Current Urology

2009 Current Urology

doi: 10.1159/000209827

Kirollos, Magdi M.

2009 Current Urology

doi: 10.1159/000209828

Introduction: Currently, there is no quantitative reference range for hematuria as a marker for urothelial cancers despite its worldwide use in this context. Materials and Methods: Analysis of the results of 100 consecutive newly diagnosed bladder tumors. Results: The sensitivity of quantitative hematuria in detecting bladder tumors at various thresholds is described, e.g. ranging from 68 to 90% and from 47 to 77% at 10 and 40/μl, respectively, depending on the number of urinalyses, period of observation and the stage of the disease. Infection was present in 28% of cases, and its effect on RBC concentration was marginal. Significant hematuria was present in 8% of cases longer than 1 year prior to diagnosis. Conclusion: There are major obstacles in utilising urinary concentration of RBC as a stand-alone screening test for bladder tumors. There is no safe lower limit. However, this study provides original data regarding the expected sensitivity at various thresholds and provides new evidence that the sensitivity is higher for invasive disease and better on multiple testing and clearly suggests that the latency of bladder tumors is longer than generally perceived.

Omrani, Mir D.; Bazargani, Soroush; Bageri, Morteza

2009 Current Urology

doi: 10.1159/000209829

Background: The genetic background of prostate cancer (PCa) is not completely understood. Objective: To assess whether an association exists between interlukin-10 (IL-10), interferon-γ(IFN-γ), tumor necrosis factor-α(TNF-α) poly-morphisms and PCa and benign prostatic hyperplasia (BPH). Patients and Methods: Forty-one patients with PCa, 100 pa-tients with BPH and 100 healthy individuals were genotyped using the allele-specific oligonucleotide-polymerase chain reaction method. Results: The moderate expressing form of IFN-γ+874 (A/T) polymorphism is more frequent in PCa and BPH cases. The homozygous form of G/G or A/A genotype of IL-10 –1082 cytokine was significantly increased in the pa-tients groups. The TNF-α–308 polymorphism significant in-creased in low producing G/G genotyped in the PCa group. Conclusion: IL-10, IFN-γ, TNF-αexpression levels may play a role in the development of PCa and BPH.

Balacescu, Ovidiu; Neagoe, Ioana; Balacescu, Loredana; Crisan, Nicolae; Feciche, Bogdan; Tudoran, Oana; Coman, Ioan; Irimie, Alexandru

2009 Current Urology

doi: 10.1159/000189664

Objective: The goal of this study was to determine if the concentrations of a set of 8 angiogenic molecules (plateletderived growth factor-BB (PDGF-BB), vascular endothelial growth factor, basic fibroblast growth factor, angiogenin, keratinocyte growth factor (KGF), tissue inhibitor of metalloproteinases-1 (TIMP-1), intercellular adhesion molecule-1, angiopoietin-2) in serum can be used as a noninvasive diagnostic test for prostate pathology in addition to use of the prostate specific antigen value, abnormal digital rectal examination, and pathological confirmation. Materials and Methods: Sera from 40 patients without cancer (control group), with prostate cancer, with benign prostatic hyperplasia, or with chronic prostatitis were used for FAST Quant® (Whatman) analysis. Results: The Shapiro-Wilk test was used for testing the normality of distribution. Angiopoietin-2, KGF, PDGF-BB, and TIMP-1 showed normal distributions (p > 0.05). Our results showed that there are significant serum concentration differences between prostate cancer, benign prostatic hyperplasia, chronic prostatitis, and the control group for the angiogenic molecules KGF, angiopoietin-2, PDGF-BB, and TIMP-1. Conclusion: Our data suggest that FAST Quant® (Whatman) analysis of multiple serum biomarkers consisting of angiogenesis molecules can improve the diagnosis of prostate pathology in a noninvasive manner.

Chatterjee, Suman; Kleinman, Nir; Gharajeh, Aash; Kapoor, Anil; Whelan, J.P.; Yemen, Brian; Pinthus, Jehonathan H.

2009 Current Urology

doi: 10.1159/000209831

Background: Obesity is a risk factor for renal cell carcinoma (RCC). Plasma levels of adiponectin, a hormone secreted solely by adipocytes, inversely correlate with adverse prognostic factors in RCC. Since the volume of the metabolically active visceral adipose tissue (VAT) better reflects obesity associated morbidity than body mass index (BMI), we measured and correlated it to adiponectin levels and disease characteristics in patients with clear cell RCC (ccRCC). Patients and Methods: Visceral and subcutaneous adipose tissues were measured using preoperative CT scans in 25 ccRCC patients who had no previous history of other cancers, diabetes or impaired renal function. Tissue at fat density was separated into subcutaneous and visceral components and the pixels were summed across 3 transverse slices (upper aspect of the L2 vertebral body, the umbilicus and the anterior superior iliac spine) to create a surrogate score of percentage of VAT (visceral fat area/visceral plus subcutaneous fat area). This score was correlated to preoperative fasting plasma adiponectin levels, tumor size, grade, presence of metastasis and BMI by univariate and multivariate linear regression analysis. Results: BMI correlated strongly with total but not visceral fat. Percentage of VAT correlated inversely with plasma adiponectin levels (p < 0.05) and directly with the presence of metastasis (p < 0.05) but not with grade. BMI did not predict either. Conclusion: Visceral obesity is associated with lower levels of plasma adiponectin and also appears to be associated with metastatic disease in ccRCC. CT measurements of percentage of VAT may help in preoperative prognostication of ccRCC patients.

Blick, Christopher; Marsh, H.; Muneer, A.; Tokaca, N.; Foley, S.J.

2009 Current Urology

doi: 10.1159/000209832

Objective: The aim of this study was to investigate the sub-jective efficacy and tolerability of transurethral injection of a stabilized hyaluronic acid-based gel of non-animal origin/ dextranomer (NASHA^TM/Dx) gel using the Implacer^TM device (Zuidex^TM) as a minimally invasive treatment for stress urinary incontinence (SUI). Patients and Methods: This was a single-centre study of 150 SUI patients treated with NASHA/Dx gel. Treatment efficacy was measured subjectively by patient self-assessment and patients were followed up until they felt that their SUI was under control and did not intend to seek further treatment. Results: Post-treatment follow-up was 6 months to 5.2 years (median: 28 months). Treatment success was achieved in 74% of patients, of whom 9% received re-peat treatment. Nineteen percent underwent subsequent successful surgical intervention; the remaining 7% considered further treatment unnecessary for their symptoms. Minor treatment-related complications occurred in 24% of patients. These included urethritis (13%) and urinary retention (12%). No serious complications were observed. Conclusion: These results demonstrate that NASHA/Dx gel is an effective treatment for SUI and support its use in patients not responding to more conservative therapy.

Gokani, Sumit; Panah, Ali; Masood, Junaid; El-Husseiny, Tamer; Papatsoris, Athanasios G.; Buchholz, Noor

2009 Current Urology

doi: 10.1159/000209833

Background: Patients with prostate cancer can often have simultaneous upper and lower urinary tract pathologies. If the patient is elderly and unfit for any major surgery, treat-ment options are limited. Thermo-expandable shape-memory nickel-titanium alloy stents (Memokath^TM) offer a minimally invasive solution in such cases and are available for long-term use in both, ureter strictures and prostatic outflow obstruction in patients deemed high risk for transurethral or open surgery. Surgical Technique: We present how we man-aged to exchange in a retrograde fashion a double J ureteric stent for a ureteric Memokath 051^TM using metallic needle placed externally over the skin to mark the stricture in an elderly patient unfit for any invasive procedure in whom for the same reason we had previously inserted a prostate Memokath 028^TM. This technique allows safe and efficient access to the upper urinary tract without removing the previously sited prostatic Memokath stent. Conclusion: In patients with a prostate stent, this technique allows safe access to the upper urinary tract to exchange a double J stent to a permanent Memokath stent without displacing or requiring re-insertion of a new prostate stent. This has cost and time saving implications as well as reducing patient morbidity and hospital visits due to regular stent exchange. The use of extracorporeal needles placed on the skin to mark and measure the length of the stricture is both an efficient and accurate way of placing the sheath through which a ureteric Memokath 051^TM stent can be placed across the stricture.

Masood, J.; Panah, A.; Zaman, F.; Papatsoris, A.G.; Buchholz, N.; Junaid, I.

2009 Current Urology

doi: 10.1159/000209834

Background: One of the keys to performing successful laparoscopic surgery is good retraction and exposure of the operating field without too many instruments in a limited working space ‘getting in each others way’. Methods: We describe a very useful technique for retracting the ureter using a temporary suture inserted through the abdominal wall to aid dissection and mobilization of the ureter and kidney in procedures such as laparoscopic pyeloplasty and nephrectomy. Results: This suspension suture greatly helps with mobilization of the ureter and if placed close to the pelviureteric junction it also helps hilar as well as dissection of the posterior part of the kidney. We have had no complications with this technique. Conclusion: Although this technique is not new, to our knowledge it is not widely used or known about. We wish to highlight this simple yet very effective technique as laparoscopic surgeons may find it extremely useful for a variety of procedures.

Miah, Saiful; Madan, Sanjeev; Khan, Mansoor; Urwin, Graham; Stower, Michael

2009 Current Urology

doi: 10.1159/000209835

Giant bladder calculi are rare and giant vaginal stones are an exceptional finding. We report the case of a 76-year-old female who presented with bilateral hydronephrosis and was discovered to have giant bladder calculus with a synchronous giant vaginal stone. The vaginal stone was broken into fragments and removed with the discovery of a copper intrauterine contraceptive device at the core whilst the bladder calculus required a planned open cystolithotomy. Subsequently two cystograms were conducted with the initial one not showing any vesico-vaginal communication how-ever the second cysrtogram showed the contrary and subsequently the patient underwent further surgery to correct this fistula.

Hinev, Alexander I.; Angelov, Angel; Marinova, Lena

2009 Current Urology

doi: 10.1159/000209836

A 73-year-old man presented to our clinic with a 3-month history of a growing painless tumor mass in the left hemi-scrotum. The epididymis at exploration was totally engaged by a large tumor attached to the scrotal skin, and it was histologically defined as malignant fibrous histiocytoma. Radical inguinal orchiectomy was performed; however, the tumor locally recurred within 1 month after surgery. Wide repeat excision of the left hemi-scrotum, followed by adjuvant radiotherapy to the ipsilateral groin and pelvis proved to be the appropriate therapeutic strategy that achieved long-term control over the disease. A world literature search revealed that this was the second reported case of malignant fibrous histiocytoma, arising primarily in the epididymis. We discuss the diagnostic and treatment aspects of this rare disease.

Naguib, Nader N.; Sharaf, Usama I.

2009 Current Urology

doi: 10.1159/000209837

Approximately 20% of all enterovesical fistulas are rectovesical. The common causes of acquired vesicoenteric fistula have shifted from diseases of the past (e.g. typhoid, amoebiasis, syphilis, tuberculosis) to diverticulitis, malignancy, Crohn’s disease and iatrogenic causes. Rectovesical fistulas are frequently associated with malignancy. Interestingly, bladder carcinoma rarely, if ever, is associated with fistula formation. Rarely, the bladder can be the origin of the inflammatory process. It is extremely rare that the urinary bladder stones can fistula into the rectum and cause vesicorectal fistula.

Jain, Manas; Matin, Surena F.; Kamat, Ashish M.

2009 Current Urology

doi: 10.1159/000209838

Anomalies of the inferior vena cava (IVC) afflict about 8% of the general population. Absence or atresia of the infrarenal segment of the IVC is a rare event comprising 6% of all IVC anomalies. Since an atretic IVC promotes the formation of venous thrombosis and collateral veins in the retroperitoneum, it may be confused with retroperitoneal lymphadenopa-thy as outlined in our report. Here, we describe such a case in which collateral vessels seen with an atretic IVC mimic retroperitoneal lymphadenopathy. We also discuss diagnostic measures to avoid associated pitfalls and explore the association between IVC anomalies and venous thrombosis and von Hippel-Lindau disease.

Tyagi, Manoj G.

2009 Current Urology

doi: 10.1159/000209839

2009 Current Urology

doi: 10.1159/000209840

2009 Current Urology

doi: 10.1159/000209841

2009 Current Urology

doi: 10.1159/000209842