Current Urology

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

2010 Current Urology

doi: 10.1159/000253413

Introduction: We investigated the hypothesis that histopathological changes occur in corpora cavernosa (CC) of patients with combined venous leakage and testosterone deficiency, and that these changes could be corrected by testosterone administration. Material and Methods: Study included 21 patients with low plasma testosterone and erectile dysfunction. Investigations revealed corporal veno-occlusive dysfunction. Patients were administered 200 mg testosterone undecanoate injection every 2 weeks for 6 months. CC biopsy was examined and serum testosterone was recorded. Results: Fourteen of the 21 patients showed increased serum testosterone and improved erectile function after 15.6 ± 2.2 weeks of androgen treatment. Pretreatment CC biopsy showed degenerated muscle fibers and collagen; post-treatment picture was normalized in 6 of 8 patients. Seven patients showed no improvement. Conclusion: Histopathological changes are detected in patients with venous leakage and low serum testosterone. Correction of testosterone deficiency can improve histopathologic changes and erectile dysfunction in most of the patients.

Hadj-Moussa, Miriam; Zhang, Lifang; Brown, James A.

2010 Current Urology

doi: 10.1159/000253414

Objective: To assess whether high shock number is associated with higher rates of short-term complication development following extracorporeal shock wave lithotripsy (ESWL). Patients and Methods: A retrospective chart review was conducted of 224 patients from 1998 to 2008 at a state medical center. Shock number and postoperative complication development were collected for each procedure. All procedures were conducted at 24 kV. Treatments were split into three cohorts based on shock number (≤2,400, 2,401–3,999, and ≥4,000). Postoperative complication development was compared among cohorts. A short-term complication was defined as: pain requiring narcotics, gross hematuria >24 hours, urinary retention, nausea and vomiting, fever, and/ or dysuria within one month of ESWL in a patient without a significant residual stone (≥4 mm). Results: Two hundred and twenty-four patients underwent 294 ESWL procedures. Shock number was unavailable for four treatments. ESWL treatments recorded for the low, medium, and high shock number cohort were 97 (33.4%), 75 (25.9%), and 118 (40.7%), respectively. Overall complication rate was 11.6% (n = 22). Complication rate for each shock number cohort (patients lacking significant residual stone) was 3.2% (n = 6), 4.2% (n = 8), and 4.2% (n = 8), respectively. A chi-squared test showed no statistical difference between shock number cohort and complication development. Complications attributed to a significant residual stone occurred following 45.5% (n = 46) of treatments. Conclusion: At a high voltage, high shock number was not shown to cause higher rates of acute postoperative complications when ESWL was successful. Complication rates associated with a significant residual stone burden were approximately four times as common. Foregoing higher shock number in the presence of a residual stone may therefore increase the risks of sequelae immediately following ESWL.

Ciftci, Halil; Savas, Murat; Yeni, Ercan; Verit, Ayan; Topal, Ufuk

2010 Current Urology

doi: 10.1159/000253415

Objective: Chronic scrotal pain (CSP) is one of the difficult medical evaluations. Approximately 25% of patients with chronic orchialgia have no obvious cause for the pain. The aim of this study was to identify the frequency of CSP in daily urological practice and associated diseases for our patients. Patients and Methods: In this study, 2,375 men over 18 years of age who applied to the urology outpatient clinics in our city from March 2007 to June 2007 were evaluated for chronic unilateral, bilateral or mixed orchialgia. Also evaluated was the pain score on a scale of 0 (no pain) to 10 (pain as bad as imaginable), duration of pain and pain location. Results: CSP was identified in 4.75% of the patients (113/2,375), with a mean age of 32.5 ± 10 years, and a range of 18–55 years. Associated diseases were: untidy sexual intercourse (19.5%), normal (18.6%), infertility (9.7%), varicocele (8.8%), medium and lower ureteral stones (7.1%), chronic prostatitis (5.3%), lumber pain (4.4%), stress (4.4%), epididymal cysts (4.4%), irritable bowel (4.4%), infection (3.5%), previous operation (2.7%), driving (2.7%), hernia (2.7%), and hydrocele (1.8%). Conclusion: CSP has an important place in daily urology practice with a frequency of 4.75%. It is very important to identify the reasons lying behind it and to plan effective treatment in the name of preventive medicine.

Safarinejad, Mohammad R.

2010 Current Urology

doi: 10.1159/000253416

Objectives: Exposure to mustard gas, a vesicant chemical warfare agent, has widespread early and long-term effects on the affected subjects. However, long-term effects of mustard gas on sperm chromatin structure have not been fully identified. The purpose of the present study was to examine sperm DNA integrity as a long-term complication in mustard gas casualties. Patients and Methods: A total of 268 subjects including 66 mustard gas-injured infertile men (aged 37–55 years) (group 1), 68 mustard gas-injured fertile men (aged 39–57 years) (group 2), 68 non-mustard gas-injured infertile controls (group 3) with idiopathic oligoasthenoteratozoospermia (aged 35–55 years), and 66 non-mustard gas-injured normozoospermic healthy fertile control men (aged 35–55 years) (group 4) were recruited in the study. Sperm DNA integrity was assessed using sperm chromatin structure assay. Ultrasonography of scrotal contents, serum luteinizinghormone, follicle stimulating hormone, thyroid stimulating hormone, prolactin, testosterone measurements and semen analysis were performed. Results: There was a significant increase in the frequency of sperm DNA damage in mustard gas-injured men compared with matched controls. For DNA fragmentation index (DFI), the mean value for mustard gasinjured infertile men was 41.6 ± 4.4% compared with 35.8 ± 4.5% among the non-mustard gas-injured infertile men (p = 0.01). Severely injured mustard gas casualties have a significantly increased DFI (44.8 ± 4.2%) compared with moderate (40.4 ± 4.3%) and mild (36.7 ± 4.5%) exposure to mustard gas (p = 0.01). Conclusion: There are strong correlations between the levels of mustard gas exposure and sperm DNA damage as measured by DFI.

Anderson, Stephen M.; Brown, James A.

2010 Current Urology

doi: 10.1159/000253417

Objective: To assess the learning curve and outcomes of a low volume practice of laparoscopic renal tumor cryoablation. Patients and Methods: Five patients with 1.5–3.5 cm renal tumor(s) underwent laparoscopic renal tumor cryoablation by a single surgeon between August 2005 and May 2007 (3 cases/year average). Two and 3 cases were performed using the Endocare system and the Galil (formerly Oncura) cryoablation system, respectively. Intraoperative ultrasound tumor localization was performed. Two retroperitoneoscopic, 2 standard and 1 hand-assisted laparoscopic, in a tuberous sclerosis patient with multiple tumors, procedures were performed. Age, operative time, estimated blood loss, complications, transfusions, biopsy pathology findings, hospitalization, computerized tomography findings, and serum creatinine levels were recorded. Results: Mean patient age was 49 years (range 13–65 years). Mean tumor size was 2.6 cm (1.5–3.5 cm). All cryoablations were completed successfully. One patient was converted due to severe perinephric fibrosis after prior renal surgery. Excluding the hand-assisted laparoscopic procedure, mean operative time was 193.5 minutes (range 141–237 minutes). Complications included a small renal capsular tear (in the patient with severe perinephric fibrosis), a small peri-ureteral vein laceration and left arm phlebitis. Renal biopsy pathology included clear cell carcinoma, papillary carcinoma (2 patients), angiomyolipoma and tubular epithelial atypia suspicious for neoplasia. Mean hospital stay was 2 days (range 1–3 days). Serum creatinine returned to baseline in all patients. No patient has demonstrated local recurrence or metastases to date. Conclusions: Laparoscopic renal tumor cryoablation can be safely and effectively performed at a low frequency (<3 cases/year) with good results and no significant surgeon learning curve.

Tayib, Abdulmalik M.S.; Alsayyad, Ahmed J.

2010 Current Urology

doi: 10.1159/000253418

Objective: To confirm the feasibility and safety of laparoscopic pyelolithotomy in partial staghorn stones. Patients and Methods: Seventeen patients who underwent laparoscopic pyelolithotomy for partial staghorn stone were included in the prospective study at King Abdulaziz University Hospital in the period between May 2007 and Feb 2009. Preoperatively all patients had blood work, urine culture, ultrasonography and CT renal stone study. Inclusion criteria included stones with largest diameter of more than 25 mm (measured by CT), branching into one or more group of calices, and no contraindication for laparoscopic surgery. All patients underwent cystoscopy, double J stent insertion prior to the procedure, while prophylactic antibiotics were provided for all the patients with or without positive urine culture. Results: All patients were completed laparoscopically where none required conversion to open surgery or developed intraoperative complications. The largest diameter of the stones varied between 29 and 48 mm with mean diameter of 41 mm, and the number of stones removed was 1–4 with mean of 1.3. The mean operative time was 175 minutes (range 125–240 minutes) and the estimated blood loss was 20–150 ml with mean of 49 ml. All patients cleared from their stones except 2 patients had small residual stones of 5 and 7 mm which were managed later by extracorporeal shock wave lithotripsy. One patient developed ileus postoperatively. Conclusion: Laparoscopic removal of partial staghorn stones is safe and feasible and has an equal outcome to open surgery.

Lee, Michael C.; Irwin, Brian H.; Desai, Mihir M.

2010 Current Urology

doi: 10.1159/000253419

Introduction: A refluxing ureteral stump after nephrectomy resulting in an urinoma is an uncommon occurrence. We describe a novel technique to obstruct the refluxing ureteral stump after Foley catheter drainage failed. Material and Methods: A 52-year-old man who developed a persistent ureteral stricture after a Boari flap ureteroneocystostomy resulting in compromised function of the kidney, underwent a laparoscopic simple nephrectomy. Intraoperative instillation of methylene blue in the bladder did not show extravasation at the transected ureteral end. Postoperatively patient developed a urinoma that failed an adequate trial of Foley catheter drainage of the bladder. We cystoscopically combined subureteric injection of dextranomer/hyaluronic acid copolymer and electrocautery to induce ureteral stump occlusion. Results: Postoperative cystogram at 2 weeks showed resolution of extravasation from the ureteral stump. The patient remains symptom-free with complete resolution of the stump reflux at 2 months after discontinuation of the bladder drainage. Conclusions: In the uncommon event of a refluxing ureteral stump after nephrectomy, endoscopic combination of dextranomer/hyaluronic acid copolymer injection and electrocautery to the ureter is a minimally invasive option to successfully occlude the ureter and prevent extravasation.

Abdelwahab, Osama; Shedid, Ibrahim; Al-Adl, Ahmed M.

2010 Current Urology

doi: 10.1159/000253420

Objective: To study the safety and efficacy of both tensionfree vaginal tape (TVT) and secure tension-free vaginal tape (TVT secur) in treatment of female stress urinary incontinence. Patients and Methods: Sixty female patients diagnosed as stress urinary incontinence were evaluated in the urogynecology clinic of the Benha Faculty of Medicine. All patients completed the impact of Incontinence on Quality of Life Questionnaire. They were randomly divided into 2 equal groups: group I (n = 30) underwent TVT procedure and group II (n = 30) underwent TVT secur procedure. The 2 techniques were compared regarding operative time, intraoperative bleeding, duration of catheterization, intra- and post-operative complications and hospital stay. All patients were followed up for 9 months and subjected to evaluation by history, examination, and urodynamics pre- and post-operatively. Results: Operative time and intra-operative morbidity were significantly lower in the TVT secur group than in the TVT group. No significant difference could be detected regarding catheterization period and success rate. The cure rate was 90.1% in group I and 93.4% in group II and this difference was statistically insignificant. Patients with a Valsalva leak point pressure lower than 60 cm H2O had poor outcome in both groups. Conclusion: TVT secur could be considered as a safe, easy and effective alternative to TVT with less morbidity.

Wason, Shaun E.L.; Viazmenski, Alexei; Sargent, Steven K.; Poplack, Steven; Bihrle III, William

2010 Current Urology

doi: 10.1159/000253421

Sarcoidosis of the genitourinary system is an extremely rare phenomenon. We report the case of a 46-year-old male with neurosarcoidosis and bilateral hypoechoic masses on scrotal ultrasound. Organ-sparing ultrasound guided percutaneous biopsy was successful in establishing a diagnosis of testicular sarcoidosis, minimally invasive without morbidity.

Sugimoto, Koichi; Koike, Hiroyuki; Hashimoto, Kiyoshi; Esa, Atsunobu

2010 Current Urology

doi: 10.1159/000253422

This report concerns a case of testicular metastases from prostate cancer with cystic formation in a 69-year-old man, which presented with prostate specific antigen elevation (1,287 ng/ml). Trans-peritoneal needle biopsy demonstrated poorly differentiated adenocarcinoma of the prostate. With a clinical diagnosis of prostate cancer (T4N1M1) with cystic formation, bilateral subcapsular orchiectomy was performed. Histopathological examination concluded testicular metastases from carcinoma of the prostate.

Jaidane, Mehdi; Hidoussi, Adnen; Gharbi, Mohamed; Slama, Adel; Hmida, Wissem; Sorba, Nabil Ben; Mosbah, Faouzi

2010 Current Urology

doi: 10.1159/000253423

Surgical repair is the recommended treatment for intraperitoneal bladder rupture while conservative management is the standard of care in most cases of extraperitoneal bladder rupture. The goal of this case series is to question the possibility of conservative treatment in isolated intraperitoneal rupture of native bladders. Four patients were admitted at our institution with isolated intraperitoneal baldder rupture following abdominal trauma, transurethral resection of bladder tumor or laparoscopic gynecological surgery. Patients were managed by bladder drainage using urethral catheter and broad-spectrum antibiotics. All patients had a good evolution with complete bladder healing after 12–15 days of bladder drainage without needing for a laparotomy. We suggest that conservative treatment could be successful in appropriately selected cases of intraperitoneal bladder rupture.

Hakim, Jonathan I.; Basu, Amit; Luchey, Adam; Zaslau, Stanley

2010 Current Urology

doi: 10.1159/000253424

Clinically significant iatrogenic ureteral injuries, excluding ureteroscopy, are likely underreported but considered a rare occurrence in pelvic surgery. An intraoperative consult for double ureter injury has never been documented in the medical literature. Presented herein is a case of a 53-year-old female undergoing conversion from a laparoscopic to open sigmoid resection for diverticular disease. There was an injury to a pelvic left ureter, which was then identified intraoperatively as left double ureter. Reconstruction was performed with left double side-to-side stented ureteroureterostomy followed by ureteroneocystotomy.

Martin, George L.; Nunez, Rafael N.; Martin, Aaron D.; Naidu, Sailen G.; Castle, Erik P.

2010 Current Urology

doi: 10.1159/000253425

Bleeding from ileal conduit peristomal varices is an uncommon complication of hepatic cirrhosis. Treatment with local measures such as compression and suture ligation is associated with high recurrence rates and does not address the underlying pathology. Herein we describe two similar cases of bleeding peristomal varices managed differently due to unique patient characteristics. One was treated with transjugular intrahepatic portosystemic shunt and the other with direct percutaneous access of the varix with coil embolization.