Current Urology

Adamis, Stefanos; Skolarikos, Andreas; Kontoangelos, Konstantinos; Alivizatos, Gerasimos; Deliveliotis, Charalambos

2010 Current Urology

doi: 10.1159/000253427

Introduction: Normal function of the genitourinary system relies on the coordination of endocrine, vascular, neurological, as well as psychological factors. Diseases such as enuresis, incontinence, chronic pelvic pain, and erectile dysfunction are described from a psychologic-psychiatric point of view, which will probably confront the urologist most frequently in practice. Materials and Methods: A PubMed search was used to identify evidence that a range of psychopathological features is associated with several urologic diseases. The search was concentrated on urological as well as on psychiatric journals, regarding the investigation and description of psychological interrelationships in the field of urology. Discussion: Today, it is acknowledged that some urological diseases might be psychosomatically induced or might show a psychiatric comorbidity, which has been recognized and characterized both as causative factor and as result of these diseases. Numerous studies accentuate the need for a psychiatric-psychosomatic approach of these diseases, which pathogenetic mechanisms are not fully understood yet. Conclusion: The appreciation of the adjuvant psychiatric-psychosomatic approach in diagnosis and intervention in current therapeutic strategies is growing, as it may result in an improved treatment outcome.

Donat, R.; Lalak, A.; Lin, B.P.C.; Mitterdorfer, A.J.; Handelsman, D.J.

2010 Current Urology

doi: 10.1159/000253431

Introduction: Seminal cytology has been reported to show abnormal prostatic epithelial cells in up to 75% of men with prostate cancer on biopsy. We examined the practical value of seminal cytology for non-invasive diagnosis of prostate cancer in 52 unselected men undergoing prostate biopsy. Patients and Methods: Semen samples from 52 men requiring prostate biopsy were examined for cytological abnormalities and seminal prostate specific antigen (PSA) concentration measured. The findings were correlated with the biopsy results (cancer, prostatic intraepithelial neoplasia, inflammation, and normal), serum PSA, total and transitional zone prostate volume and semen volume. Prostate cancer diagnosis by transrectal ultrasound core biopsies was used as reference standard. Results: Tests on 50 patients were fully evaluable. Seminal cytology was abnormal in 13 patients (28%) showing mostly atypical prostatic cells rather than definite cancer cells. Abnormal seminal cytology had a 40% sensitivity and an 88% specificity for prostate cancer. Its sensitivity for either cancer or high-grade prostatic intraepithelial neoplasia was 34% with a specificity of 93%. Men with biopsy proven prostate cancer had a higher serum PSA (p < 0.01) and a lower seminal PSA (p < 0.05) compared to men without biopsy proven cancer. Conclusion: Seminal cytology is a simple and non-invasive test which warrants further study to determine its role as possible adjunct in diagnosing prostate cancer.

Sakai, Iori; Miyake, Hideaki; Terakawa, Tomoaki; Muramaki, Mototsugu; Takenaka, Atsushi; Fujisawa, Masato

2010 Current Urology

doi: 10.1159/000253434

Background: This study presents a review of our experience with surgical therapy for Japanese men with squamous cell carcinoma (SCC) of the penis. Patients and Methods: This study assessed the clinical outcomes in 64 Japanese patients undergoing surgical therapy for primary SCC of the penis. Results: Of these 64, 3 underwent local excision, 43 partial penectomy, 15 total penectomy and 3 emasculation. During the mean observation period of 37 months, 14 patients developed disease recurrence, and 12 died of the progression of penile SCC. The 5-year recurrence-free and cancerspecific survival rates of these 64 patients were 76.0 and 81.4%, respectively. Univariate analysis identified clinical as well as pathological inguinal lymph node (LN) metastases as significant predictors for cancer-specific survival, of which only pathological LN metastasis was independently associated with cancer-specific survival on multivariate analysis. Furthermore, pathological LN metastasis appeared to be independently predicted by clinical LN metastasis and microvascular invasion on multivariate analysis. Conclusions: Pathological LN metastasis would have a powerful predictive value for the prognosis of patients with SCC of the penis following surgical treatment; therefore, intensive therapeutic strategy, including lymphadenectomy, should be warranted for those at high risk of pathological LN metastasis.

Singh, Vishwajeet; Sinha, Rahul J.; Mehrotra, Seema; Sankhwar, Pushpa L.; Vatsal, Priti; Sankhwar, S.N.

2010 Current Urology

doi: 10.1159/000253437

Aim: To document our experience regarding the management of ureteric injury following gynecologic surgery. Material and Methods: Between January 2004 and December 2008, 24 patients with ureteric injury were referred to our institute. A retrospective review of the hospital charts, clinical notes and the operation theatre register was carried out. Unilateral ureteric injury was observed in 18 patients and bilateral ureteric injury (BUI) in 6 patients. The clinical presentation was urinary incontinence with normal voiding (ureterovaginal fistula) in 12 patients, recurrent flank pain (due to lower ureteric stricture) in 6 patients and anuria (due to BUI) in 6 patients. Patients were managed by urinary diversion or double J stent insertion followed by delayed ureteric repair or by immediate abdominal exploration and ureteric repair. Results: One patient suffering from BUI died of septicemia, uremia and electrolyte imbalance. All the other patients were doing well as per their last follow-up. Conclusion: Timely detection and proper referral of ureteric injury followed by judicious and expeditious management can reduce morbidity and help save lives.

Grocela, Joseph A.; Jura, Ying H.

2010 Current Urology

doi: 10.1159/000253440

Introduction: We performed a prospective, randomized, double-blinded controlled trial to investigate whether use of DOVERTM Urine Collection Systems with top vent (Tyco Healthcare Group L.P. d/b/a Couidien, Marshfield, MA, USA) top-vented urinary catheters cause fewer epithelial and vascular changes in the bladder mucosa than conventional non-vented catheters. Materials and Methods: Women undergoing a mid-urethral sling were randomized to either placement of a non-vented or top-vented catheter. Primary outcome was change in appearance of the bladder mucosa as graded on a 4-point scale (0–3) after a single drainage event. Secondary outcome was change in red and white blood cell counts per high power field between urinalyses collected intraoperatively and after overnight bladder drainage. A paired T-test with Wilcoxon rank sum was used to compare the grade of mucosal change and the change in cell count. Results: Forty-one women were randomized. The mean change in appearance of the bladder mucosa was significantly greater in the conventional drainage catheter group (2.0 ± 0.23 vs. 0.4 ± 0.11, p < 0.0001). There was no significant difference in the mean cell count intervals on urinalyses between the two groups (1.2 ± 0.34 vs. 0.8 ± 0.34, p = 0.08). Conclusions: By avoiding suction on the bladder mucosa, top-vented urinary catheters cause fewer epithelial and vascular changes in the bladder mucosa compared to conventional catheters.

Steiner, Hannes; Berg, Bernadette; Stöhr, Brigitte; Fritzer, Andreas; Ramoner, Reinhold; Aigner, Friedrich; Bartsch, Georg; Zangerl, Florian

2010 Current Urology

doi: 10.1159/000253441

Introduction: We retrospectively analysed the predictive value of numerous clinical and radiological parameters to identify a predictor for either necrosis or residual tumors found by retroperitoneal lymph node dissection (RPLND) histology in a collection of nonseminomatous germ cell tumor (NSGCT) patients. Materials and Methods: A database was created containing detailed clinical, radiological and histological information of all consecutive NSGCT patients, who underwent post chemotherapy RPLND between 1984 and 2007. According to the histology of the RPLND specimen, patients were assigned to the “necrosis-only” group or the “residual tumor” group. Associations between clinical and radiological parameters and histology of RPLND were analyzed. Results: Histology of dissected masses showed complete necrosis in 57.4% of patients and residual tumors in 42.6% (3.1% viable cancer and 39.5% teratoma). Univariate analysis showed significant correlation of RPLND histology and the following parameters: teratoma-positive primary tumors, pre-chemotherapy α-fetoprotein (AFP) and – less pronounced – human chorionic gonadotropin levels, size of metastatic mass, total volume of metastatic retroperitoneal lymph nodes, and percentage of volume reduction. The best prediction for necrosis in RPLND histology was in patients with no evidence of teratomatous elements in primary tumors and with normal pre-chemotherapy AFP levels and small lymph nodes. Stepwise multivariate logistic regression analysis confirmed AFP < 10 ng/ml as the best independent predictor for only necrosis in RPLND histology. Conclusions: At the present time we still consider all patients with metastatic NSGCT as candidates for a post-chemotherapy RPLND, arguing that in experienced hands mortality is negligible and morbidity is low and therefore not relevant compared to the risk of missing a residual tumor.

Villanueva, Carlos; Hemstreet, III, George P.

2010 Current Urology

doi: 10.1159/000253442

Background/Aims: To determine the effectiveness and limitations of a difficult urethral catheterization (DUC) algorithm. Methods: A DUC algorithm was created based on a literature review on DUC. This algorithm was then applied to 41 consecutive patients, in which urology was consulted for DUC at a university hospital. A retrospective chart review was conducted to analyze the performance of the algorithm. Results: The algorithm was followed without breaks and resulted in a successful urethral catheterization in all the patients. No major adverse events were noted, and no catheter had to be changed for malfunction. Conclusion: The majority of DUC’s at our institution were accomplished readily following this algorithm. This algorithm has the potential of being safer, minimizing urethral dilatation and optimizing resources compared to using no algorithm, assumptions which will have to be proven on future comparative trials. The algorithm may prove useful for teaching young urologists an approach to the DUC.

Siddiqi, K.; Shah, S.; Boyd, B.; Miller, J.; Brown, J.

2010 Current Urology

doi: 10.1159/000253443

Background/Aims: Partial nephrectomy (PN) is more challenging in solitary kidneys and when tumors are interpolar, hilar, endophytic, deeply penetrating, large or irregular. We propose an alternative ‘two-step’ technique for assuring negative margins and consistent parenchymal preservation in these situations. Methods: We retrospectively reviewed 6 open and 3 hand-assisted laparoscopic PNs performed between November 2001 and August 2005. Tumor enucleation was followed by resection of an approximate 1 cm thick rim (wafer) of tissue from the tumor bed. Clinical variables and intraoperative data were reviewed. Results: Mean patient age was 57.4 years (49–69 years). Mean enucleated tumor diameter was 3.7 cm (1–9 cm). Three of nine (33%) enucleated tumors had positive margins. The wafer surface adjacent to the enucleated specimen was positive in all three, and the average depth of tumor invasion into the wafer was 5.4 mm (3.2–8 mm). The wafer surface adjacent to normal parenchyma was never positive. The average wafer depth removed was 1.19 cm. Average vessel clamp and total operative times were 24.5 and 295 minutes, respectively. Mean estimated blood loss was 372 ml. Mean preoperative and postoperative creatinine was 1.05 and 1.53 mg/dl, respectively. No patient has developed a local or distant recurrence (mean follow-up 27.1 months). Conclusions: A ‘two-step’ PN appears to be an effective surgical margin and renal parenchymal preserving technique. It is important to remove a 1 cm thick wafer as 1/3 of cases demonstrated tumor infiltration to a depth of 3–8 mm. This technique minimizes the need to address a positive frozen section margin.

Lewis Jr., Bertram A.; Zebrowski, Brian; Yumiaco, Noel S.; Michaels, Paul; Erling, Marcus

2010 Current Urology

doi: 10.1159/000253444

Rarely, independent genitourinary primaries present in a patient. Furthermore, sarcomas of the kidneys, bladder or male genitalia are a small subset of cancers involving these organs. We report a case of a very large renal cell carcinoma found incidentally upon metastatic survey after resection of a primary paratesticular liposarcoma.

Forsyth, Robert; Venkateshan, Satish K.C.N.; Hickerton, Beth C.; Collins, Gerald N.

2010 Current Urology

doi: 10.1159/000253445

Background: Abdominal compartment syndrome is very poorly described in urological literature and is not described as a potential complication of renal trauma in the European guidelines. Objective: To characterise urological compartment syndrome, increase awareness of the condition among urologists and to describe state of the art investigation and management of the condition. Methods: Case-based review with Medline/PubMed search for all relevant publications on compartment syndrome. Evidence Synthesis: Our understanding of compartment syndrome has improved lately leading to earlier diagnosis and intervention. Patients at risk can be easily monitored while management can be conservative in selected cases. Conclusions: While previously the domain of intensivists and those managing multi-trauma patients, the relevance of compartment syndrome to urologists is likely to increase with the trend towards conservative management of renal trauma. All urologists should thus be aware of the condition and its management.