Current Urology

Rikken, Berend; Hartwig, Nico G.; van den Hoek, Joop

2008 Current Urology

doi: 10.1159/000115292

Renal candidiasis in neonates and young infants is a potentially life threatening condition. It occurs mainly in neonates and young infants with secondary risk factors and underlying congenital urinary tract abnormalities. The diagnosis can easily be established and is usually followed by antifungal therapy with fluconazole. However, fluconazole therapy might fail and there seems to be no consensus on best second-line therapy. We describe 4 patients with renal candidiasis, which illustrate the different aspects to be considered during treatment. A literature study was performed to search for the best therapeutic modality to achieve cure. Based on the few papers that describe the management of invasive candidiasis and the experience with the 4 cases, a therapy protocol is proposed in which systemic antifungal therapy is combined with an irrigation procedure.

Hadzi-Djokic, Jovan; Pejcic, Tomislav P.; Acimovic, Miodrag; Dzamic, Zoran

2008 Current Urology

doi: 10.1159/000115371

Objective: To analyze the indications, diagnosis, and basic principles and aims of surgical reconstruction of tuberculous bladder contracture. Patients and Methods: From October 1993 to June 2006, 12 patients with severe bladder contracture due to tuberculous infection underwent augmentation cystoplasty in 3 urological institutions in Serbia. Results: All patients underwent subtotal cystectomy and bladder augmentation, using a segment of the ileum. Compliance increased from 2.72 ± 1.35 (range 0.92–4.85 ml/cm H₂O) to 46.24 ± 35.44 ml/cm H₂O (range 12.73–120.0 ml/cm H₂O). Mean total bladder capacity increased from 180 ± 105 to 610 ± 192 ml (p < 0.001) and mean maximum detrusor pressure decreased from 79 ± 45 to 20 ± 14 cm HO. Average residual urine was 130 ml (50–220 ml). Conclusion: The presented surgical procedure is relatively easy, the compliance and the capacity of the augmented bladder are satisfactory and the complication rate is low.

Aguilera, Alfredo; Utrilla, Manuel P.; Martín, Mario; Girón, Manuel; Cisneros, Jesús; de la Peña, Javier

2008 Current Urology

doi: 10.1159/000115372

Objective: Partial nephrectomy is a safe procedure in renal tumors less than 4 cm. The laparoscopic technique is one of the most complex surgeries in urology. We present our experience in 12 years with open and laparoscopic technique. Material and Methods: The analyzed period covers from 1995 to 2006, during which 96 parenchymal sparing renal surgical procedures were performed, 75 of them open (1995–2004) and 21 laparoscopic (2004–2006). Absolute contraindications for laparoscopic surgery were solitary kidney, tumor size greater than 4 cm and location of the tumor close to the hilus. Results: There are statistically significant differences in operating time (shorter in laparoscopy), intraoperative bleeding and transfusion (greater in open surgery), and hospital stay (3.3 d in laparoscopic vs. 7.5 d in open). The positive margins are greater (not statistically significant) in laparoscopic procedure because the learning curve. Conclusion: Conservative renal surgery is a common approach for tumors less than 4 cm. The laparoscopic procedure is a difficult surgery and should be performed by surgeons with expertise in laparoscopy. The development of both laparoscopic instruments and new biological sealants allows for an easier implementation of this minimally invasive procedure.

Gangopadhyay, A.N.; Pandey, A.; Gupta, D.K.; Upadhyay, V.D.; Sharma, S.P.; Kumar, V.; Gopal, S.C.; Srivastava, A.

2008 Current Urology

doi: 10.1159/000115373

Background: Bladder stone is a common problem in chil-dren of developing countries. Traditional treatment of open suprapubic cystolithotomy is followed by bladder and ret-ropubic drainage. We have modified the operation as day care surgery without any type of drainage which is practi-cally feasible. Patients and Methods: All patients presented from 1997 to 2007 were operated by our technique of open suprapubic cystolithotomy. After removal of the stone the bladder was meticulously closed in 3 layers: inner mucosal continuous, middle muscular continuous and outer serosal interrupted without any drainage. Results: The total number of patients was 158. Ninety-six (60.75 %) were males and the rest (n = 62, 39.24 %) females. Mean age of patients was 5.58 years (range 2–10 years). An abdominal X-ray was diagnostic in all the patients. One hundred and twenty-two (79.75%) passed urine within 4 to 8 h (mean 6 h). Complications noted in our series were minor wound infection (5%), transient he-maturia (3.8%) and fever (2.5%). There was no mortality in the study. One hundred and fifty (94.93%) patients were dis-charged on the same day in the evening. The mean duration of follow-up was 5.2 months. No patient had any late compli-cation in the follow-up. Conclusion: Cystolithotomy as day care surgery is an easy option both for the surgeon and the patient. Day care cystolithotomy shortens the hospital stay and promotes early mobility. It should be remembered that proper case selection is a must for successful outcome.

2008 Current Urology

doi: 10.1159/000122689

A spelling error occurred in the article: Patra et al: Sex differences in cystometry of normal and hypertensive conscious rat. Curr Urol 2007;1:84–88. The telephone number for correspondence author should read +1 610 270 5061. In figure 1 of the versions of this article initially published online and in print, there was an error in the labeling of this figure which has been corrected in the PDF versions of the article. Numerical numbers on the left side of the tracings should be in reverse order. The corrected figure appears right.

Patra, Phani B.

2008 Current Urology

doi: 10.1159/000115374

Background: With reference to our recent observations that there is a sex difference in the micturition pattern be-tween male and female normotensive Wistar Kyoto (WKY) and spontaneously hypertensive rats (SHR), the aim in this investigation was to examine the respective contribution of cyclooxygenase (COX)-1 vs. COX-2 inhibition in the micturi-tion pattern of male and female SHR and WKY rats. Materials and Methods: Cystometry was performed in conscious male and female SHR and WKY rats. Void volume, void interval, and peak void pressure were measured during cystometry before and after intraduodenal administration of ketopro-fen (10 mg/kg), a relatively selective inhibitor against COX-1, and meloxicam (10 mg/kg), a selective COX-2 inhibitor. Results: Male SHR and WKY had shorter void intervals than female SHR and WKY under control conditions. Ketoprofen and meloxicam increased void interval in male WKY (124 and 59%), male SHR (119 and 127%), female WKY (33 and 30%), and female SHR (50 and 34%), compared to their respective vehicle groups. Conclusion: Present study indicates that ke-toprofen and meloxicam had a robust effect on micturition in male SHR and WKY than female SHR and WKY. The COX-

Kusljic, Snezana; Dey, Anupa; Nguyen, Dan-Thanh T.; Lang, Richard J.; Exintaris, Betty

2008 Current Urology

doi: 10.1159/000115375

Objective: Prostatic interstitial cells (PIC) have been previously identified in the young guinea pig and human prostates and have been suggested to be a potential new therapeutic target for diseases of the prostate gland. In this study we have established the presence of PIC and their intercellular communication via connexin 43, in the ageing guinea pig prostate. Materials and Methods: Immunohistochemical and electrophysiological techniques were used. Results: Microscopic examination of preparations of guinea pig pros-tate revealed the presence of c-Kit immunoreactive cells in the region between the smooth muscle (SM) and glandular layers in ageing guinea pigs. Connexin 43 immunoreactive cells were observed within the border between the glandu-lar layer and SM layer but not within SM layer itself. Three distinct types of electrical activity were recorded in the ageing guinea pig prostate gland: slow waves, spontaneous transient depolarisations and spike potentials. Pacemaker potentials were not recorded. Conclusion: C-Kit immuno-reactive cells are present in the ageing guinea pig prostate gland and appear to communicate to each other, but not to SM cells via connexin 43 protein. Ageing prostates do not appear to exhibit pacemaker activity, although PIC are pres-ent, indicating that the characteristics of the PIC may change with age. These results have implications in better under-standing and treating prostate-specific conditions such as benign prostatic hyperplasia.

Videira, Paula A.; Ligeiro, Dário; Correia, Manuela; Trindade, Hélder

2008 Current Urology

doi: 10.1159/000115377

Gene expression studies demand that data be normalized to an endogenous control gene. The selection of this control is not straightforward, in particular for tumor tissue samples. We have measured the expression of genes engaged in the immune response in matched samples of superficial bladder cancer relative to normal urothelium. The β-actin and glyceraldehyde-3-phosphate dehydrogenase genes were selected from a panel of common reference genes as the most stably expressed and were used for normalization. Even so, we found that in some samples, the immunity genes expression, when normalized to either β-actin or to glyceraldehyde-3-phosphate dehydrogenase was contradictory. For more trusting results, the combination of both reference genes had to be considered. Nevertheless, gene expression studies should be regarded as qualitative rather than quantitative. Our study stresses required prudence when selecting endogenous control genes. The gold standard normalization is most probably obtained with the mean expression of multiple endogenous controls.

Shafik, Ahmed; Shafik, Ali A.; El-Sibai, Olfat; Shafik, Ismail A.

2008 Current Urology

doi: 10.1159/000115378

Objective: The role of the dartos muscle (DM) during erection is not known. We investigated the hypothesis that the DM contracts during erection. Patients and Methods: Electromyographic response of the DM to erection was studied in 23 healthy volunteers (mean age 37.2 ± 10.7 years). Erection was induced by intracavernosal injection of alprostadil. The DM response was tested before and after glans penis anesthetization. Results: The DM showed resting slow waves and action potentials. Slow wave frequency, amplitude and conduction velocity exhibited a significant increase on erection. Anesthetization of the erect glans penis was not associated with increase of slow wave variables. Conclusion: The DM appears to contract during coitus; this action is postulated to be reflex and mediated through the ‘glans-dartos excitatory reflex’. DM contraction seems to elevate and impart warmth to the testicles with a resulting increase of testicular blood flow. It may also effect testicular compression, expressing its secretions into the vas deferens.

Grases, Felix; Perello, Joan; Isern, Bernat; Costa-Bauza, Antonia

2008 Current Urology

doi: 10.1159/000115379

Background and Aims: One poorly studied factor that probably has a significant influence on the development of calcium oxalate renal calculi is the presence of urinary het-erogeneous nucleants, since the urine of all individuals is per-manently supersaturated with calcium oxalate. In this study we investigated and evaluated the role of calcium fluoride (CaF₂) as seed crystals for the induction of calcium oxalate urolith development. Materials and Methods: Induction of calcium oxalate urolith development in the presence of CaF₂seed crystals was studied using batch crystallizers and flow systems in the presence of both fluoride ions and CaF₂seed crystals. The effects of diverse crystallization inhibitors were also evaluated. Results: The results suggest that the forma-tion of CaF₂crystals in urine, even considering the excretion of high amounts of fluoride ions, is very unlikely. Nevertheless, when formed, CaF₂crystals acted as heterogeneous nucleants of calcium oxalate crystals. This effect was delayed in the presence of the crystallization inhibitors phytate and pyrophosphate at concentrations similar to those normally found in urine. Citrate, chondroitin sulfate and pentosan polysulfate were not inhibitory. Conclusion: High urinary fluoride levels alone do not cause calcium oxalate stone development; other factors must also exist, such as retention of CaF₂ crystals and deficit of crystallization inhibitors.

Petrut, Bogdan; Coman, Ioan; Nechita, Florin; Metes, Ovidiu; Coman, Radu T.

2008 Current Urology

doi: 10.1159/000115381

Background: Ureteral reimplantation can be performed by a large number of surgical procedures. Almost all of the surgical anti-reflux reimplantation methods are based on the creation of a sub-mucosal tunnel. All of these techniques are very difficult to perform by the laparoscopic approach due to the large number of delicate dissections and intracor-poreal sutures. We evaluated a new ureteroneocystostomy technique which provides a good anti-reflux mechanism and can be easily applied by the laparoscopic approach. We specially adapted this technique to be done by laparoscopy. Materials and Methods: We applied the new ureteroneo-cystostomy technique to a group of 8 pigs with a medium weight of 34 kg. The surgical approach was transperitoneal, using a zero degree laparoscope. A unilateral reimplanta-tion was performed in all cases. The feasibility of the new laparoscopic method was assessed by: the operating time and the time consuming steps of the surgical procedure, the difficult maneuvers, the intra-operative incidents and the post-operative complications. Retrograde cystography was performed 2 weeks later. Six weeks post-operatively we extracted specimens for histopathologic examination. Results: The new method provides a short operative time, aiming for less than 35 min. The new method also excludes time consuming maneuvers and excessive sutures on the new ureterovesical junction. Pathologic examination of the intravesical ureteral segment showed viable junction tissue. Conclusion: The short operating time is a strong argument for the further development and implementation of this method. The technical simplicity and efficacy of this laparoscopic method recommend it as an appropriate alternative to classical ureteroneocystostomy techniques.

Casale, Pasquale

2008 Current Urology

doi: 10.1159/000122690

Vardar, Enver; Gunlusoy, Bulent; Sayhan, Sehnaz; Degirmenci, Tansu

2008 Current Urology

doi: 10.1159/000115382

Microcystic urothelial carcinoma of the urinary system is an unusual type of transitional cell carcinoma. We presented a 52-year-old man with microcystic urothelial carcinoma in the bladder without significant medical history. Transurethral resection was performed and subsequent pathologic evaluation defined the lesion as a microcystic urothelial car-cinoma. Microscopic examination showed muscle invasive transitional cell carcinoma with prominent cystic features. The cysts lined by multiple layers of flattened or cuboidal cells with atypia were of varying sizes. Immunohistochemical analysis using the streptavidin-biotin peroxidase technique and immunoreactivity for different cytokeratins was performed, confirming the pathologic diagnosis. The patient underwent radical cystectomy and pelvic lymphadenectomy. The patient had no metastasis at 10-months follow-up. Microcystic urothelial carcinoma of the bladder which contains predominant irregular cystic areas can mimic benign lesions. Due to the similarity of this tumor to other cystic lesions, the pathologist should be aware of this rare entity in differential diagnosis.