Brain Metastases from Malignant Germ Cell Tumors of the Testis: Our Experience of 5 Cases with a Review of the LiteratureKurahashi, Toshifumi; Miyake, Hideaki; Kumano, Masafumi; Muramaki, Mototsugu; Takenaka, Atsushi; Fujisawa, Masato
2008 Current Urology
doi: 10.1159/000115383
Objective: The aim of this study was to report our experience and review the literature on brain metastases from malignant germ cell tumors (MGCTs) of the testis in order to characterize the clinical features of this disease. Patients and Methods: Between 1993 and 2007, 92 patients with metastatic MGCT were treated at our institution. Of these 92 patients, 5 developed brain metastases and are included in this study. The clinicopathological features of these 5 patients were retrospectively analyzed with reference to previously reported studies focusing on brain metastasis from MGCTs of the testis. Results: Brain metastases were diagnosed at presentation in 1 patient, following complete remission in 1 patient, or along with extra-cerebral tumor progression in 3 patients. All 5 patients presented some symptoms suggesting the presence of intracranial disease, and had bulky thoracic disease. After detecting brain metastases, 2 patients had only radiotherapy, 1 patient had chemotherapy plus radiotherapy, 1 patient received chemotherapy, radiotherapy, plus surgery; however, the remaining patient did not receive any treatments because of a poor general condition associated with brain hemorrhage from the metastatic lesions. Three of the 5 patients died 1, 3 and 4 months after the diagnosis of brain metastases, while the remaining 2 were alive with no evidence of disease 41 and 15 months after the completion of treatments. Conclusion: Considering the current data as well as the literature, the prognosis of patients with brain metastases is extremely poor; therefore, routine cranial imaging should be performed in patients with advanced tes-ticular MGCT, particularly those with bulky thoracic disease.
Long Term Results in Augmentation Phalloplasty through a 2-cm Incision: Technique, Anatomical Description in a Human Cadaver and Satisfaction AssessmentProtogerou, Vassilis D.; Anagnostopoulou, Sofia; Varkarakis, John M.; Venieratos, Dionissis; Konstantinidis, Kostas G.; Kostakopoulos, Athanassios N.
2008 Current Urology
doi: 10.1159/000115384
Objective: An increase in the length of the penis is feasible with techniques that either divide the penis’ ligaments (fundiform and triangle) or use grafts to increase the size of the corpora. Girth enhancement can be done with fat autoinjection or with dermal grafts. We present our technique together with an anatomical description in a human cadaver. Patients and Methods: Forty patients underwent augmentation phalloplasty. To increase the length of the penis the ligament was divided through a small 2-cm incision at the base of the penis. Girth enhancement was achieved through fat autoinjection with fat taken from the inner thighs. The dissection of the ligament was also demonstrated in a human cadaver to allow for more explicit presentation of the anatomy of the area. A questionnaire was used to assess the patients’ satisfaction. Results: Before operation all patients had a normal penis with a length 9.5 ± 2.2 cm (8.1–13.5 cm) in the flaccid state and 11.8 ± 1.9 cm (10.9–17.2 cm) in the erect state. The mean circumference was 9.9 ± 2.3 cm (7.6–11.8 cm). The increase in length 12 months post-operatively was 3.5 ±1.3 cm (2.3–5.1 cm) in the flaccid state, 1.8 ± 1.4 cm (1.4–3.2 cm) in the erect state and 3.5 ± 1.4 cm (2.1–5.2 cm) in girth. There was a statistically significant difference (p < 0.005) between pre-operative and post-operative status. The overall satisfaction rate was 67.5%, and 57.5% of the patients stated that the surgical outcome met their pre-operative expectations. Conclusion: Penile lengthening is technically possible provided that some basic principles are followed. Psychological disturbance though, might be present and such patients might not be pleased even after a successful operation.
Patency and Pregnancy Rates are Related to the Effects of Vasectomy on the Human TestisDanilovic, Alexandre; Pasqualotto, Fábio F.; Hallak, Jorge; Pasqualotto, Eleonora B.; Lucon, Antônio M.; Srougi, Miguel
2008 Current Urology
doi: 10.1159/000115385
Objectives: To evaluate the effects of vasectomy on the human testis by serum follicle-stimulating hormone, luteinizing hormone and total testosterone levels, testicular volume and testicular biopsy. Also, to correlate patency and pregnancy rates following vasectomy reversal. Patients and Methods: Fifty-seven patients who underwent vasectomy reversal and testicular biopsy were divided in 2 groups: group I consisted of patients with an interval of obstruction of 3–8 years (n = 34), and group II, patients with 9–15 years interval of obstruction (n = 23). Results: Serum follicle-stimulating hormone, luteinizing hormone and total testosterone levels and testicular volumes were normal in each evaluated patient. A normal testis biopsy was found in 61.2% (41/67) of the patients in group I and in 45.6% (21/46) in group II. Compared to group II, group I had higher patency (p < 0.05) and pregnancy rates (p < 0.05) following vasectomy reversal. Patients with atrophic testis did not have patency or established a pregnancy in their wives. Patients with normal spermatogenesis had a higher patency and pregnancy rate compared to others. Conclusion: Up to 15 years after vasectomy, spermatogenesis evaluated by testicular biopsy may not be compromised. Vasectomy causes time-dependent damage as observed in men who request vasectomy reversal within or more than 9 years after their vasectomy. Patients with normal spermatogenesis had a higher patency and pregnancy rates compared to patients with signs of atrophy. These results should be taken into account when vasectomized men, who request reestablishment of fertility after vasectomy, are being counseled and in the selection of patients for treatment.
Ureterovesical Anastomosis and Urinary Infections after Kidney Transplantation: Two Techniques ComparisonAdani, Gian L.; Baccarani, Umberto; Lorenzin, Dario; Benzoni, Enrico; Montanaro, Domenico; Tulissi, Patrizia; Gropuzzo, Maria; Vallone, C.; Risaliti, Andrea; De Anna, Dino; Bresadola, Vittorio
2008 Current Urology
doi: 10.1159/000115386
Objective: Urinary infections developing after kidney transplantation may depend on the type of ureterovesical anastomosis performed. Patients and Methods: A randomized prospective study was performed on 56 patients, from October 2004 to March 2006, receiving kidney transplants from cadaveric donors to compare 2 types of ureterovesical anastomosis. We considered the number and types of urinary infections, the duration of their treatment, and their complete/ partial resolution during the first year after transplantation. Twenty-eight patients (group A) underwent ureterovesical anastomosis according to the Lich-Gregoir technique, the other 28 patients (group B) using the Knechtle method. The 2 groups were comparable in terms of donor and recipient characteristics. Results: The mean duration of the period of antibiotic treatment was 17 ± 11 days in group A and 15 ± 7 days in group B (p = 0.63), while the intravenous antibiotic treatment lasted a mean 11 ± 6 days in group A and 10 ± 3 days in group B (p = 0.54). The antibiotic treatment completely resolved the urinary infection in all cases treated. No grafts were lost due to complications of urinary infections. Conclusion: Our data revealed no statistically significant differences between the 2 types of ureterovesical anastomosis considered in terms of the prevalence of infections or graft survival during the first year of follow-up.
Retrospective Analysis of Percutaneous Stone Surgery Utilizing Nephrostomy Tube versus Tubeless Technique with Fibrin SealantWalters, R. Chanc; Stroup, Sean P.; Santomauro, Michael G.; L’Esperance, James O.; Auge, Brian K.
2008 Current Urology
doi: 10.1159/000115387
Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment of large renal stones. Using fibrin seal-ants for PCNL is known to be safe and feasible. We evaluated the safety, efficacy, and complication rates of tubeless PCNL using fibrin sealant compared to PCNL performed with nephrostomy tube (NT). Materials and Methods: A retrospective review was completed for PCNL performed from January 2002 to October 2006. A total of 141 PCNL were included (81 tubeless/60 NT). We assessed demographics, stone size, blood loss, renal function, hospital stay, targeted stone free rate, and complications. Results: Patient demographics were similar in both groups. Mean stone size was 2.41 cm<sup>2</sup> in the tubeless and 2.83 cm<sup>2</sup> in the NT group (p = 0.18). The change in creatinine and hemoglobin were not statistically significant between groups. Hospital stay was 1.07 days in the tubeless group versus 2.37 in the NT group (p < 0.0001), with 93% of patients were discharged on post-operative day one versus only 32%, respectively. Immediate targeted stone free rate was 69% in the tubeless group versus 56% in NT group, which improved to 88% and 76% when considering residual stones fragments <4 mm. Long term stone free rates for the tubeless and NT groups were 96% and 83% (p = 0.08) for fragments <4 mm at a median of 3 and 6 months, respectively. Complications in the tubeless group included one pseudoaneurysm, one urine leak, three small subcapsular hematomas, and two re-admissions (one for flank pain and one for non-cardiac chest pain). In the NT group, there was one aborted procedure, two pseudoaneurysms, one colocutaneous fistula, and two re-admissions (one for flank pain and one for urinary obstruction). Conclusion: Tubeless PCNL with fibrin sealants appears to have similar safety and efficacy to traditional NT. In our practice, tubeless PCNL was associated with a decrease in hospital stay.
Validation of a Nomogram for Predicting a Positive Repeat Prostate Biopsy in a Multi-Specialty Group Practice Model with a Rural, Referral-Based PopulationRitter, Robert H.; Bird, Erin T.; Coffield, K. Scott; Speights, V.O.; Rampisela, Debby; Kattan, Michael
2008 Current Urology
doi: 10.1159/000115388
Background: An earlier biopsy nomogram model was designed at an international cancer referral center and validated in a patient population in New York City. We believe that the rural demographics of our multispecialty institution would be useful in further validation of the nomogram prior to advocating widespread clinical application. Patients and Methods: We retrospectively reviewed 247 patients who un-derwent repeat prostate biopsies over a 2-year period. Results: Data sets were created by extracting such informations as: high-grade prostatic intraepithelial neoplasia, prostate specific antigen, prostate specific antigen slope, and family history, among other variables. Conclusion: Ultimately we found that our nomogram carried out upon a rural community responded similarly to the urban population in which it was originally established and validated.
Evaluation of Different Ureteroscopic Lithotripsy Techniques in the Management of Ureteral Stones at Different Locations: An Experience of 1909 Cases over 10 YearsGunlusoy, B.; Arslan, M.; Degirmenci, T.; Nergiz, N.; Minareci, S.; Ayder, A.R.
2008 Current Urology
doi: 10.1159/000115389
Objective:To evaluate the success rates of different ureteroscopic lithotripsy techniques in the management of ureteral stones at different locations. Patients and Methods:A total of 1,909 ureteroscopic procedures were performed between May 1992 and November 2005. Atotal of 1,567 patients underwent ureteroscopic lithotripsy for treatment of ureteral stones at different locations; ultrasonic, electrohydraulic, pulsed-dye laser and pneumatic lithotripsy were used as ureteroscopic procedures. Results:The overall success rate was 89.0% for all procedures. The success rate of ultrasonic, electrohydraulic, pulseddye laser and pneumatic lithotripsy were 79.6, 72.0, 87.6 and 96.1%, respectively. Significant complications which were defined as ureteral perforation and strictures, occurred in 9 of 866 patients (0.9%) currently, compared to 30 of 701 (4.3%) previously. Conclusion:Among different procedures, pneumatic lithotripsy was the most effective method with low failure rates.
Harpoon Excision: A Simple Technique for Excision of Epididymal CystsLavelle, Mike A.; Khadra, Abbas; Coker, Charles
2008 Current Urology
doi: 10.1159/000115390
Epididymal cysts are benign structures found during scrotal examination. Clinical management options include conservative, aspiration, sclerosant injection and surgery. Surgical excision carries the risk of infection, hematoma, chronic epididymal pain and morbidity associated with general anesthesia. With this in mind, we present a simple method of excising epididymal cysts under local anesthesia. The method described involves the use of local anesthesia, a 16 guage cannula and minor operating instruments. This technique can be performed using local anesthesia, hence making it suitable for older less fit patients, and as a day case procedure. The technique does not alter the indications for treating epididymal cysts, and as most cysts are multiple, the patient must be warned about the possibility of recurrence.
Retroperitoneoscopic Nephropexy in a Pateint with a Solitary Functioning KidneySahai, Arun; Raychaudhuri, Bikram; Hassy, Arek; Khan, Mohammad S.; Dasgupta, Prokar
2008 Current Urology
doi: 10.1159/000115391
Background: Symptomatic nephroptosis is rare, requiring surgical management in very select cases. We report a surgical technique and a case of symptomatic nephroptosis in a solitary functioning kidney treated by retroperitoneoscopy. Patients and Methods: A 37-year-old female presented with right loin pain worse when standing, urinary tract infections and hematuria. Intravenous urography in supine/erect positions demonstrated significant nephroptosis of >6 cm. Renography failed to show any obstruction. After thorough discussion she elected to undergo retroperitoneoscopic nephropexy. Results: A standard 3-port retroperitoneal technique was employed and was successful with no complications. The kidney was stented to ensure no hindrance to drainage. Tissue sealant was used in addition to sutures to stop any cortical bleeding and promote fibrosis. The opera-tive time was 132 minutes and blood loss <10 ml. Inpatient stay totalled 3.5 days. Intravenous urography at 3 months showed a reduction in renal displacement and no demonstrable nephroptosis was evident on ultrasound scan at 1 year. The patient remains asymptomatic at 24 months follow-up. Conclusion: Retroperitoneoscopic nephropexy is feasible even in patients with a solitary kidney. We recommend stenting the kidney and the use of tissue sealant in addition to sutures for the nephropexy in such cases.
Bilateral Testicular Infarction and Orchiectomy as a Complication of Polyarteritis NodosaStroup, Sean P.; Herrera, Shannon R.; Crain, Donald S.
2008 Current Urology
doi: 10.1159/000115392
We report an unusual case of a 28-year-old male with constitutional symptoms and bilateral testicular pain. After diagnosis of cytomegalovirus hepatitis, his constitutional symptoms and testicular pain worsened despite treatment for epididymoorchitis. Ultrasound was concerning for infarction. Exploration in the operating room revealed bilateral testicular infarction requiring bilateral orchiectomy with subsequent androgen hormone replacement. Pathologic diagnosis was polyarteritis nodosa (PAN). PAN is a rare systemic vasculitis that affects multiple organs. There are no previous reports of PAN-induced vasculitis leading to bilateral testicular infarction and bilateral orchiectomy.
A Calcified Papillary Renal Cell Carcinoma Masquerading as a Renal Pelvic CalculusRoesel, Gwen C.; Toepfer, Nicholas J.; Battino, Benjamin S.; Bell, Thomas E.
2008 Current Urology
doi: 10.1159/000115395
A patient had undergone unsuccessful extracorporeal shock wave lithotripsy for a renal calculus 2 months prior to presentation. The stone neither fragmented nor passed. Computed topography scan and plain radiographs demon-strated a large (2–3 cm) renal pelvic calculus with an unusual appearance of a dense calcified rim surrounding a soft tissue core. The calculus was removed via percutaneous nephroli-thotomy. The ‘stone’fragmented easily with the combination pneumatic/ultrasonic lithotripter. The core of the stone was soft-tissue and was a papillary renal cell carcinoma, grade 2/4. This is an unusual case; not only was it not a stone as it appeared to be on imaging, but it was a renal cell carcinoma rather than the usual transitional cell carcinoma associated with calculi.