 o'clock position (around the penis), the superficial layer of albuginea of the crura penis was sutured to the prepubic ligament with 2-0 non-absorbable sutures to prevent the retraction of the penis (the 1st knot). The same procedure was used for the 10 o'clock position (the 2nd knot); At the 2 o'clock position, the skin and subcutaneous tissue at the pubic mound were sutured to the prepubic ligament to reconstruct the appearance of dorsum penis (the 3rd knot). The same procedures were used for the 10 o'clock position (the 4th knot). At the 5 o'clock position, the ventral albuginea was sutured to the tunica dartos and subcutaneous tissue at the penoscrotal junction to reconstruct the penoscrotal angle (the 5th knot). The same procedures were used for the 4 o'clock position (the 6th knot). Finally, the gloved prepuce was reset and circumcision was conducted if the redundant prepuce existed.
Results: We have done a total of 64 cases of SS procedures for concealed penis; mean length improvement was 3.8 ± 0.5 cm, with a satisfying 95 percent (61 / 64), which was much longer than the outcome of the above-mentioned methods.
Mean operative time was 62.3 ± 12.1 minutes, and there was no serious intraoperative or postoperative complication (only 2 presented scar hyperplasia at the incision site).
Conclusions: In conclusion, after the SS procedure, patients with buried penis can acquire an almost 4 cm improvement of penile length and covert incision at the midline of the scrotum, with an acceptable and low incidence of adverse events.
This safe and effective procedure may be a viable option for the surgical management of pediatric and adult buried penis.
Available at: http://www.intbrazjurol.com.br/video-section/20170688_ Lei_et_al
Int Braz J Urol. 2018; 44 (Video #X): XXX-X
Adequate rectal preparation reduces hospital admission for urosepsis after transrectal ultrasound – guided prostate biopsy
Vol. 44 (x): 2018 June 7.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0181
Yu-Chen Chen 1, 2, Hao-Wei Chen 1, 2, Shu-Pin Huang 2, Hsin-Chin Yeh 3, Ching-Chia Li 2
1 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 2 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 3 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
Objectives: Previous studies have compared infectious outcomes on the basis of whether rectal preparation was performed; however, they failed to evaluate the quality of each rectal preparation, which may have led to confounding results. This study aimed to compare hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy between patients with adequate and traditional rectal preparations.
Materials and Methods: Between January 2011 and December 2016, a total of 510 patients who underwent transrectal ultrasound – guided prostate biopsy at our institutions and were orally administered prophylactic antibiotics (levofloxacin) were included. Two rectal preparations were performed: (1) adequate rectal preparation confirmed by digital rectal examination and transrectal ultrasound (Group A, n = 310) and (2) traditional rectal preparation (Group B, n = 200). All patient characteristics were recorded. A logistic regression model was used to assess the effects of the two different rectal preparations on urosepsis, adjusted by patient characteristics.
Results: There were a total of three and nine hospitalizations for urosepsis in Groups A and B, respectively. Differences in the demographic data between the two groups were insignificant. Logistic regression showed that adequate rectal preparation before biopsy significantly decreased the risk for urosepsis after biopsy (adjusted odds ratio: 0.2; 95% confidence interval: 0.05 – 0.78; P = 0.021).
Conclusions: Adequate rectal preparation could significantly reduce hospitalizations for urosepsis within 1 month after transrectal ultrasound-guided prostate biopsy. The quality of rectal preparation should be evaluated before biopsy. If adequate rectal preparation is not achieved, postponing the biopsy and adjusting the rectal preparation regimen are suggested.
Keywords: Prostate; Prostatic Neoplasms; Ultrasound, High-Intensity Focused, Transrectal
Easy, reproducible extraperitoneal pelvic access for robot – assisted radical prostatectomy
Vol. 44 (x): 2018 July 7.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0175
Antonio Rebello Horta Gorgen 1, Christian P. Pavlovich 2
1 Hospital de Clínicas de Porto Alegre, Porto Alegre, Brasil; 2 Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
Robot – assisted radical prostatectomy is commonly performed transperitoneally (tRARP), although the extraperitoneal (eRARP) approach is a safe and effective alternative that may be preferred in certain situations. We developed a novel method of direct access into the space of Retzius with a visual obturator port (VisiportTM) for laparoscopic or robotic prostatectomy.
We present an instructional video of extraperitoneal pelvic access for eRARP with both internal and external camera views. The patient is first placed in lithotomy and 15° Trendelenburg position. The camera is inserted infraumbilically and angled caudally. The pre-peritoneal space is accessed through the anterior rectus fascia using a VisiportTM (Covidien, $ 60 www.esutures.com), and the working space is developed with a kidney – shaped balloon OMSPDBS2TM (Covidien, $ 49 www.esutures.com). After the space is insufflated, subsequent trocars are angled in extraperitoneally under direct vision. The average time from incision to final port placement after a learning curve of about 50 cases is 8 minutes (IQR 7-10).
We have performed over 1.000 cases using this technique and eRARP has become our procedure of choice. Our last 500 + cases were performed robotically. Approximately 10% of the time peritoneotomies were noted, but rarely did these require conversion to tRARP. There have been no bowel or other abdominal organ injuries, major vascular or other complications in any of these cases.
Available at: http://www.intbrazjurol.com.br/video-section/20180175_Gorgen_et_al
Int Braz J Urol. 2018; 44 (Video #X): XXX-X
Impact of patient position on the outcomes of percutaneous neprolithotomy for complex kidney stones
Vol. 44 (x): 2018 June 7.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0163
Fabio Carvalho Vicentini 1, Rodrigo Perrella 1, Vinicius M. G. Souza 1, Marcelo Hisano 1, Claudio Bovolenta Murta 1, Joaquim Francisco de Almeida Claro 1
1 Departamento de Urologia, Setor de Endourologia e Litíase, Hospital Brigadeiro, São Paulo, SP, Brasil
Purpose: To evaluate the impact of the patient position on the outcomes of PCNL among patients with complex renal stones.
Material and Methods: From July 2011 to July 2014, we collected prospective data of consecutive patients who underwent PCNL. We included all patients with complex stones (Guy's Stone Score 3 or 4 (GSS) based on a CT scan) and divided them based on the position used during PCNL (prone or supine). The variables analyzed were gender, age, body mass index, ASA score, stone diameter, GSS, number of punctures, calyx puncture site, intercostal access and patient positioning. Complications were graded according to the modified-Clavien Classification. Success was considered if fragments ≤ 4mm were observed on the first postoperative day CT scan.
Results: We analyzed 240 (46.4%) of 517 PCNL performed during the study period that were classified as GGS 3-4. Regarding patient positions, 21.2% were prone and 79.8% were supine. Both groups were comparable, although intercostal access was more common in prone cases (25.5% vs 10.5%; p=0.01). The success rates, complications, blood transfusions and surgical times were similar for both groups; however, there were significantly more visceral injuries (10.3% vs 2.6%; p=0.046) and sepsis (7.8% vs 2.1%; p=0.042) in prone cases.
Conclusion: Supine or prone position were equally suitable for PCNL with complex stones and did not impact the success rates. However, supine position was associated with fewer sepsis cases and visceral injuries.
Keywords: Kidney Calculi; Nephrolithotomy, Percutaneous; Supine Position; Prone Position
An unusual cause of renal colic: ovarian teratoma
Vol. 44 (x): 2018 Mach 3.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0141
Pablo Garrido-Abad 1, Miguel Ángel Rodríguez-Cabello 1, Arturo Platas Sancho 1, Mairena Coronado Ruiz 2, Juan José Ortiz Zapata 3
1 Department of Urology, Hospital Sanitas La Moraleja, Madrid, Spain; 2 Department of Gynecology. Hospital Sanitas La Moraleja, Madrid, Spain; 3 LABCO (SYNLAB) Pathology. Madrid, Spain
No available
A martius flap in the treatment of iatrogenic distal urogenital fistula
Vol. 44 (x): 2018 July 7.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0444
Ivan Ignjatovic 1, 2, Dragoslav Basic 1, 2, Milan Potic 1, 2, Ljubomir Dinic 1, Aleksandar Skakic 1
1 Clinical Center Nis, Serbia; 2 University in Nis, Faculty of Medicine Nis, Serbia
Introduction: Distal urogenital fistulas (DUF) are usually iatrogenic and are uncommon in Europe. They occur in the urethra or near the bladder neck, and can be caused by vaginal hysterectomy, para-urethral cyst surgery, or erosion of the bladder or urethra from tension-free slings or meshes. The psychological and physical health consequences of DUF are devastating because most patients consider themselves "healthy" before surgery. Incontinence can appear after successful DUF closure due to previously occult incontinence or urethral incompetence. Additional surgery for incontinence is sometimes necessary to achieve satisfactory outcome.
Materials and Methods: A Martius flap was used in 23 patients between 2000 and 2015. Patient age range was 38-75 years (mean, 58.7). DUF was due to gynecologic surgery for benign disease (15 / 23; 65.2%), mesh / sling erosion (2 / 23; 8.7%), and malignancy (6 / 23; 26.1%). The follow-up period was one year.
Results: DUF was closed in 22 patients (95.6%). Satisfaction and complete dryness was achieved in 16 patients (69.6%) after the first procedure. Postoperative complications were: postoperative hematoma in 1 (4.4%), primary failure in 1 (4.4%), overactive bladder (OAB) syndrome in 3 (13.2%) and postoperative incontinence in 6 (26.4%) patients. A fascial sling was placed in patients with incontinence. All patients were dry after the secondary surgery. Anticholinergics were used for the treatment of OAB syndrome. Discomfort at the flap harvesting site was of minor importance. Finally, 22 out of 23 patients (95.6%) were satisfied.
Conclusion: A Martius flap and additional fascial sling could be successfully used to optimize DUF treatment.
Available at: http://www.intbrazjurol.com.br/video-section/20170444_Ignjatovic_et_al
Int Braz J Urol. 2018; 44 (Video #X): XXX-X
Addressing the challenges of reoperative robotic-assisted sacrocolpopexy
Vol. 44 (x): 2018 July 7.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0037
Wilson Lin 1, Nitya Abraham 2
1 Yeshiva University Albert Einstein College of Medicine, NY, USA ; 2 Department of Urology, Montefiore Medical Center, NY, USA
Sacrocolpopexy is the gold-standard repair for apical pelvic organ prolapse (POP). However, over half of women with POP who undergo the surgery experience recurrence, particularly those with higher preoperative stage, younger age, and greater body weight. We address the challenges of repairing recurrent POP in a patient with a prior transabdominal mesh sacrohysteropexy.
Available at: http://www.intbrazjurol.com.br/video-section/20180037_Lin_et_al
Int Braz J Urol. 2018; 44 (Video #X): XXX-X
Simultaneous treatment of parapelvic renal cysts and stones by flexible ureterorenoscopy with a novel four-step cyst localization strategy
Vol. 44 (x): 2018 July 7.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0074
Ning Kang 1, Xing Guan 1, Liming Song 1, Xiaodong Zhang 1, Junhui Zhang 1
1 Department of Urology, Institute of Urology, Capital Medical University, University Beijing Chaoyang Hospital
Objective: To assess the safety, feasibility, and efficacy of simultaneous treatment of parapelvic renal cysts and stones by flexible ureterorenoscopy with a novel four-step cyst localization strategy in selected patients.
Patients and Methods: We retrospectively reviewed 11 consecutive cases of parapelvic renal cysts with concomitant calculi treated by flexible ureterorenoscopy and laser lithotripsy (FURSL). Marsupialization was performed subsequently with holmium: YAG laser in our institution. Fragmentation was used to manage renal stones and a novel four-step cyst localization strategy was applied in each case for marsupialization.
Results: There were no intraoperative complications. Two cases of cystitis were reported postoperatively. The mean operative times of FURSL and marsupialization were 23.6 ± 3.9 minutes and 29.1 ± 9.7 minutes, respectively. During marsupialization, seven patients underwent the first two steps of the new strategy, two patients underwent three steps and two patients underwent all four steps. The mean reduction in hemoglobin level was 4.7 ± 1.7 g / L (range 3-8 g / L). The mean length of hospital stay was 1.2 ± 0.4 days. During a mean follow-up duration of 18 months, all cases remained stonefree and there was no stone recurrence. Parapelvic cysts became undetectable in eight cases and decreased in size by at least half in three cases.
Conclusion: With appropriate patient selection, FURSL and marsupialization with a four-step cyst localization strategy is feasible, safe, and effective in treating parapelvic renal cysts with concomitant calculi.
Keywords: Calculi; Lithotripsy; Renal Colic
Impact of 68GA-PSMA PET / CT on treatment of patients with recurrent / metastatic high risk prostate cancer – a multicenter study
Vol. 44 (x): 2018 June 6.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0632
Aline B. Mattiolli 1, Allan Santos1,2,3, Andreia Vicente 3, Marcelo Queiroz 3, Diogo Bastos 3, Daniel Herchenhorn 4, Miguel Srougi 3, Fabio A. Peixoto 5, Lisa Morikawa 4, 5, João Luiz Fernandes da Silva 3, Elba Etchebehere 1, 2, 3
1 Universidade Estadual de Campinas (UNICAMP), Campinas, Brasil; 2 Medicina Nuclear de Campinas, Campinas, SP, Brasil; 3 Hospital Sírio – Libanês, São Paulo, SP, Brasil; 4 Centro de Oncologia de D'Or, Rio de Janeiro, RJ, Brasil; 5 Grupo Américas Centro de Oncologia Integrado, Rio de Janeiro, RJ, Brasil
Purpose: The purpose of our study was to evaluate the clinical impact of 68Ga-PSMA PET / CT in the setting of biochemical recurrence of prostate cancer.
Materials and Methods: We retrospectively evaluated 125 prostate cancer patients submitted to the 68Ga-PSMA PET / CT due to biochemical recurrence. The parameters age, Gleason score, PSA levels, and the highest SUVmax were correlated to potential treatment changes. The highest SUVmax values were correlated with age and Gleason score. The median follow-up time was 24 months.
Results: 68Ga-PSMA PET / CT led to a treatment change in 66 / 104 (63.4%) patients (twenty-one patients were lost to follow-up). There was a significant change of treatment plan in patients with a higher Gleason score (P = 0.0233), higher SUVmax (p = 0.0306) and higher PSA levels (P < 0.0001; median PSA = 2.55 ng / mL).
Conclusion: 68Ga-PSMA PET / CT in prostate cancer patients with biochemical recurrence has a high impact in patient management.
Keywords: Prostatic Neoplasms; Tomography, X-Ray Computed; Positron-Emission Tomography
Dynamic 11C-Choline PET / CT for the primary diagnosis of prostate cancer
Vol. 44 (x): 2018 June 7.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0035
Shay Golan 1, Meital Nidam 2, Hanna Bernstine 2, Jack Baniel 1, David Groshar 2
1 Institute of Urology, and 2 Department of Nuclear Medicine, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Sackler Faculty of Medicine, Israel
Objectives: To test the ability of dynamic 11C-PET / CT to discriminate cancerous tissue from background tissue in patients with localized prostate cancer.
Materials and Methods: Twenty-four consecutive patients with prostate cancer were prospectively evaluated with dynamic 11C-choline PET / CT prior to radical prostatectomy.
The PET / CT scan was divided into 18 sequences of 5 seconds each, followed by 9 sequences of 60 seconds each. Whole-mount sections of harvested prostates served as reference standards. Volumes of interest were positioned on the dynamic PET / CT images and the following quantitative variables were calculated: perfusion coefficient (K1), washout constant (K2), area under the curve (AUC) at 175 and 630 seconds, and average and maximum standardized uptake values (SUVavg, and SUVmax). Wilcoxon signed-ranks test was used to compare benign and cancerous areas of the prostate.
Results: Areas of cancerous tissue were characterized by higher SUVavg and SUVmax than areas of benign tissue (3.67 ± 2.7 vs. 2.08 ± 1.3 and 5.91 ± 4.4 vs. 3.71 ± 3.7, respectively, P < 0.001), in addition to a higher K1 (0.95 ± 0.58 vs. 0.43 ± 0.24, P < 0.001) and greater cumulative tracer uptake, represented by the AUC at 175 and 630 seconds (P <0.001). No associations were found between dynamic parameters and preoperative prostate specific antigen level or Gleason score.
Conclusions: In this pilot study, 11C-choline PET / CT demonstrated increased tracer uptake with higher values of static and dynamic parameters in areas of prostate cancer compared to areas of benign tissue. Larger studies are warranted to validate these results and examine the potential applicability of 11C-choline dynamic PET / CT for the diagnosis of prostate cancer.
Keywords: Positron-Emission Tomography; Tomography, X-Ray Computed; Prostatic Neoplasms
Analysis of the association between bladder carcinoma and arsenic concentration in soil and water in southeast Brazil
Vol. 44 (x): 2018 June 6.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0543
Jonathan Doyun Cha 1, Danilo Budib Lourenço 2, Fernando Korkes 1, 2
1 Departamento de Urologia, Faculdade de Medicina do ABC, SP, Brasil; 2 Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
In approximately 50% of cases of bladder carcinoma, an associated predisposing factor can be established. The main factors are exposure to tobacco, arsenic (As) ore and aromatic compounds. Arsenic is a metalloid with a low average concentration in the earth's crust, and one of the most dangerous substances for human health. The present study aims to evaluate the incidence of hospitalization and mortality from bladder neoplasia and its possible association with As concentration in water and soil in two of the most critical regions of Brazil: the states of São Paulo and Minas Gerais.
We have investigated bladder cancer hospitalization and mortality in the states of São Paulo and Minas Gerais during 2010-2014. Water and soil samples were analyzed and As concentrations were established. Data were obtained through the Department of Informatics of the Brazilian Unified Health System. Correlation was made with water samples from São Paulo and with data on soil analysis from Minas Gerais.
The results revealed no direct association in the distinctive municipalities. Areas with high environmental As concentration had a low bladder cancer rate, while areas with normal as levels had similar cancer rates. The quantitative variables did not present a normal distribution (p < 0.05).
In conclusion, we did not observe a correlation between as concentration in water or soil and bladder cancer's hospitalization and mortality rates in the states of São Paulo and Minas Gerais.
Keywords: Arsenic; Urinary Bladder; Neoplasms
Evaluation of incidence and histolopathological findings of soft tissue sarcomas in genitourinary tract: Uludag university experience
Vol. 44 (x): 2018 June 6.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0048
Berna Aytac Vuruskan 1, Mıne Ozsen 1, Burhan Coskun 2, Ulviye Yalcinkaya 1
1 Department of Surgical Pathology, Uludag University, Faculty of Medicine, Bursa, Turkey; 2 Department of Urology, Uludag University, Faculty of Medicine, Bursa, Turkey
Purpose: In this study we aimed to review urological soft tissue sarcomas of genitourinary tract that were diagnosed in our institution and their prognostic factors for survival.
Materials and Methods: The clinical and pathological records of 31 patients who had diagnosis of soft tissue sarcomas primarily originating from the genitourinary tract between 2005-2011 were reviewed.
Results: The most common site was kidney (17 cases, 54.8%), and most common diagnosis was leiomyosarcoma (11 cases, 35.4%). A total of 24 patients (77.4%) had surgical excision. The surgical margins were positive in 7 patients who presented with local recurrence after primary resection. Twelve patients developed metastatic disease. During follow-up (range 9-70 month), 26 of the 31 patients (88.9%) were alive. Significant survival differences were found according to histological type (p: 0.001), with lower survival rates for malignant fibrous histiocytoma. The tumor size, the presence of metastasis at the time of diagnosis and tumor localization were not statistically significant for overall survival.
Conclusions: In our series, prostate sarcomas, paratesticular rhabdomyosarcoma and malignant fibrous histiocytoma had poor prognosis, especially in patients presenting with metastatic disease.
Keywords: Genitourinary Tract Anomalies [Supplementary Concept]; Sarcoma; Survival
Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, and laparoscopic pectopexy for apical prolapse
Vol. 44 (x): 2018 June 6.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0692
Alper Biler 1, I. Egemen Ertas 1, Gokhan Tosun 1, Ismet Hortu 2, Unal Turkay 3, Ozge E. Gultekin 4, Gulfem Igci 3
1 Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey; 2 Department of Obstetrics & Gynecology, Ege University School of Medicine, Izmir, Turkey; 3 Department of Obstetrics and Gynecology, University of Health Sciences Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey; 4 Department of Statistics, Ege University, Izmir, Turkey
Objective: To investigate differences in perioperative complications and short-term outcomes of patients who underwent abdominal sacrocolpopexy / sacrohysteropexy, laparoscopic sacrocolpopexy / sacrohysteropexy, or laparoscopic pectopexy due to apical prolapse.
Materials and Methods: A retrospective cohort study was performed on 110 patients who underwent apical prolapse surgery between January 1, 2011, and July 31, 2017. Only symptomatic uterine or vaginal vault prolapse patients with stage 2-4, according to the pelvic organ prolapse quantification system, were included. Baseline and intraoperative variables of groups; perioperative complications, including hemorrhage, urinary, and wound complications, blood transfusion, ileus, and short-term outcomes were compared.
Results: A total of 68 abdominal sacrocolpopexies (44 sacrocolpopexies and 24 sacrohysteropexies), 14 laparoscopic sacrocolpopexies (10 sacrocolpopexies and 4 sacrohysteropexies), and 28 laparoscopic pectopexies (16 pectopexies and 12 pectohysteropexies) were analyzed. Baseline characteristics and intraoperative variables were similar. However, the mean operating time was significantly shorter in the laparoscopic pectopexy group (74.9 min) when compared with that of the other groups (p < 0.01). During the six-month follow-up period, no prolapse recurrence and mesh erosion / exposure were observed in any group. De-novo stress urinary incontinence, urgency, and defecation problems, as well as perioperative complication rates, were not statistically significantly different between the groups.
Conclusions: Although the complication rates and short-term outcomes were not significantly different between the groups, minimally invasive approaches were associated with reduced procedural-related morbidity. Laparoscopic pectopexy is a promising endoscopic prolapse surgery and can be an alternative technique to sacrocolpopexy.
Keywords: Laparoscopy; Pelvic Organ Prolapse; complications [Subheading]
A review of the possibility of adopting financially driven live donor kidney transplantation
Vol. 44 (x): 2018 June 6.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0693
Aline Adour Yacoubian 1, 2, Rana Abu Dargham 1, 2, Raja B. Khauli 1, 2
1 Department of Surgery and 2 Division of Urology and Renal Transplantation, American University of Beirut Medical Center, Beirut, Lebanon
Kidney transplantation for end-stage renal disease remains the preferred solution due to its survival advantage, enhanced quality of life and cost-effectiveness. The main obstacle worldwide with this modality of treatment is the scarcity of organs. The demand has always exceeded the supply resulting in different types of donations. Kidney donation includes pure living related donors, deceased donors, living unrelated donors (altruistic), paired kidney donation and more recently compensated kidney donation. Ethical considerations in live donor kidney transplantation have always created a debate especially when rewarding unrelated donors. In this paper, we examine the problems of financially driven kidney transplantation, the ethical legitimacy of this practice, and propose some innovative methods and policies that could be adopted to ensure a better practice with accepted ethical guidelines.
Keywords: Kidney Transplantation; Kidney Diseases; Review [Publication Type]
The present and future enhanced recovery after surgery for bladder cancer
Vol. 44 (x): 2018 April 4.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0282
Michael A. Poch 1, Sephalie Patel 2, Rosemarie Garcia-Getting 2
1 Department of Genito-Urinary Oncology, Moffitt Cancer Center, Tampa, Florida, United States; 2 Department of Anesthesia, Moffitt Cancer Center, Tampa, Florida, United States
Not available
Lowering positive margin rates at radical prostatectomy by color coding of biopsy specimens to permit individualized preservation of the neurovascular bundles: is it feasible? a pilot investigation
Vol. 44 (x): 2018 April 4.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0328
Leslie A. Deane 1, Wei Phin Tan 1, Andrea Strong 1, Megan Lowe 1, Nency Antoine 1, Ritu Ghai 1, Shahid Ekbal 1
1 Department of Urology, Rush University Medical Center, Chicago, IL, USA
Objective: To evaluate whether color-coding of prostate core biopsy specimens aids in preservation of the neurovascular bundles from an oncological perspective.
Materials and Methods: MRI guided transrectal ultrasound and biopsy of the prostate were performed in 51 consecutive patients suspected of being at high risk for harboring prostate cancer. Core specimens were labeled with blue dye at the deep aspect and red dye at the superficial peripheral aspect of the core. The distance from the tumor to the end of the dyed specimen was measured to determine if there was an area of normal tissue between the prostate capsule and tumor.
Results: Of the 51 patients undergoing prostate biopsy, 30 (58.8%) were found to have cancer of the prostate: grade group 1 in 13.7%, 2 in 25.5%, 3 in 7.8%, 4 in 7.8% and 5 in 3.9% of the cohort. A total of 461 cores were analyzed in the cohort, of which 122 showed cancer. Five patients opted to undergo robotic assisted laparoscopic radical prostatectomy. No patients had a positive surgical margin (PSM) or extra prostatic extension (EPE) on radical prostatectomy if there was a margin of normal prostatic tissue seen between the dye and the tumor on prostate biopsy.
Conclusion: Color-coding of prostate biopsy core specimens may assist in tailoring the approach for preservation of the neurovascular bundles without compromising early oncological efficacy. Further study is required to determine whether this simple modification of the prostate biopsy protocol is valuable in larger groups of patients.
Keywords: Robotic Surgical Procedures; Prostatectomy; Laparoscopy
Personalized 3D kidney model produced by rapid prototyping method and its usefulness in clinical applications
Vol. 44 (x): 2018 June 6.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0162
Hakmin Lee 1, Ngoc Ha Nguyen 2, Sung Il Hwang 3, Hak Jong Lee 3, Sung Kyu Hong 1, Seok-Soo Byun 1
1 Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea; 2 Department of Urology, Cho Ray hospital, Ho Chi Minh city, Vietnam; 3 Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
Background: Three-dimensional (3D) printing has been introduced as a novel technique to produce 3D objects. We tried to evaluate the clinical usefulness of 3D-printed renal model in performing partial nephrectomy (PN) and also in the education of medical students.
Materials and Methods: We prospectively produced personalized renal models using 3D-printing methods from preoperative computed tomography (CT) images in a total of 10 patients. Two different groups (urologist and student group) appraised the clinical usefulness of 3D-renal models by answering questionnaires.
Results: After application of 3D renal models, the urologist group gave highly positive responses in asking clinical usefulness of 3D-model among PN (understanding personal anatomy: 8.9 / 10, preoperative surgical planning: 8.2 / 10, intraoperative tumor localization: 8.4 / 10, plan for further utilization in future: 8.3 / 10, clinical usefulness in complete endophytic mass: 9.5 / 10). The student group located each renal tumor correctly in 47.3% when they solely interpreted the CT images. After the introduction of 3D-models, the rate of correct answers was significantly elevated to 70.0% (p < 0.001). The subjective difficulty level in localizing renal tumor was also significantly low (52% versus 27%, p < 0.001) when they utilized 3D-models.
Conclusion: The personalized 3D renal model was revealed to significantly enhance the understanding of correct renal anatomy in patients with renal tumors in both urologist and student groups. These models can be useful for establishing the perioperative planning and also education program for medical students.
Keywords: Printing, Three-Dimensional; Kidney Neoplasms; Nephrectomy
Does total testicular volume predict testicular volume difference in adolescent males with varicocele?
Vol. 44 (x): 2018 June 6.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0652
Ari P. Bernstein 1, Ethan B. Fram 1, 2, Amanda North 1, 2, Anthony Casale 1, 2, Beth A. Drzewiecki 1, 2
1 Albert Einstein College of Medicine, NY, USA and 2 Montefiore Medical Center, NY, USA
Introduction: We evaluated the relationship between total testicular volume (TTV) and testicular volume differential (TVD) in adolescent males with varicocele. Both low TTV and high TVD have been independently associated with higher incidences of infertility later in life, but a predictive relationship between TTV and TVD directly has yet to be described.
Materials and Methods: We retrospectively analyzed a database of Tanner 5 boys ages 16-21 who presented with varicocele at a single institution between 2009 and 2017. All patients had a scrotal sonogram prior to surgical intervention. TTV and TVD were calculated for each individual and four non-exclusive groupings of patients were cre¬ated for statistical analysis. We chose 30 cc as a cut off value for low TTV based on prior studies.
Results: 209 patients met our inclusion criteria. Mean age was 18.3 years (16-21, SD 1.7) with a mean total testicular volume of 36 cc (13.5-78.2, SD 11.1). Cut off points of TVD of 20% and TTV of 30 cc were used to separate patients. There were 65 boys (31%) with TTV < 30 cc and 58 boys (28%) with TVD ≥ 20%. Among males with TTV < 30 cc, 23 (35%) had a TVD ≥ 20%. Among males with TTV ≥ 30 cc, 35 (24%) had a TVD ≥ 20%. The relationship between TVD and TTV was found to be non-significant (p > 0.05).
Discussion: Adolescent varicoceles continue to pose a challenge to pediatric urologists. The dilemma of over-aggressive treatment has proven difficult to balance with the risk of infertility. We hoped that elucidating the relationship between TTV and TVD could be useful in identifying patients who are at greater risk for infertility while decreasing the need for more intrusive testing, such as semen analysis, in an adolescent popula¬tion. We looked at the direct relationship between low TTV and high TVD. In our popu¬lation, there was a non-significant relationship between TTV < 30 cc and TVD ≥ 20% (p > 0.05) indicating that in adolescents with varicocele, TTV and TVD are independent variables. Our study limitations include the inherent user dependent bias of ultrasound measurements and data collection at a single institution with high ethnic diversity, possibly not comparable to all patient populations.
Conclusions: Low TTV (< 30 cc) itself is not predictive of high TVD (≥ 20%) in ado¬lescent boys with varicocele, despite their reported independent associations with im¬paired fertility in other studies.
Keywords: Varicocele; Adolescent; Infertility
Objective value on ADC map to categorize the intensity of DWI restriction for prostate cancer detection on MRI
Vol. 44 (x): 2018 June 6.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0038
Thais Caldara Mussi 1, Tatiana Martins 1, 2, Adriano Tachibana 1, Pedro Nogueira Mousessian 1, Ronaldo Hueb Baroni 1
1 Hospital Israelita Albert Einstein, São Paulo, SP, Brasil and 2 Ecoar Medicina Diagnostica, Belo Horizonte, MG, Brasil
Purpose: To identify objective and subjective criteria on multiparametric prostate MRI that can be helpful for prostate cancer detection.
Materials and Methods: Retrospective study, IRB approved, including 122 patients who had suspicious lesion on MRI and who underwent prostate biopsy with ultrasonography (US)/MRI imaging fusion. There were 60 patients with positive biopsies and 62 with negative biopsies. MRI of these patients were randomized and evaluated independently by two blinded radiologists. The following variables were analyzed in each lesion: morphology, contours, T2 signal, diffusion restriction (subjective impression and objective values), hyper-enhancement, contact with transition zone or prostatic contour, prostatic contour retraction, Likert and PIRADS classification.
Results: Apparent diffusion coefficient (ADC) value was the best predictor of positivity for prostate cancer, with mean value of 1.08 (SD 0.20) and 1.09 mm2/sec (SD 0.24) on negative biopsies and 0.81 (SD 0.22) and 0.84 mm2/sec (SD 0.22) on positive biopsies for readers 1 and 2, respectively (p < 0.001 in both analysis). For the others categorical variables evaluated the best AUC for reader 1 was subjective intensity of diffusion restriction (AUC of 0.74) and for reader 2 was hyper-enhancement (AUC of 0.65), all inferior comparing to the value of ADC map. Interobserver agreement ranged from 0.13 to 0.75, poor in most measurements, and good or excellent (kappa > 0.6) only in lesion size and ADC values.
Conclusions: Diffusion restriction with lower ADC-values is the best parameter to predict cancer on MRI prior to biopsy. Efforts to establish an ADC cutoff value would improve cancer detection, especially for less experience reader.
Keywords: Magnetic Resonance Imaging; Prostatic Neoplasms; Prostate
Neovagina construction and continent cutaneous urinary reservoir using a previous orthotopic ileal neobladder
Vol. 44 (x): 2018 June 6.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0005
Cinthia Alcántara-Quispe 1, Roberto Dias Machado 1, Wesley Justino Magnabosco 1, Alexandre Cesar Santos 1, Eliney Ferreira Faria 1
1 Departamento de Urologia, Hospital do Câncer de Barretos, Barretos, SP, Brasil
Standard radical cystectomy (RC) in women involves removal of the distal ureters, bladder, proximal urethra, uterus, ovaries, and adjacent vagina. Furthermore, pelvic organ-preserving RC to treat selected women has become an accepted technique and may confer better postoperative sexual and urinary functions than standard RC, avoid¬ing complications such as incontinence, prolapse, neobladder-vaginal fistula (NVF), and sexual dysfunction, without compromising oncological outcome.
This article reports a different surgical approach: a patient who underwent a cutane¬ous continent reservoir and neovagina construction using a previous ileal orthotopic neobladder after RC. Patient presented no complications and she has no evidence of recurrent disease and is sexually active, with a satisfactory continent reservoir. This case is the first report of this procedure that was able to treat concomitant dyspareunia caused by short vagina and neobladder-vaginal fistula.
In conclusion, standard radical cystectomy with no vaginal preservation can have a negative impact on quality of life. In the present case, we successfully treated neoblad¬der fistula and short vagina by transforming a previous ileal orthotopic neobladder into two parts: a continent reservoir and a neovagina. However, to establish the best approach in such patients, more cases with long-term follow-up are needed.
Keywords: Urinary Bladder Neoplasms; Cystectomy; Urinary Reservoirs, Continentx
Impact of intravesical hyaluronic acid treatment on bladder inflammation in interstitial cystitis rat model
Vol. 44 (x): 2018 April 4.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0713
Ilker Fatih Sahiner 1, Hakan Soylu 2, Erhan Ates 3, Nuray Acar 2, Ismail Ustunel 2, Ahmet Danısman 1
1 Department of Urology, Akdeniz University School of Medicine, Antalya, Turkey; 2 Department of Histology and Embryology, Akdeniz University School of Medicine, Antalya, Turkey; 3 Department of Urology, Adnan Menderes University School of Medicine, Aydin, Turkey
Objective: To evaluate the effect of intravesical hyaluronic acid (HA) treatment on inflammatory cells and the severity of inflammation in an interstitial cystitis rat model created with hydrogen chloride (HCL) via immunohistochemical studies and myeloperoxidase activity for the first time in the literature.
Materials and Methods: A total of 30 adult female white Rattus Norvegicus rats were divided into 3 groups as the HCL group, hyaluronic acid treatment (HCL-HA) group and control group. Chemical cystitis was created by administering HCL(400 microL,10 mM) except control group. A single dose of intravesical HA(0.5 mL,0.8 mg/mL) was administered to the treatment group. The bladder tissues of all subjects were immunohistochemically stained. The cell surface markers were used to evaluate inflammatory cell infiltration. Mast cell activation and IL-6 was evaluated to assess the inflammation and severity of inflammation, respectively. Myeloperoxidase activity was measured as it shows neutrophil density. Statistical significance was accepted as P<0.05.
Results: It was observed that there was rich monocyte, T lymphocyte, B lymphocyte, and Natural Killer cells infiltration and high IL-6 levels in the bladder tissue after the intravesical hydrogen chloride instillation, especially in the stroma layer(p<0.005). In the HCL-HA group, severity of inflammation had statistically significantly regressed to the levels of the control group(p<0.005). An increase was observed in the bladder myeloperoxidase activity of the HCL group compared to the other two groups(p<0.05).
Conclusions: Single dose intravesical hyluronic acid instillation reduces inflammatory cell infiltration and the severity of bladder inflammation in the rat model of bladder pain syndrome/interstitial cystitis.
Keywords: Interstitial cystitis; Inflammation; Hyaluronic Acid
Comparison of renal function after robot – assisted laparoscopic radical prostatectomy versus retropubic radical prostatectomy
Vol. 44 (x): 2018 April 4.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0103
Giray Ergin 1, Omer Gokhan Doluoglu 2, Mustafa Kıraç 1, Muhammet Fatih Kilinc 2, Burak Köprü 1, Bugra Bilge Keseroglu 2, Mustafa Burak Hoscan 3
1 Department of Urology Clinic, Yuksek Ihtisas University, Medical Faculty, Koru Hospital, Ankara, Turkey; 2 Department of Urology Clinic, Ankara Training and Research Hospital, Ankara, Turkey; 3 Department of Urology Clinic, Medstar Topcular Hospital, Antalya, Turkey
Purpose: To investigate the effect of robot assisted laparoscopic radical prostatectomy (RALP) and open retropubic radical prostatectomy (RRP) on early renal function in this study.
Materials and Methods: Preoperative and postoperative urea, creatinine, Hb, eGFR values of patients who had undergone RALP and RRP with prostate cancer (PCa) diagnosis were recorded in our clinic. The percentages of change in these values are calculated. Preoperative and postoperative urea, creatinine, Hb and eGFR changes were compared with each other. Student-t test was used for intergroup comparison, and paired sample t test was used to compare changes between preoperative and postoperative values of the same group.
Results: There were 160 and 93 patients in the RALP and RRP group, respectively. In the RALP group, postoperative urea and creatinine increased significantly compared to preoperative baseline values while eGFR was decreased (p = 0.0001, p = 0.001, p = 0.0001, respectively). Except for Hb in the RRP group, the changes in these values were statistically insignificant (p = 0.50, p = 0.75, p = 0.30, respectively).
Conclusions: We should be more careful when we perform RALP in patients at risk of impaired renal function despite being a minimally invasive surgical method with superior visual characteristics.
Keywords: Prostatic Neoplasms; Prostatectomy; Video-Assisted Surgery
Seasonal variations in urinary calcium, volume, and vitamin d in kidney stone formers
Vol. 44 (x): 2018 May 5.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0095
Kyrollis Attalla 1, Shubha De 1, Carl Sarkissian 1, Manoj Monga 1
1 Glickman Urologic & Kidney Institute, Cleveland Clinic, OH, USA
Objectives: To investigate the seasonal variations in urinary calcium, serum vitamin D, and urinary volume in patients with a history of nephrolithiasis.
Materials and Methods: Patients included were those who completed a 24-hour urine metabolic evaluation on two occasions; one in summer (June-Aug) and one in winter (Nov-Jan), and who had not started any medications or been instructed on dietary modifications in the interval between the two tests that may have impacted the results. Patients were excluded if they were on thiazide diuretics or were taking calcium and / or Vitamin D supplementation. Welch's t-test was used to compare the difference in average summer and winter values. Unpaired Student t-test was used to compare baseline parameters (age, BMI), and Paired Student t-test was used to compare average seasonal measurements in men vs. women.
Results: 136 patients were identified who were not taking calcium or vitamin D supplements or thiazide diuretics, and who were not instructed on dietary modifications in the interval between the two measured parameters. No significant differences were observed when comparing male to female baseline parameters of age or BMI (Table-1). Average 24-hour urine calcium was higher (226.60) in the winter than in summer (194.18) and was significant in males (p = 0.014) and females (p < 0.001). No significant seasonal difference was seen in 24-hour urine volume or serum vitamin D levels.
Conclusions: Urinary calcium is higher in winter months compared to summer months. As such, tailoring medical preventative strategies to the time of year may be helpful.
Keywords: Kidney; Calculi; Urinary Tract
Supposed pituitary-production of human chorionic Gonadotropin induced by androgen deprivation therapy
Vol. 44 (x): 2018 April 4.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0654
Koji Yoshimura 1, Yoshiharu Nakashima 1, Kyohei Sugiyama 1, Naoki Kohei 1, Akitoshi Takizawa 2
1 Department of Urology, Shizuoka General Hospital, Shizuoka, Japan; 2 Department of Urology, International Goodwill Hospital, Yokohama, Japan
Introduction: The main cause of slightly elevated human chorionic gonadotropin (HCG) after successful treatment of male germ cell tumors is considered to be pituitary-derived HCG. It is well known that pituitary-derived HCG is frequently detected in postmenopausal women. We evaluated the status of serum HCG in men with elevated gonadotropins, which were induced by androgen deprivation therapy, using commercially available assays.
Materials and Methods: We enrolled 44 patients with prostate cancer, who underwent luteinizing-hormone releasing hormone agonist treatment. We measured serum follicle-stimulating hormone (FSH), serum luteinizing hormone (LH), serum total HCG, serum free HCG–β subunit, and urine total HCG 3 times per patient, on the day of treatment initiation, the next day, and 3 months after.
Results: On the day after treatment initiation, serum and urine HCG was detected in 61% and 73% of patients, respectively. Markedly strong correlations were observed between serum/urine HCG and FSH/LH. In particular, receiver operating characteristic curve analysis indicated excellent area under the curve (0.977, 95% confidence interval 0.951–1.003)) for serum HCG-detectable LH. At the cutoff value of 21.07 mIU/mL for serum HCG-detectable LH, the sensitivity and specificity were 96.7% and 95.3%, respectively. Serum HCG-β was not detectable at any times in any patients.
Conclusions: Suggested pituitary-derived HCG can be frequently detected in patients with elevated gonadotropins, and there is a firm association between HCG detection and gonadotropin levels.
Keywords: Chorionic Gonadotropin; Neoplasms, Germ Cell and Embryonal; Androgens; Luteinizing Hormone
Prognostic role of preoperative albumin to globulin ratio in predicting survival of clear cell renal cell carcinoma
Vol. 44 (x): 2018 April 4.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0012
Murat Yavuz Koparal 1, Fazlı Polat 2, Serhat Çetin 3, Ender Cem Bulut 4, Tevfik Sinan Sözen 2
1 Department of Urology, Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey; 2 Department of Urology, School of Medicine, Gazi University, Ankara, Turkey; 3 Urology Clinic, Viranşehir State Hospital, Şanliurfa, Turkey; 4 Department of Urology, Van Training and Research Hospital, Van, Turkey
Purpose: To investigate the prognostic role of preoperative albumin/globulin ratio (AGR) in predicting disease-free survival (DFS) and overall survival (OS) in localized and locally advanced clear cell renal cell carcinoma (RCC) patients.
Patients and Methods: 162 patients who met the criteria specified were included in the study. The DFS and OS ratios were determined using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the prognostic factors affecting DFS and OS.
Results: Median follow-up period was 27.5 (6-89) months. There was a statistically significant relationship between low AGR and high pathological tumor (pT) stage, presence of collecting system invasion, presence of tumor necrosis, and a high platelet count (p = 0.012, p = 0.01, p = 0.001, and p = 0.004, respectively). According to the Kaplan-Meier survival analysis, both OS and DFS were found to be significantly lower in the low AGR group (p = 0.006 and p = 0.012). In the multivariate Cox regression analysis, collecting system invasion and tumor necrosis were found to be independent prognostic factors in predicting OS and pT stage was found to be an independent prognostic factor in predicting DFS (HR: 4.08, p = 0.043; HR: 8.64, p = 0.003 and HR: 7.78, p = 0.041, respectively).
Conclusion: In our study, low AGR was found to be associated with increased mortality and disease recurrence in localized and locally advanced RCC.
Keywords: Albumins; Globulins; Carcinoma, Renal Cell
Localized chromophobe renal cell carcinoma: preoperative imaging judgment and laparoscopic simple enucleation for treatment
Vol. 44 (x): 2018 April 4.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0519
Wenbiao Ren 1, Bichen Xue 1, Jiandong Qu 1, Longfei Liu 1, Chao Li 1, Xiongbing Zu 1
1 Department of Urology, Xiangya Hospital, Central South University, Changsha, China
Objective: To evaluate the preoperative imaging manifestation and therapeutic effect of laparoscopic simple enucleation (SE) for localized chromophobe renal cell carcinoma (chRCC).
Materials and Methods: Clinical data of 36 patients who underwent laparoscopic SE of localized chRCC at our institute were retrospectively analyzed. All patients underwent preoperative renal protocol CT (unenhanced, arterial, venous, and delayed images). CT scan characteristics were evaluated. After intraoperative occlusion of the renal artery, the tumor was free bluntly along the pseudocapsule and enucleated totally. The patients were followed up regularly after the operation.
Results: Mean tumor diameter was 3.9±1.0 cm, 80% of tumors were homogeneous and all the tumors had complete pseudocapsule. The attenuation values were slightly lower than normal renal cortex and degree of enhancement of the tumors were significantly lower than normal renal cortex. Mean operation time was 104.3±18.2 min. Mean warm ischemia time (WIT) was 21.3±3.5 min. Mean blood loss was 78.6±25.4 mL. No positive surgical margin was identified. Mean postoperative hospital stay was 5.3±1.5 d. Hematuria occurred in 3 patients and all disappeared within 3 days. After a mean follow-up of 32.1±20.6 months, no patient had local recurrence or metastatic progression.
Conclusion: Localized chRCCs have a great propensity for homogeneity and complete pseudocapsule. The attenuation values were slightly lower than normal renal cortex and small degree of enhancement. Laparoscopic SE is a safe and effective treatment for localized chRCC. The oncological results were satisfactory.
Keywords: Carcinoma, Renal Cell; Laparoscopy; Therapeutics
Incidence and treatment of malignant tumors of the genitourinary tract in renal transplant recipients
Vol. 44 (x): 2018 April 4.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0471
Juan Manuel Ochoa-Lopez 1, Bernardo Gabilondo-Pliego 1, Sylvain Collura-Merlier 1, Jaime O. Herrera-Caceres 1, Mariano Sotomayor de Zavaleta 1, Francisco Tomas Rodriguez-Covarrubias 1, Guillermo Feria-Bernal 1, Fernando Gabilondo-Navarro 1, Ricardo Alonso Castillejos-Molina 1
1 Department of Urology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México
Purpose: To provide data of the incidence and management of common urological malignancies in renal transplant recipients.
Materials and Methods: We conducted a retrospective analysis of a prospective database from August 1967 to August 2015. A descriptive analysis of the sample was performed.
Results: Among 1256 consecutive RTR a total of 88 patients developed malignancies (7%). There were 18 genitourinary tumors in the 16 patients (20.45 % of all malignant neoplasms), incidence of 1.27%. The most common neoplasm encounter was renal cancer (38.8%), followed by urothelial carcinoma (33.3%). Median follow-up of transplantation was 197 months (R, 36-336). Mean time from RT to cancer diagnosis 89±70 months (R, 12-276). CsA and AZA was the most common immunosuppression regimen in 68.75%. Mean follow-up after diagnosis was 103±72 months (R 10-215). Recurrence free survival rate of 100%. Overall survival of 89.5% of the sample; there were two non-related cancer deaths during follow-up. Conclusions: The incidence of neoplasms in RTR was lower than in other series, with favorable functional and oncologic results after treatment. This suggests that actions to reduce the risk of these malignancies as well as a strict follow-up are mandatory for an early detection and treatment.
Keywords: Neoplasms; Urinary Tract; Kidney Transplantation
Encrusted cystitis caused by corynebacterium urealyticum: a case report with novel treatment strategy of intravesical dimethyl sulfoxide
Vol. 44 (x): 2018 April 4.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0588
Tayyar Alp Ozkan 1, Mustafa Savas Yalcin 2, Ozdal Dillioglugil 2, Ibrahim Cevik 3
1 Department of Urology, Kocaeli Derince Traning and Research Hospital, Kocaeli, Tukey; 2 Department of Urology, Kocaeli University, School of Medicine, Kocaeli, Tukey; 3 Okan University, School of Medicine, Department of Urology, Istanbul, Tukey
Encrusted cystitis (EC) was first described as chronic cystitis with mucosal calcification in 1914 (1). It is a very rare chronic inflammatory disease presenting with dysuria, pelvic pain and gross hematuria. Voided urine contains mucus or calcified mucopurulent stone like particles. Urinalysis always reveals alkaline pH. It may be present in healthy individuals with no predisposing etiological factors (2-4). Etiologically, previous urological diseases, immunosuppression, urinary infection with urea splitting bacteria, or urological interventions resulting in bladder mucosa trauma may also be present (5, 6). In the present case report, we describe a novel treatment for EC with intravesical dimethyl sulfoxide.
Keywords: Corynebacterium; Cystitis; Dimethyl Sulfoxide
5-alpha Reductase Inhibitors and risk of male breast cancer: a systematic review and meta-analysis
Vol. 44 (x): 2018 April 4.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0531
Jiamin Wang 1, Shankun Zhao 1, Lianmin Luo 1, Ermao Li 1, Xiaohang Li 1, ZhiGang Zhao 1
1 Department of Urology & Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of GuangZhou Medical University, Guangzhou, Guangdong, China
Objective: To assess the relationship between 5α-reductase inhibitors (5ARIs) and the risk of male breast cancer (MBC).
Material and Methods: We systematically searched Medline via PubMed, Embase and the Cochrane Library Central Register up to May 2017 to identify published articles related to 5ARIs and the risk of MBC.
Results: Summary effect estimates were calculated by a random-effect model, and tests for multivariable-unadjusted pooled risk ratios (RR) and heterogeneity, as well as the sensitivity analyses were conducted to assess publication bias. All four studies were conducted in a quality assessment according to the Newcastle Ottawa Scale system. The strength of association between 5ARIs and the prevalence of MBC was evaluated by using summarized unadjusted pooled RR with a 95% confidence interval [CI]. Four studies involving 595.776 participants, mean age range from 60 to 73.2 years old, were included in a meta-analysis, which produced a summary unadjusted RR of the risk of MBC for the treatment of 5ARIs of 1.16 (95% CI 0.85-1.58, P=0.36) and the multivariable-adjusted RR is 1.03, (95% CI 0.75-1.41, p=0.86). There was no heterogeneity among included studies (I2=0%, P=0.49). Estimates of total effects were generally consistent with the sensitivity.
Conclusion: We did not observe a positive association between the use of 5ARIs and MBC. The small number of breast cancer cases exposed to 5ARIs and the lack of na association in our study suggest that the development of breast cancer should not influence the prescribing of 5ARIs therapy.
Keywords: 5-alpha Reductase Inhibitors; Breast Neoplasms, Male; Meta-Analysis as Topic
Recto-urethral fistula presenting as fever of unknown origin: a rare complication of prostatic abscess
Vol. 44 (x): 2018 February 2.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0468
Sun Hwa Lee 1, Seong Jong Yun 2, Seokyong Ryu 1
1 Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea; 2 Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
Not available
The Lithocatch (TM) by Boston Scientific: how to use it and how to solve a common problem
Vol. 44 (x): 2018 March 3.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2018.0105
Giuseppe Giusti 1, Marco Lucci Chiarissi 1, Antonello De Lisa 1
1 Department of Urology, University of Cagliari, Cagliari , Italy
Introduction: The LithocatchTM basket is a immobilization device commercialized by Boston Scientific. It allows to collect multiple stone fragments from the ureter. The ability of the basket to capture a large number of stone fragments, is however responsible for a problem connected to its usage: the entrapment of the basket inside the ureter. In this video we explain how to use it and how to solve this problem.
Material and Methods: After positioning the LithocatchTM over the fragments, the basket is opened and it is rotated through a special handle to collect stones. One frequent problem occurs when too many fragments are collected at once, preventing the extraction of the device. We research our archives to extrapolate the total number of procedures carried out with the LithocatchTM in the last two years and the total number of complications occurred.
Results: We experienced the above mentioned complication in 16 procedures (14% of the total) of 114 surgeries performed. The way described to solve this complication was efficient and did not produce any damage to the ureter or to the basket.
Conclusion: The LithocatchTM has an excellent ability to capture small stones so it allows to reduce the length of the procedure. Paying attention to limit the amount of fragments collected, it is possible to avoid the entrapment of the basket. If this complication occurs, the problem can be solved by reducing the size of the stone fragments. The preferable type of energy is the ballistic one.
Available at: http://www.intbrazjurol.com.br/video-section/20180105_Giusti_et_al
Int Braz J Urol. 2018; 44 (Video #X): XXX-X
Robotic excision of complex adrenal mass with retrocaval extension and encasement of renal hilum with renal preservation
Vol. 44 (x): 2018 March 3.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0384
Vishnu Raveendran 1, Ramaprasad Manasseri Koduveli 1, Kishore Thekke Adiyat 1
1 Aster Medcity, Kochi, Kerala, India
Objective: The purpose of this video is to present robotic excision of a complex adrenal mass with retrocaval extension and encasement of renal hilum in a 16 year old boy. Biochemical screening was negative for metabolically active component. Computerized tomographic scan with contrast revealed a homogenous mass of approximately 10.8 cm x 6.2 cm x 4.2 cm in the suprarenal area on right side that was extend-ing behind inferior vena cava and encasing renal hilar vessels. Imaging findings were that of a classical ganglioneuroma.
Material and methods: Robot assisted laparoscopic adrenalectomy with sparing of renal hilar vasculature was performed. With patient in lateral position, five ports were used, including one for liver retraction. Da Vinci® system with four arms was docked from over the right shoulder. The displaced renal hilar structures were identified by opening Gerota's fascia. Mass was dissected completely and removed through Pfan-nensteil incision.
Results: Duration of procedure was 345 minutes and console time was 290 minutes. Blood loss was 250 mL. Post-operative renal doppler showed normal blood flow. He was discharged on post-operative day three. Histopathologic examination of specimen revealed ganglioneuroma arising from adrenal gland.
Conclusion: Ganglioneuroma is a rare adrenal tumor with good prognosis on surgical removal. The advent of robotic surgery has made complex surgical procedures involving vital structures like inferior vena cava be performed using minimally invasive techniques without compromising oncologic principles.
Available at: http://www.intbrazjurol.com.br/video-section/20170384_Raveendran_et_al
Int Braz J Urol. 2018; 44 (Video #X): XXX-X
Retroperitoneal laparoscopic nephroureterectomy with distal and intramural ureter resection for a tuberculous non – functional kidney
Vol. 44 (x): 2018 March 3.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0326
Canqiang Li 1, Yi Yang 1, Le Xu 1, Minjie Qiu 1
1 Department of Urology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, Guangdong, China
Objective: To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection for a tuberculous non-functional kidney.
Materials and Methods: A total of 27 individuals diagnosed with unilateral non-functional kidney secondary to tuberculosis were treated between June 2011 and June 2015. All patients had normal renal function on the contralateral side and underwent the standard four-drug anti-tuberculosis treatment for at least four weeks before surgery. Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients, and the urinary-bladder junction of distal ureter was managed using different auto-suture techniques.
Results: Nineteen male and 8 female patients with an average age of 47.3 years (range, 36-64 years) underwent surgery. All the operations were successfully performed without conversion. The median operative time was 109.3 min (range, 75-138 min), the median blood loss was 157.5 mL (range, 70-250 mL), and the median hospitalization time was 3.7 days (range, 3-6 days). No serious perioperative complications occurred. Anti-tuberculosis chemotherapy was prescribed to all patients, with the entire course of treatment lasting six months. No recurrence of tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of 26.7 months (range, 6-54 months).
Conclusion: Retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection is a safe and feasible approach for the treatment of tuberculous non-functional kidneys.
Keywords: Tuberculosis, Renal; Nephroureterectomy; Nephrectomy
Complete supine percutaneous nephrolithotomy with GoPro®. Ten steps for success
Vol. 44 (x): 2018 March 3.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0337
Fabio Carvalho Vicentini 1, Hugo Daniel Barone dos Santos 1, Carlos Alfredo Batagello 1, Julia Rothe Amundson 2, Evaristo Peixoto Oliveira Neto 1, Giovanni Scala Marchini 1, Miguel Srougi 1, Willian Carlos Nahas 1, Eduardo Mazzucchi 1
1 Divisão de Urologia, Grupo de Endourologia do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, USP, São Paulo, SP, Brasil; 2 University of Miami, Miller School of Medicine, Miami, EUA
Objective: To show a video of a complete supine Percutaneous Nephrolithotomy (csPCNL) performed for the treatment of a staghorn calculus, from the surgeon's point of view. The procedure was recorded with a GoPro® camera, demonstrating the ten essential steps for a successful procedure.
Materials and methods: The patient was a 38 years-old woman with 2.4cm of left kidney lower pole stone burden who presented with 3 months of lumbar pain and recurrent urinary tract infections. She had a previous diagnosis of polycystic kidney disease and chronic renal failure stage 2. CT scan showed two 1.2cm stones in the lower pole (Guy's Stone Score 2). She had a previous ipsilateral double J insertion due to an obstructive pyelonephritis. The csPCNL was uneventful with a single access in the lower pole. The surgeon had a Full HD GoPro Hero 4 Session® camera mounted on his head, controlled by the surgical team with a remote control. All of the mains steps were recorded. Informed consent was obtained prior to the procedure.
Results: The surgical time was 90 minutes. Hemoglobin drop was 0.5g/dL. A post-operative CT scan was stone-free. The patient was discharged 36 hours after surgery. The camera worked properly and didn't cause pain or muscle discomfort to the surgeon. The quality of the recorded movie was excellent.
Conclusion: GoPro® camera proved to be a very interesting tool to document surgeries without interfering with the procedure and with great educational potential. More studies should be conducted to evaluate the role of this equipment.
Available at: http://www.intbrazjurol.com.br/video-section/20170337_Vicentini_et_al
Robotic adenomectomy using a laparoscopic dissector
Vol. 44 (x): 2018 March 3.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0609
Lessandro Curcio Gonçalves 1, Felipe Monnerat Lott 2, Rafael Rosa 1
1 Serviço de Urologia, Hospital Federal de Ipanema, Rio de Janeiro, RJ, Brasil; 2 Departamento de Urologia, Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brasil
Introduction: Only few reports are known about the use of robotic surgery for prostate benign enlargement. The robotic surgery can be improved by laparoscopic tricks. We show a video of robotic adenomectomy where a laparoscopic dissector is used to help create the plan between prostatic capsule and adenoma.
Materials and methods: A 62 years old male had severe urinary flow outlet obstruction. Medical therapy was not effective.
Ultrasound detected a 92gr enlarged prostate with a large middle lobe. Robotic assisted adenomectomy was scheduled.
The procedure followed this sequence: opening of Retzius space, superficial suture of the Dorsal vein complex, horizontal cistotomy. The plan was created with electrocautery and blunt dissection with the laparoscopic dissector. Haemostatic sutures were placed between prostate fossa and the posterior bladder neck and closure of the cistotomy.
Results: Whole operation time was 160 minutes, with a blood loss of 80cc. There was no perioperative or post-operative complication. Catheter was removed after 4 days. Post-operatory uroflowmetry shows a peak flow of 30ml/sec. Pathological examination is negative for tumor. After 60 days IPSS was 8.
Conclusion: Robotic prostate adenomectomy using the laparoscopic dissector is a safe and effective minimally invasive treatment for benign prostatic enlargement. It is a novel technique to find and dissect the plane between prostatic adenoma
and capsule. This could be one more use of laparoscopic technology to improve surgical outcomes in robotic field.
Available at: http://www.intbrazjurol.com.br/video-section/20170609_Goncalves_et_al
Completely endophytic renal tumor: A laparoscopic approach
Vol. 44 (x): 2018 March 3.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0534
Victor Espinheira Santos 1, Rafael Ribeiro Meduna 1, Wilson Bachega Jr. 1, Gustavo Cardoso Guimarães 1
1 Serviço de Urologia, Departamento de Cirurgia Pélvica, AC Camargo Cancer Center, São Paulo, SP, Brasil
Kidney cancer is the third most common urologic malignancy and a 2% annual increase in the incidence has occurred over the past two decades, largely because of the increased utilization of imaging. The majority of these tumors are small, so the indications for nephron-sparing surgery and for minimally invasive surgery are continually expanding. Complex kidney lesions, such as those completely endophytic, are still a challenge even for experienced surgeons.
Our objective is to demonstrate the operative technique for laparoscopic partial nephrectomy with the aid of intra-operative ultrasound in a man with a totally endophytic renal lesion.
Case: A 52 years old man, asymptomatic, with incidental renal mass of 2.9 cm, completely endophytic (R.E.N.A.L score 9p) submitted to partial laparoscopic nephrectomy. Surgical time was 2 hours, with 20 minutes of ischemia. Pathological anatomy confirmed tumor of clear cells T1a, free margins.
ARTICLE INFO: Available at: http://www.intbrazjurol.com.br/video-section/20170534_Santos_et_al
Vitamin C inhibits crystallization of struvite from artificial urine in the presence of Pseudomonas aeruginosa
Vol. 44 (x): 2018 March 3.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0656
Muhammed A. P. Manzoor 1, Surya Ram Duwal 2, M. Mujeeburahiman 3, Punchappady-Devasya Rekha 1
1 Yenepoya Research Centre, 2 Department of Biochemistry, 3 Department of Urology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India
Background: Formation of struvite stones is associated with urinary tract infection by urease-producing bacteria. Biogenic crystal growth in natural and synthetic materials is regulated by the action of inhibitors, ranging from small ions, molecules to large macromolecules.
Materials and Methods: We report the dynamics of in vitro crystallization of struvite in presence of vitamin C in synthetic urine using single diffusion gel growth technique. Sodium metasilicate gel of specific gravity 1.05 and the aqueous solution of ammonium dihydrogen phosphate were used as the medium for growing the struvite crystals. The crystallization process was induced by a urease positive struvite stone associated Pseudomonas aeruginosa to mimic the infection leading to stone formation. The grown crystals were characterized by ATR-FTIR and powder XRD. The surface morphology was analysed through FE-SEM for comparison between treatments.
Results: We observed decrease in number, dimension, and growth rate of struvite crystals with the increasing concentrations of vitamin C. Crystals displayed well-defined faces and dendritic morphology of struvite in both control and biogenic systems.
Conclusion: The results strongly suggest that, vitamin C can modulate the formation of struvite crystals in the presence of uropathogenic bacteria.
Keywords: Struvite; Pseudomonas aeruginosa; Ascorbic Acid
Prognostic significance of the dynamic changes of systemic inflammatory response in metastatic renal cell carcinoma
Vol. 44 (x): 2018 March 3.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0500
Beihe Wang 1, 2, Weijie Gu 1, 2, Fangning Wan 1, 2, Guohai Shi 1, 2, Dingwei Ye 1, 2
1 Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
Purpose: To elucidate the prognostic value of systemic inflammatory response in patients with metastatic renal cell carcinoma (mRCC) who are treated with sunitinib, we evaluated the prognostic role of C-reactive protein (CRP) kinetics. This study also compared prognostic models containing CRP kinetics and neutrophil-to-lymphocyte ratio (NLR) kinetics.
Materials and Methods: A consecutive cohort of 94 patients with mRCC who were treated with sunitinib was retrospectively included from Fudan University Shanghai Cancer Center. According to dynamic changes in CRP and the NLR, patients were divided into three groups for analysis of CRP and NLR kinetics. The associations between survival and potential prognostic factors were assessed. The incremental value of prognostication was evaluated.
Results: A significant difference (P<0.001) in overall survival (OS) was observed among the three groups of CRP kinetics. The median OS of the non-elevated group was nearly 1.3-fold longer than that of the normalized group (33.0 vs. 26.3 months), and two times longer than that of the non-normalized group (33.0 vs. 14.0 months). Multivariate analysis showed that CRP and NLR kinetics were independent prognostic indicators. The model containing CRP kinetics had a better predictive accuracy than that with NLR kinetics, which was supported by the C-index (0.731 vs. 0.684) and the likelihood ratio χ² test (79.9% vs. 44.9%).
Conclusion: Our study suggests that dynamic changes in CRP can better predict survival in patients with mRCC who are treated with sunitinib. Routine assessment of CRP before and after targeted therapy would help identify patients at risk of a poor outcome.
Keywords: Carcinoma, Renal Cell; Molecular Targeted Therapy; Prognosis
Retroperitoneoscopic resection of retroperitoneal nonadrenal ganglioneuromas: our technique and clinical outcomes
Vol. 44 (x): 2018 March 3.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0460
Changjin Shi 1, Feng Li 1, Yanchao Wang 1, Long Pei 1, Tao Wang 2
1 Department of Urology, the Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China; 2 Department of Nephrology, Hebei Provincial General Hospital, Shijiazhuang, China
Objective: To report our experience of retroperitoneoscopic technique in semi-lateral decubitus position for the retroperitoneal nonadrenal ganglioneuromas in 18 patients, and to evaluate its clinical outcomes.
Materials and Methods: From January 2012 to May 2016, 18 patients with retroperitoneal nonadrenal ganglioneuromas underwent retroperitoneoscopic resection. With the patients in semi-lateral decubitus position, a 4-port retroperitoneal approach was used. Data were collected on the tumor size, tumor location, perioperative outcomes, pathology, and lastknown disease status. We reviewed the operative videos to identify surgical tips and tricks.
Results: All procedures were carried out successfully without converting to open surgery.
The tumors had an average size of 5.2cm. The mean operative time was 86.5 min, with a mean estimated blood loss of 85.4mL. There were three patients suffering from intraoperative complications. Postoperatively, all patients achieved an uneventful recovery; the mean postoperative hospital stay was 5.5 days. The postoperative pathology revealed to be retroperitoneal ganglioneuromas. With a mean follow-up of 39.5 months, all patients were recurrence free. The review of the operative videos revealed several tips and tricks, including keeping peritoneum and posterior Gerota fascia intact to provide a favorable operative exposure of tumors, and placing the harmonic scalpel through different ports during tumor dissection.
Conclusions: With the patient in semi-lateral decubitus position and a 4-port retroperitoneal approach, retroperitoneoscopic resection of retroperitoneal nonadrenal ganglioneuroma is a feasible, effective, and safe procedure. This approach has distinct advantages including direct access to the tumor, optimal exposure of tumor and less intraperitoneal interference.
Keywords: Retroperitoneal Neoplasms; Ganglioneuroma; Pathology
Laparoscopic management of paraganglioma in a pregnant woman: a case report
Vol. 44 (x): 2018 March 3.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0698
Mohammad Hadi Radfar 1, Behnam Shakiba 1, Amir Afyouni 1, Hassan Hoshyar 1
1 Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Introduction: Paraganglioma is an extremely rare catecholamine-producing tumor during pregnancy. Paraganglioma carries high risks of fetal and maternal mortality during pregnancy. We report a pregnant woman with paraganglioma in the second trimester.
Case Description: A 24-year-old pregnant woman presented with severe hypertension in the 17th week of gestation. Hormonal examination and Magnetic Resonance Imaging (MRI) confirmed the diagnosis of extra adrenal pheochromocytoma (paraganglioma). She underwent laparoscopic tumor excision successfully.
Conclusions: A high index of suspicion is needed to diagnose paraganglioma in a pregnant patient with hypertension. Laparoscopic tumor removal for paraganglioma seems to be a feasible and safe procedure during pregnancy.
Keywords: Laparoscopy; Paraganglioma; Pregnant Women
Neurofibromas of the bladder in a child with neurofibromatosis type 1
Vol. 44 (x): 2018 February 2.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0199
Gulec Mert Dogan 1, Ahmet Siğirci 1, Leyla Karaca 1
1 Department of Radiology Pediatric, Inonu University Malatya, Turkey
No abstract available
Laparoscopic dismembered pyeloplasty combined with port entrance flexible renoscopic lithotripsy
Vol. 43 (x): 2017 November 11.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0401
Kaan Gokcen 1, Gokhan Gokce 1, Gokce Dundar 2, Resul Cicek 1, Halil Gulbahar 1, Emin Yener Gultekin 1
1 Department of Urology, Cumhuriyet University Faculty of Medine, Sivas, Turkey; 2 Department of Urology, Cizre State Hospital, Cizre, Turkey
Introduction: Ureteropelvic junction obstruction and concomitant calculus disease may coexist. We demonstrate our use of flexible renoscopy during laparoscopic pyeloplasty for caliceal stone removal.
Patient and methods: A 28-year-old female patient presented with recurrent attacks of flank pain of two years duration.
When noncontrast-CT and DTPA were performed, the patient was diagnosed with ureteropelvic junction stenosis and 3 stones with a total burden of 14mm in the lower pole of right kidney. After pneumoperitoneum was established in right flank position, three 10mm trocars were placed including one camera port. 5mm trocar was placed for convenience to retraction and dissection. The surgery was uneventful, with no operative complications or evidence of intra-abdominal bleeding.
Results: The duration of the surgery was 110 minutes. The amount of bleeding was 30ml. On the postoperative 2nd day, the urethral catheter was removed and the patient was discharged on the fourth day postoperatively. Stent removal was done on the 3rd postoperative week and retrograde pyelogram showed normal ureter. Post-operative follow-up with ultrasound showed that hydronephrosis had regressed.
Conclusıons: Laparoscopic pyeloplasty and concomitant flexible renoscopy through lowermost trocar with basket extraction is a simple, attractive alternative for the simultaneous treatment of ureteropelvic junction obstruction presenting with coexisting nephrolithiasis. This method is useful and feasible, with minimal invasiveness and an early post-operative recovery.
Available at: http://www.intbrazjurol.com.br/video-section/20170401_Gokcen_et_al
Robot-Assisted Nephropexy
Vol. 43 (x): 2017 November 11.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0390
Marcelo Langer Wroclawski 1, 2, Guilherme Andrade Peixoto 2, Marcio Covas Moschovas 2, Arie Carneiro 1, Milton Borrelli Jr. 1, José Roberto Colombo Jr. 1
1 Hospital Israelita Albert Einstein, São Paulo, SP, Brasil; 2 Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, SP, Brasil
Introduction: Renal ptosis is defined as the renal descent when there is a change from supine to orthostatic position, usually with a change of two vertebral bodies or more than five cm apart. Although rare, it is one of the causes of chronic flank pain or of upper abdomen. The typical patient of renal ptosis is young, female, thin, with complaint of pain when in an upright position (1, 2).
Objective: Demonstrate a robot-assisted nephropexy technique in a young woman diagnosed with symptomatic renal ptosis on the right kidney, confirmed by imaging tests.
Materials and Methods: A 29-year-old female patient with a history of chronic right-sided pain and palpable renal mobility on physical examination. The diagnosis of renal ptosis was confirmed by ultrasound imaging, excretory urography (Figure -1), and renal scintigraphy with 99mTc-DTPA (Figure-2). She was submitted to a robotic-assisted right nephropexy with a polypropylene mesh fixing the right kidney to the ipsilateral psoas muscle fascia.
Result: We reported a 96-minute surgical time. The patient was discharged in the first postoperative day. At the one-month follow-up, there was an important improvement of the symptoms, with normality renal function and imaging tests describing adequate renal positioning.
Conclusions: Robotic-assisted nephropexy is feasible and can be an excellent minimally invasive alternative technique for the proposed surgery. We reported a shorter hospital stay and a faster postoperative recovery compared with the opened procedure.
Available at: http://www.intbrazjurol.com.br/video-section/20170390_wroclawski_et_al
Int Braz J Urol. 2017; 43 (Video #X): XXX-X
Early term effect of ureterorenoscopy (URS) on the Kidney: research measuring NGAL, KIM-1, FABP and CYS C levels in urine
Vol. 43 (x): 2017 July 7.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2016.0638
Erdal Benli 1, Sema Nur Ayyildiz 2, Selma Cirrik 3, Tevfik Noyan 2, Ali Ayyildiz 4, Abdullah Cirakoglu 1
1 Department of Urology, Faculty of Medicine, Ordu University, Ordu, Turkey; 2 Department of Biochemistry, Faculty of Medicine, Ordu University, Ordu, Turkey; 3 Department of Physiology, Faculty of Medicine, Ordu University, Ordu, Turkey; 4 Department of Urology, Research and Training Hospital, Ankara, Turkey
Aim: URS is a very commonly used procedure for treatment of ureter stones. Increased hydrostatic pressure in the collecting system linked to fluids used during the procedure may cause harmful effects on the kidney. The aim of this study is to determine whether the URS procedure has a negative effect on the kidney by investigating NGAL, KIM-1, FABP and Cys C levels in urine.
Material and Methods: This study included 30 patients undergoing ureterorenoscopy (URS) for ureter stones. Urine samples were collected 5 times; before the URS procedure (control) and at 1, 3, 5 and 12 hours following the procedure. NGAL, KIM-1, FBAP and Cys C levels were measured in urine and compared with the control values.
Results: The NGAL levels in urine before the procedure and at 1, 3, 5 and 12 hours after the procedure were 34.59±35.34; 62.72±142.32; 47.15±104.48; 45.23±163.16 and 44.99±60.79ng/mL, respectively (p=0.001). Similarly, the urinary KIM-1, FABP and Cys C levels were found to increase compared to control values; however this increase did not reach statistical significance (p >0.05).
Conclusions: After the URS procedure, there were important changes in NGAL, FABP, KIM-1 and Cys C levels. These changes reached statistical significance for NGAL, but did not reach significance for the other parameters. In conclusion, the URS procedure significantly affects the kidney; however, this effect disappears over time.
Keywords: Acute Kidney Injury; Kidney; Lithotripsy
WITHDRAWN: Comparison of vacuum-assisted closure therapy and debridement with primer surgical closure for fournier's gangrene treatment: 10 years' experience of a single centre
Vol. 43 (x): 2017 July 7.[Ahead of print]
doi: 10.1590/S1677-5538.IBJU.2017.0052
Mustafa Ozan Horsanali 1, Utku Eser 2, Burcu O. Horsanali 3, Omer Altaş 3, Huseyin Eren 4
1 Department of Urology, Izmir Katip Celebi University Ataturk Training and Research Hos-pital, Izmir, Turkey; 2 Department of Family Medicine, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey; 3 Department of Anesthesiology and Reanimation, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey; 4 Department of Urology, Recep Tayyip Erdogan University, Rize, Turkey.
The International Brazilian Journal of Urology will retract this article because the authors were not authorized to publish the data according to the Department of Urology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey, where the paper was done.