Current Urology

van Hemelrijck, Mieke J.J.; Cools, Martine ; Hoebeke, Piet

2008 Current Urology

doi: 10.1159/000106534

Objective: To review the various etiological concepts andpossible effects of tobacco, alcohol and diet on the risk oftesticular cancer. Methods: A PubMed search was done onthe keywords ‘testicular cancer’, ‘tobacco’, ‘alcohol’, and ‘diet’.Relevant articles and their references were reviewed for dataon the association between these behavior risk factors andtesticular cancer. Results: We found that various conceptsand hypotheses were introduced, all with the aim of explainingthe effect of tobacco, alcohol and diet on the risk of testicularcancer. However, the studies’ results were inconsistentfor the causal relationship between these risk factors andtesticular cancer. Conclusion: There is no firm evidence of acausal relation between behavior risks and testicular cancer.Nevertheless, interventions for smoking cessation, less alcoholconsumption and adapted diet can also be protective forother cancers and diseases. Good health education and preventionare therefore extremely useful, even if future studiesdemonstrate no effect on testicular cancer.

Gioia, Kevin T. ; DaJusta, Daniel G. ; Barone, Joseph G.

2008 Current Urology

doi: 10.1159/000106535

We reviewed the current literature for studies involving thetreatment of intermittent daytime urinary incontinence witha-blocker therapy in the pediatric patient population. Fivesuch studies were identified and the safety and efficacy ofsuch treatment were evaluated. A total of 174 patients wereincluded in 3 cohorts, 1 double-blind placebo controlled, and1 randomized prospective study. All 3 cohort studies showedeffective use of this treatment modality and reported markedimprovement in their patients, exhibited by decreased postvoidresidual volumes, uroflow parameters and incontinenceepisodes. While the double-blind randomized trial did notshow a statistically significant improvement, the authors didreport a significant increase in parental satisfaction and subjectivesymptom score. The randomized prospective studyshowed results comparable in efficacy to biofeedback. Allreviewed studies indicated that a-blockers are safe for usein children, with 2.6% experiencing a dose-dependant orthostatichypotension. Our review supports the contentionthat a-blocker therapy is both safe and effective in the treatmentof intermittent daytime urinary incontinence in children,but indicates that further randomized control studiesare necessary to determine dosing and long-term efficacy.

Formiga, Cipriano C. ; dos Santos Jr., Carlos A.; dos Santos, André M.; Varzim, Carlos A.B. ; Carcinoni, Thiago M. ; Miyaoka, Ricardo ; Alvarenga, Cesar A. ; Castilho, Lísias N.

2008 Current Urology

doi: 10.1159/000106536

Objective: To present our data and review the literature onclinical presentations, pathology and surgical treatment ofadrenal pseudocystic lesions. Patients and Methods: Sevencases of diagnosed adrenal pseudocystic lesions are described.All underwent surgery in our hospital between 2002and 2006. After ultrasound and CT, symptoms were reportedand associated with the size of the lesions. Six patients hada laparoscopy and only the biggest lesion was treated byopen surgery. Results: For laparoscopy, the mean surgicaltime was 79 min (range 40-135 min) and patients stayed 44h (range 24-48 h) in the hospital. Open adrenalectomy wasperformed in 60 min and the hospital stay was 72 h. Therewere no complications in all the patients. Three of the lesionswere on the left gland (42%). All patients were female.Follow-up ranged between 7 and 49 months (mean 35.3months). All the patients remained asymptomatic withoutrecurrences. Pathological findings in all cases showed no lininglayer and wall composed of fibrous tissue. Discussion:Adrenal pseudocysts are lesions rarely found in clinical practice.Patients usually have a long history of symptoms whichmay be associated with adrenal trauma or neoplasms. Basicimaging investigations include abdominal radiography, ultrasoundand CT. The laparoscopic approach is safe and it isa good option depending on lesion size and the surgeon’stechnical skills.

Drewa, Tomasz ; Adamowicz, Jan ; Krawczyk, Agnieszka ; Polasik, Joanna ; Pielichowski, Jan ; Lysik, Joanna

2008 Current Urology

doi: 10.1159/000106537

Background: The function of a reconstructed bladder dependson the contracting bladder wall. This can be obtainedwith sufficient angiogenesis. Polyglycolic acid (PGA) is usedas a cell vehicle for bladder reconstruction. Chitosan supportsadhesion and differentiation of endothelial cells. Theaim of the study was to compare PGA with PGA/chitosan‘sandwich’ grafts for bladder wall regeneration. Materialsand Methods: 3T3 fibroblasts were seeded on 6 PGA and 3chitosan scaffolds and incubated 3 days at 37ºC and 5% CO2before implantation. Three rats underwent bladder reconstructionwith PGA cell seeded grafts and 3 with PGA graftscovered with chitosan cell seeded grafts (‘sandwich’ graft).Three rats as controls were not operated on. After 6 monthsreconstructed tissue was stained with H&E. Vessels wereidentified by immunohistochemistry by CD31 and CD34staining. A 4-level scale was used, (+++) referred to evidentmarker presence (high density of vessels) and (-) as lack of amarker (no vessels). Results: No complications during the 6-month period were noted. PGA/chitosan grafts were evaluatedas (+) while PGA grafts were evaluated as (+) and (-) bythe use of the CD31 antibody. The control group was evaluatedas (+). PGA/chitosan grafts were evaluated as (++) and(+) while PGA grafts were evaluated as (++) and (-) by CD34staining. The control group was evaluated as (+) and (-). Conclusion:Chitosan improved PGA abilities as a cell matrix andenhanced angiogenesis within the in vitro reconstructedgraft.

Voorham-van der Zalm, Petra J.; Elzevier, Henk W. ; Lycklama Nijeholt, Guus A.B.; Pelger, Rob C.M.

2008 Current Urology

doi: 10.1159/000106538

Objective: The aim of this study was to quantify the acuteeffect of one single application of a combination of transcutaneouselectrical nerve stimulation (TENS) on the tibialnerve and TENS applied to the sacrum at the S2-S4 foraminain patients with symptoms of the overactive bladder(OAB) syndrome, using urodynamic parameters. Patients andMethods: Prospectively 40 female patients were consecutivelyselected by entry in 2 groups: urodynamics only andurodynamics combined with TENS. We applied TENS with afrequency of 20 Hz, a burst of 2 Hz and pulse duration of 200µsec. Urodynamic evaluations were performed according tothe International Continence Society standards. Results: Bycomparing urodynamic measurements in both groups, it appearedthat the first sensation of bladder filling, cystometriccapacity, micturition volume, urethral pressure and peakflow showed statistically significant improvement (p < 0.05)during TENS. Conclusion: In the present study we were ableto demonstrate an acute effect of one application of TENS inthe combined setting on bladder function using urodynamicparameters in patients with the OAB syndrome. Whether ourfindings represent the clinical effect of TENS in patients withcomplaints of OAB symptoms, needs to be clarified.

Mokhtari, Gholamreza ; Pourreza, Farshid ; Kamran, Alireza N. ; Jamali, Maryam

2008 Current Urology

doi: 10.1159/000106539

Objective: To evaluate the hereditary behavior of varicocelethrough comparison of the prevalence of the diseasein first-degree relatives of patients with known varicoceleand normal healthy kidney donor volunteers. Patients andMethods: Sixty-two patients with known varicocele whowere admitted for surgery in Razi Hospital between September2005 and October 2006 were enrolled in the study. Theiravailable healthy first-degree relatives (n = 88) were askedto refer and be examined. A group of 100 men referred forvoluntary kidney donation were selected as a control groupand assessed for varicocele. Results: Of the 88 first-degreerelatives of patients with known varicocele, 40 (45.4%) hada clinically palpable varicocele on physical examination. Thiswas significantly more than the 11 (11%) of 100 men in thecontrol group (p < 0.001). Of the first-degree relatives, 32(55.1%) of 58 brothers and 8 (26.6%) of 30 fathers had a palpablevaricocele. Conclusion: Clinical varicoceles are prevalentamong first-degree relatives (particularly brothers) ofpatients with known varicoceles, which may be an indicatorof the hereditary behavior of the disease and may indicate aneed to screen male family members.

Patra, Phani B. ; Jugus, Malcolm J. ; Laping, Nicholas J.

2008 Current Urology

doi: 10.1159/000106540

Cystometry of the conscious rat is an effective method tostudy bladder function without compromising micturitionreflexes with anesthetics. This model can be influenced byinflammation, hormones and potentially strain of animal.Therefore, we examined whether gender has any impacton the micturition pattern of Sprague-Dawley (SD), WistarKyoto (WKY) and Spontaneously Hypertensive rat (SHR). Inthis study, recovery after surgery had a major impact on cystometryduring the early days of post-surgery. Void intervalswere shorter with very low void volume on the first day aftersurgery. However, there was a gradual increase in voidinterval and void volume from the second day onwards andwere stable on the fifth through seventh days post-surgery.Regarding strains, it was found that void volume and void intervalwere similar between SD and WKY rat. SHR, had a lowervoid volume with a shorter void interval than the WKY. Interestingly,the void interval in male rats, regardless of strain,was shorter compared to the females of the respective strain.It is concluded that a stable cystometric pattern is observedin the conscious SD rat after the fifth day of post-surgerywhich suggests that at least 1 week should be allowed afterbladder surgery to observe a stable cystometric data. Therewas a clear sex difference in the micturition pattern amongthe strains in that the frequency of micturition of the malewas higher than female SD, WKY and SHR. Studying the sexdifferences in the micturition pattern might improve understandingthe different pathophysiology of bladder control inmen and women.

Bener, Abdulbari ; Al-Ansari, Abdullah ; Zirie, Mahmoud ; Al-Hamaq, Abdulla O.A.A. ; Janahi, Ibrahim M. ; Mohammed, Hashim S.

2008 Current Urology

doi: 10.1159/000106541

Objective: The aim of the study was to determine the prevalenceof erectile dysfunction (ED), its severity and other sexualfunction domains in Qatari men with and without type 2diabetes mellitus (T2DM) at primary health care clinics. Patientsand Methods: Five hundred and forty-four men aged30-80 years were selected from Primary Health Care Centersin Qatar during a period from May to October 2006. This wasan age matched cohort study including 272 T2DM patientsand 272 non-diabetic men. Face-to-face interviews werebased on a questionnaire including variables of age, sociodemographicstatus, educational level, occupation, cigarettesmoking, and a glucose test. Sexual function was evaluatedwith the International Index of Erectile Function (IIEF). Univariateand multivariate statistical methods were performedfor data analysis. Results: The mean age for T2DM patientwas 57.1 ± 10.9 years and non-diabetic men with age 56.5 ±11.2 years. There were statistically significant differences betweenT2DM and non-diabetic men with respect to maritalstatus (p = 0.003), educational level (p = 0.003), occupationalstatus (p < 0.001), smoking (p = 0.001), and the presence ofED (p = 0.001). Diabetic patients had significantly lower IIEFscores in all sexual activity domains than non-diabetic men(p < 0.001). Overall, IIEF erectile domain scores were lowerin diabetes patients. Frequency and severity of ED increasedwith age. Age, low educational level, diabetes mellitus, andsmoking were considered statistically significant predictorsfor ED. Conclusion: The prevalence of ED was significantlyhigher in T2DM Qatari men than in non-diabetic men. Age,education level, diabetes mellitus, smoking and family historyof diabetes were considered statistically significant predictorsfor ED.

Margulis, Vitaly ; Lin, Victor K. ; Wang, Shih-Ya ; Tang, Jian ; Zimmern, Philippe E.

2008 Current Urology

doi: 10.1159/000106542

Background: Pathophysiology of primary bladder neck obstruction(PBNO) remains poorly understood. We postulatedabnormal smooth muscle (SM) differentiation and disorganizationof bladder neck musculature as key features of PBNOpathophysiology. Materials and Methods: Immunohistochemicalanalysis and gene expression profiles of bladderneck specimens derived from 11 patients urodynamically diagnosedwith PBNO, 4 patients with benign prostatic hypertrophy(BPH) and 2 normal controls were performed. Consecutivesections were processed for immunohistochemicalcharacterization using anti-SM a-actin, h-caldesmon, collagentype IV, and GAP-43 antibodies. cDNA, synthesized fromisolated RNA of the specimens, were polymerase chain reactionamplified to assess for expression of smooth musclemyosin heavy chain, collagen types I and III, non-musclemyosin heavy chain, and a1A adrenergic receptor mRNA.Results: While SM disorganization in PBNO specimens comparedwith normal bladder neck tissue was observed, PBNObladder neck specimens stained positively for SM markers:a-actin, h-caldesmon and collagen type IV, suggesting theirSM origin. Staining for GAP-43, a phosphoprotein associatedwith the growth of axons and the modulation of new nerve/muscle connection, was also positive in PBNO tissue. Reversetranscription and polymerase chain reaction measurementsof SM related gene expression indicated extremely low levelsof smooth muscle myosin heavy chain mRNA expressionin PBNO specimens when compared to BPH or normal tissue.Expression of a1A adrenergic receptor was maintainedin both PBNO and normal bladder neck specimens. Conclusion:Expression of SM specific markers in the PBNO tissuewas diminished compared to bladder neck tissue from BPHor normal controls, suggesting SM dedifferentiation or transdifferentiation.

Qazi, Hasan A.R. ; Philip, Joe ; Manikandan, Ramaswamy ; Cornford, Philip A.

2008 Current Urology

doi: 10.1159/000106544

Background: The influence of the full moon remains a commonexplanation for wide range of events from death toviolence in psychiatric setting. Research has failed to showan association with psychiatric disorders, suicide and selfpoisoningor accidents. However, an increase in unintentionalpoisoning, absenteeism and aggression has been reported.Our study assessed whether the gravitational pull ofthe moon generated a tidal wave of increased emergencyurological admissions. Patients and Methods: Data was obtainedfrom the Hospital Centralised Emergency Databasefor a 2-year period of patients who presented as urologicalemergencies. We assessed daily patterns in emergency roomattendees for age, sex, and disease against the lunar cycleand other weekdays. Results: Thirty-five hundred and fortysevenpatients presented as urological emergencies (2,057men, 1,490 women), overall mean of 4.96 patients per day.There were 68 peak days (>8 admissions/day). Emergencypresentations peaked around mid-summer and New Year.Patterns were similar for both female and male attendees.Mean daily attendances peaked on Mondays and troughedon Wednesdays (5.1 ± 2.2 vs. 4.5 ± 2.3). Full moons (5.5 ± 2.3d, p = 0.75) were associated with a higher urological emergenciescompared to other days (4.9 ± 2.4 d) while newmoons (5.1 ± 2.4 d, p = 0.89) seemed to calm the urologicalsystem. Conclusion: Emergency urological admissions werehigher on full moon days. The new moon had a calming effect.These trends though not significant, show a possibleinfluence of the lunar cycle on urological admissions. Thedebate on the lunar cycle effect on human health and behaviorcontinues.

Chen, Chieh-Hsiao ; Chang, Chao-Hsiang

2008 Current Urology

doi: 10.1159/000106545

Thromboembolism is one of the common paraneoplasticsyndromes. Approximately 15 percent of patients withthromboembolism have a diagnosis of malignancy, includingpulmonary, pancreatic, gastrointestinal, breast, ovarian,genitourinary cancers, lymphomas, and brain tumors. Thesymptoms of thromboembolism depend on the affectedorgan, such as dyspnea, chest pain and syncope in pulmonaryembolism; tenderness, swelling, and redness in deepvenous thombosis of the leg. Although thromboembolism isnot rare in lung cancer, there is no report of testicular infarctionserving as a paraneoplastic syndrome. This is the firstcase which presents bilateral testicular infarction as the earlyparaneoplastic syndrome of the lung cancer. In this case,there were no symptoms such as cough, hemoptysis, wheezing,stridor, or dyspnea which may hint a pulmonary cancer.Bilateral testicular infarction was the leading problem andmisdiagnosis might happen if we ignored the underlyingdisease. Complete evaluation of all the possibilities includingthe malignancy is important for the patients who presentthromboembolism.

Cunningham, Lucy ; Loizides, Sofronis ; Kouriefs, Chryssanthos ; Ryan, Paul ; Mufti, Gulzar R.

2008 Current Urology

doi: 10.1159/000106546

Transrectal ultrasonography and prostate biopsies have becomea common urological procedure. There is strong publishedevidence to support the use of a prophylactic antimicrobialcover during the procedure but there is no consensuson the actual antibiotic protocol. Reported here is the firstcase of septic arthritis of the acromioclavicular joint followingTransrectal ultrasonography and prostate biopsies. Thisjoint is rarely involved with sepsis. There is evidence to suggestthat delayed treatment is associated with long-termmorbidity. A high index of suspicion is therefore required forearly and effective treatment with complete recovery.

Smith, Stella R. ; Taribagil, Sanjay ; Sahni, Mohit ; Harvey, Michael ; Al-Sam, S.Z.

2008 Current Urology

doi: 10.1159/000106547

Hersey, Naomi ; Masood, Junaid ; Papatsoris, Athanasios G. ; Staios, Demetrios ; Buchholz, Noor ; Albanis, Stephanos

2008 Current Urology

doi: 10.1159/000106548

Although the nutcracker phenomenon due to compressionof the left renal vein between the superior mesenteric arteryand the aorta is documented in the literature, it is still a subjectthat few medical practitioners including urologists arefamiliar with. We present a case in a 20-year-old male andreview the literature in order to highlight the important aspectsof its pathophysiology, clinical findings, investigationand current available treatment strategies.