Current Urology

van der Aa, Madelon N.M.; Dönmez, Mustafa; Eijkemans, Marinus J.C.; van der Kwast, Theo H.; Zwarthoff, Ellen C.; Steyerberg, Ewout W.

2009 Current Urology

doi: 10.1159/000253368

Introduction: We aimed to quantify the importance of conventional clinical and pathological prognostic factors in the outcome of non-muscle invasive bladder cancer based on literature. Materials: We identified 14 publications that reported on the association between clinical and pathological prognostic factors for tumor recurrence, tumor progression and overall mortality of non-muscle invasive bladder cancer. Relative risks (RR) were estimated using meta-analytic techniques to combine results of separate studies. Results: In total, 2,536 of 5,021 patients had a tumor recurrence, 317 of 3,313 had tumor progression and 531 of 1,548 died. The strongest prognostic factor for tumor recurrence was the result of the first 3-monthly cystoscopy (RR 2.2, 95% confidence interval (CI) 1.8–2.7). The strongest prognostic factor for tumor progression was grade 3 compared to grade 1 (RR 6.7, 95% CI 4.7–9.5). The presence of carcinoma in situ had a strong effect on tumor progression (RR 4.4, 95% CI 3.4–5.5) and on the overall mortality (RR 4.0, 95% CI 2.4–6.5). Tumor shape, grade 3 and patient age also had strong effects on survival. Conclusion: Clinical and pathological prognostic factors could not predict tumor recurrence, but showed strong associations with tumor progression and overall mortality. To individualize surveillance strategies emphasis should be on the search for a panel of conventional and molecular prognostic factors that can reliably predict recurrence and progression.

Kim, Dennis H.; Faruqui, Nuzhat; Mahdy, Ayman; Ghoniem, Gamal M.

2009 Current Urology

doi: 10.1159/000253369

Introduction: Minimally invasive treatments (MITs) for benign prostatic hypertrophy are effective treatments in properly selected patients. Despite being minimally invasive, significant complications can still arise. The objective of this study is to describe a tertiary care center experience with complications arising from MITs for benign prostatic hyper-trophy. Patients and Methods: A retrospective chart review was done from January 2007 to August 2008 to identify patients who developed stress incontinence or a urethral stricture after undergoing a MIT for benign prostatic hyper-trophy. Results: Three patients were identified as experiencing a complication. All 3 patients had undergone a prior transurethral microwave thermotherapy procedure at 9, 14, and 13 months prior to presentation. No patients had prior pelvic radiation, bladder or urethral trauma. No patients had prostate cancer. Patient ages were 61, 71, and 90 years. One patient developed a urethral stricture without incontinence. The other 2 patients developed both stress incontinence as well as urethral strictures. Conclusions: MITs for benign prostatic hypertrophy are effective treatments in properly selected patients. Despite being minimally invasive, significant complications can still arise. Proper training and good surgical technique are required to minimize and avoid complications.

Chen, Wen-Chi; Liu, Hsin-Ping; Wu, Hsi-Chin; Tsai, Chou-Huang; Chen, Huey-Yi; Chen, Hsin-Yi; Tsai, Fuu-Jen; Chang, Chiao-Hui; Liu, Po-Len; Lin, Feng-Yen; Chang, Yi-Chun; Lin, Wei-Yong; Chen, Yung-Hsiang

2009 Current Urology

doi: 10.1159/000253370

Ethylene glycol (EG), a frequently used lithogenic agent, causes calcium oxalate crystal deposits in the renal cortex and causes death if over-dosage. In this study, we compared the protein expression pattern of rat renal lithiasis induced by EG with that of normal renal tissues using two-dimensional electrophoresis (2-DE). Sixteen male Sprague-Dawley rats were divided into 2 groups. In control group (n = 8), rats were fed with normal drinking water; in EG group (n = 8), rats were fed with 0.75% EG in drinking water. After 4 weeks, rats fed with EG had calcium oxalate deposited in renal cortex. The renal cortex proteins were extracted and isolated by 2-DE. Comparative analysis of the respective spot patterns on 2-DE were identified by matrix-assisted laser desorption ionization-time of flight-mass spectrometry technique. Among

Zaslau, Stanley; Riggs, Dale R.; Jackson, Barbara J.; Talug, Can; Kandzari, Stanley J.

2009 Current Urology

doi: 10.1159/000253371

Introduction: We hypothesized that inositol hexaphosphate (IP6) would modulate cell cycle and cellular growth in bladder cancer. Materials and Methods: Bladder cancer cell lines were treated with 2.5 or 4.5 mM/well IP6. Cell viability was measured by MTT at 24 and 48 h. Cell cycle analysis was measured by DNA staining and quantified by FACS analysis. Results: Cell growth was inhibited in the TCCSUP, HTB9 and T24 cells (p < 0.001) with the exception of the HTB9 cells at 24 h. G1 phase fractions increased in the TCCSUP and HTB9 cells, while S phase fraction was decreased (p < 0.001). G2 phase was decreased in the TCCSUP cells (p < 0.001). G1 phase fraction was decreased in the T24 line with 4.5 mMIP6 (p < 0.001), while a significant increase in the S phase was observed in the T24 cells (p < 0.001). Conclusions: These results indicate that IP6 is potentially a highly effective treatment for carcinoma of the bladder.

Pandey, Ashwani K.; Sharma, Girish K.; Bansal, Harbans; Swain, Samir; Trivedi, Sameer; Dwivedi, Udai S.; Singh, Pratap B.

2009 Current Urology

doi: 10.1159/000253372

Aim: We compared the outcome of retropubic radical prostatectomy with or without our modified technique of total posterior reconstruction. The technique differs from the standard technique in the form of reconstruction of retrotrigonal tissue using a detrusor muscular flap. The free end of the flap is sutured to the Denonvillier’s fascia to complete posterior reconstruction. Materials and Methods: From August 2006 to July 2008, 32 patients with localized prostate carcinoma who underwent radical retropubic prostatecto-my were prospectively evaluated in 2 groups operated on by 1 surgeon. The first 22 patients underwent standard technique of radical retropubic prostatectomy and subsequently we used and are now using a modified technique. The first 10 patients operated on by the modified technique are included in the present study. Both groups were compared for postoperative continence. Continence was assessed using quality of life questionnaires. A patient was considered incontinent if he had to change more than 1 pad per 24 h. Results: Continence rates in group 1 were 72.73, 81.82, 86.40 and 95.46% at 1, 3, 6, and 12 months follow-up respectively as opposed to 80, 90, 90, and 100% respectively in group 2 patients. Conclusion: Total posterior reconstruction is an effective way to achieve an early return of continence.

Garaffa, Giulio; Christopher, Nim A.; Ralph, David J.

2009 Current Urology

doi: 10.1159/000253373

At the moment a variety of different techniques of total phallic construction in female to male transsexuals are available. This is consequence of the progresses in plastic surgery and of microsurgery and the fact that none of the phallic reconstruction techniques fulfils all the ideal requirements. This paper concentrates on the history and evolution of the techniques of phallic construction.

Kaplan, Josh R.; Johnson, Emilie K.; Faerber, Gary J.

2009 Current Urology

doi: 10.1159/000253374

While the presence of foreign bodies in the urinary tract is a known cause of calculus formation, foreign body-induced lithiasis of the upper urinary tract is quite unusual. We present a case of renal lithiasis associated with a human body hair in a patient with neurogenic bladder. Additionally, we discuss the management course selected for this rare clinical situation and postulate mechanisms for upper tract foreign body presence in our patient.

Mehrazin, Reza; Derweesh, Ithaar; Giem, Andrew; Balazs, Lousia; Diblasio, Christopher

2009 Current Urology

doi: 10.1159/000253375

We report a case of a 37-year-old HIV positive African-American man initially presenting with a 2-month history of 0.5 cm right scrotal mass, consequently diagnosed as testicular fibroma. The diagnosis was made with intraoperative frozen section of the mass, and managed with organ sparing surgi-cal excision.

Zaman, Faruquz; Patel, Sheena; Ismail, Mohamed; Grey, Alastair; Buchholz, Noor; Pati, Jhumur; Masood, Junaid

2009 Current Urology

doi: 10.1159/000253376

We present a case of a 63-year-old gentleman with intermittent macroscopic hematuria, in whom the only abnormality was an isolated large tortuous varicosity on the posterior wall of the bladder. Vesical varices are very rare and are only reported to be associated with pregnancy, portal hypertension, retroperitoneal fibrosis, schistosomiasis and iliac vein thrombosis. This patient did not have any of these underlying pathologies. We present an up to date review of the current literature and discuss treatment options on this rare but important cause of hematuria.

Vricella, Gino J.; Boncher, Nicholas A.; Jankowski, Jason T.; Ponsky, Lee E.; Cherullo, Edward E.

2009 Current Urology

doi: 10.1159/000253377

Introduction: Laparoscopic radical nephrectomy is an ac-cepted treatment option for localized renal cell carcinoma (RCC) in appropriately selected patients. There have been 6 previous reports of locoregional port-site tumor metastasis following laparoscopic radical nephrectomy. We present a case of RCC metastasis occurring in the lumbar musculature within a previous trocar site 11 months after retroperitoneo-scopic radical nephrectomy. Methods: A 78-year-old Caucasian male underwent an uncomplicated right retroperito-neoscopic radical nephrectomy for a 6.5-cm right renal mass (stage pT1bN0M0). Eleven months postoperatively, he was found to have metastatic disease with recurrence in the liver and within the lumbar musculature at a previous port site. A biopsy of this lesion was performed and confirmed meta-static RCC. We performed a comprehensive Medline search for all published studies of port-site recurrences following laparoscopic radical nephrectomy for organ-confined RCC. Results: Six cases of port-site recurrence following successful laparoscopic radical nephrectomy for locally confined disease have been reported. The reported proposed etiologic factors for port-site recurrence include biologic aggressiveness of the tumor, patient immunosuppression, local wound factors, procedure and technique related factors. We report the seventh case of recurrent disease within a port-site following successful laparoscopic radical nephrectomy for organ-confined disease. Conclusion: Port-site tumor recurrence after laparoscopic radical nephrectomy for RCC is a rare occurrence. One of the factors that contribute to its oc-currence may be surgeon-related, and therefore, potentially preventable.