Current Urology

Vasdev, Nikhil; Dominguez-escrig, Jose L.; Paez, Edgar; Thorpe, Andrew C.; Greene, Damien

2011 Current Urology

doi: 10.1159/000327440

With a global increase in the routine performance of prostate specific antigen levels in men, there continues to be a steady increase in prostate biopsies. Despite the rapid developments in radiological imaging of the prostate, modifications in prostate specific antigen evaluations (free/total levels) and development of biomarkers for prostate cancer detection, transrectal ultrasound guided biopsies continue to be a methodology for diagnosis of prostate cancer worldwide. Despite current developments the so called biopsy ‘gold standard’ remains to be fully defined. We review current literature to evaluate the role of performing saturation prostatic biopsies in patients routinely and describe the role of new developments as an alternative to the technique.

Baseskioglu, Barbaros; Can, Cavit; Yenilmez, Aydin; Kaya, Coskun

2011 Current Urology

doi: 10.1159/000327441

Objective: Penile fractures are infrequent cases in urological emergencies and 21 patients (23 cases) that were treated at our clinic together with relevant literature were discussed in this study. Methods: The medical data of patients with penile fracture from 1999 to 2009 was collected and retrospectively analyzed. All patients were clinically diagnosed as penile fracture. Information was updated by phone interview and patients were asked if they had sufficient erection for vaginal penetration. Associated literature was obtained from PubMed using the key word ‘penile fracture’. Results: Twenty-one patients presented with penile fracture. Nineteen patients (82.6%) came from urban areas and 14 patients (60.8%) had penile fracture during sexual intercourse. Two patients had a second penile fracture. Twenty-two patients evaluated with clinical presentation and did not need any imaging tools. A retrograde urethrogram was performed only on one patient who was in urinary retention and this patient was diagnosed as fracture of the corpus spongiosum with complete urethral rupture. Seventeen patients (73.9%) were treated with urgent surgical repair. One patient suffered from intact bilateral corporeal bodies in surgery and only one patient had wound infection after surgery. Six patients (26.1%) were followed-up conservatively. The rate of erectile dysfunction after surgery and conservative treatment was 11 and 33.3%, respectively. Time to resume normal sexual function was a mean of 4.9 months (1 to 24 months). Conclusion: As an Asian-European country the etiologies in our study were more similar to Western types. Diagnosis was usually based on patient’s history and examination of the penis. Urethral examination should not be forgotten. Early surgery was successful, similar with the literature. Also we have to notice those patients for which vigorous sexual action causes a second fracture.

Comploj, Evi; Mian, Michael; Koen, Mark; Berger, Christoph; Becker, Tanja; Riccabona, Marcus

2011 Current Urology

doi: 10.1159/000327442

Aim: To compare the outcomes of patients with abdominal testes undergoing single-stage Fowler-Stephens (FSI) vs. two-stage (FSII) procedures. Patients and Methods: Between 01/1993 and 06/2009, a total of 41 children (median age 24.5 months) with 50 abdominal testes were treated. Orchidopexy was performed according to the surgeon’s choice, resulting in 33 FSI and 17 FSII open procedures. In this retrospective study the charts of all children followed in our outpatient department at one, three and 12 months postoperatively and afterwards annually by the use of volumetry and color Doppler-sonography were reveiwed. Data regarding testicular position, size (consistency), and atrophy were recorded. Results: In FSI, the overall success rate was 79%: 64% (21/33) were of normal size with a normal scrotal position; 15% (5/33) were not at the deepest scrotal point, and 21% (7/33) developed testicular atrophy. In FSII, the overall success rate was 82%: 76% (13/17) were found to be of normal size and 6% (1/17) were not at the deepest point of the scrotum, and 18% (3/17) developed testicular atrophy. Conclusions: In this consecutive series there were no significant differences observed between the two procedures with regard to size, blood supply, position, or atrophy rate of the testes.

Banakhar, Mai A.; Al-Sayyad, Ahmed J.; Altayib, Abdul malik M.; Mosli, Hisham A.

2011 Current Urology

doi: 10.1159/000327443

Objective: To study the effect of body mass index (BMI) on percutaneous nephrolithotomy (PCNL) stone-free rate and operative complication rate. Materials and Methods: Retrospective cohort study included patients who underwent PCNL from January 2005 till December 2007. All were stratified according to world health organization BMI classification (normal, overweight, obese, morbidly obese) into the effect of BMI on PCNL stone-free rate and operative complications including bleeding, transfusion, septicemia, intensive care unit admission and urinary leak. Results: Totally 70 patients were included in our study with mean age of 42 years, male to female ratio 5:1, and 68.2% of them had no comorbid factors while 11.6% with diabetic, 9.3% with hypertensive, and 4.7% having both and 15.5% having the history of previous pyelolithotomy. Most of the patients (94.3%) had performed intravenous pyelogram preoperatively, in which 7% showed anomalous kidney (horseshoe, malrotated), 44% staghorn and 42% pelvic stones > 2 cm in size. The indications for PCNL in our study group were staghorn stone in 41.4%, failed extracorporeal shock wave lithotripsy in 14.3%, large stones > 2 cm in 44.3%. The operative success rate was 87.1%. When we stratified our patients according to the world health organization BMI, 28.6% were normal BMI, 37.1% overweight and 34.3% obese. Multiple regression analysis revealed that increasing BMI do influence the operative risk of bleeding, transfusion, leak, intensive care unit admission, sepsis with significant p = 0.026 (CI 8.7–0.59) and inversely influence the stone-free rate with p = 0.017 (CI 0.012–0.64). Conclusion: Obese patients have higher operative complication risk and low stone-free rate on PCNL.

Protogerou, Vassilis; Tekerlekis, Panagiotis; Argyropoulos, Vassilis; Patrozos, Kostas; Kostakopoulos, Athanassios

2011 Current Urology

doi: 10.1159/000327444

Background: Vescica ileala padovana (VIP) is a technique of bladder substitution following radical cystectomy with the advantage of resulting in a shape that anatomically resembles the real bladder. We studied whether the VIP neobladder is a viable alternative following cystectomy. Patients and Methods: Forty-five patients with muscle invasive bladder cancer were treated with radical cystectomy and VIP neobladder formation. Both perioperative and postoperative complications together with short- and long-term results were discussed. Results: In the early postoperative period there was one patient (2.2%) who developed ileus and one death (2.2%) due to a massive pulmonary embolism. During follow-up, 2 patients (4.4%) presented with hernias and 1 died from metastatic disease (2.2%), 3 patients (6.6%) developed ureteroileal strictures and 1 developed (2.2%) urethroileal stenosis. During follow-up, maximum capacity increased (540 ± 89 vs. 590 ± 54 ml, p = 0.014) while Qmax and end-filling pressure decreased (18 ± 2 vs. 14 ± 4 ml/s, p = 0.002 and 22 ± 3 vs. 15 ± 6 cm H2O, p = 0.012). The number of intrinsic contractions remained stable (4 ± 1 vs. 5 ± 1, p = 0.066). Daytime continence between the 3rd and the 36th month was stable (40 vs. 39 pts, 88.8 vs. 86.6%, p = 0.09). Twenty-six patients were continent during the night and this number increased to 30 patients (57.8 vs. 66.7%, p = 0.013). Conclusions: VIP has a favorable outcome and can be used for bladder orthotopic substitution following cystectomy.

Saa-Gandi, Francis; Gotov, Erdenetsetseg; Legall, George

2011 Current Urology

doi: 10.1159/000327445

Purpose: To determine the prevalence of Peyronie’s disease (PD) in a specific group of men attending two screening clinics for prostate cancer over a six-month period. Methods: From November 2007 to June 2008, all men attending two screening clinics for prostate cancer were prospectively surveyed. All the men had volunteered to have their prostate checked. Using a structured questionnaire we identified 1,030 cases. The men, who were all volunteers, were from three age group categories: 18–45, 46–60 and over 60 years, and three ethnic groups: Afro-Trinidadian, Indo-Trinidadian and mixed. No written consent was sought from the men to conduct the procedures since they had all come to the clinic, for the purpose of having their prostate checked. However, consent was obtained for individual interviews using a structured questionnaire to determine eligibility for the study. The questionnaire was adapted from universally accepted clinical presentations of PD but was not validated and hence the reliability is not reported. Data were analyzed using the SPSS version 12.0 for Windows. Results: During the six-month period a total of 1,030 men were screened and surveyed. Ages were distributed as follows: Group I included age 18–45 years (n = 220; 21.4%); Group II included age 46–60 years (n= 443; 43.0%), and Group III was composed of over 60 years: (n = 367; 36.5%). The mean age was 58 years with a range between 46 and 75 years. A total of 701 (68%) men were Africans, 182 (17.7%) were East Indians and 147 (14.3%) were of mixed ethnicity. Of the 12 (1.2%) men who satisfied the criteria for PD, 7 (58.3%) were in Group II and 5 (41.7%) in Group III. Ten (83.3%) men with PD were of African origin and 2 (16.7%) were of mixed ethnicity. There were 5 of 12 (41.6%) men with PD who took medication/s for hypertension, 3 of 12 (25.0%) were on treatment for late onset diabetes mellitus and 4 of 12 (33.3%) men received treatments for both conditions. Conclusions: The study found that the prevalence (1.2%) of PD falls within previously observed studies. It also agreed with previous studies which showed that prevalence is highest among 40–60 year olds.

Roshdy, Mamdouh; Hammam, Olfat; Wishahi, Mohamed; Nour, Hani

2011 Current Urology

doi: 10.1159/000327446

Objective: To study the expression of transforming growth factor beta 1 (TGFB1) protein and TGFB R1 (receptor) in bladder tissue sections of patients with bladder cancer (urothelial carcinoma and squamous cell carcinoma) associated with schistosomiasis or not and to correlate both markers with tumor grade, pathological stage and schistosome infestation. Patients and Methods: Sixteen patients with chronic cystitis and 60 with malignant bladder lesions (33 bladder cancer cases associated with schistosomiasis and 27 not associated) were included in the study. Five healthy individuals served as controls. TGFB1 protein and TGFB R1 expression in bladder tissue were measured using immunohistochemical techniques. Results: TGFB1 showed significant over-expression in the malignant group compared to the chronic cystitis group (p < 0.01). TGFB1 was significantly increased in the schistosomal associated bladder cancer (SABC) (including urothelial carcinoma associated with schistosomiasis and squamous cell carcinoma cases) group compared to the non-schistosomal associated bladder cancer group (NSABC) (including urothelial carcinoma not associated with schistosomiasis) (p < 0.05). Expression of TGFB1 was increased with an increase of tumor grade and stage. TGFB R1 showed decreased expression in urothelial carcinoma compared to the squamous cell carcinoma cases (p < 0.05). TGFB R1 showed decreased expression in the SABC group compared to the NSABC group (p < 0.05). TGFB R1 showed decreased expression in relation to the histopathological grade and stage. Conclusion: There is increased expression of TGFB1 protein in SABC compared to NSABC, while there is loss of expression of TGFB R1 in SABC compared to NSABC. TGFB1 and TGFB R1 expression could be used as biological markers for prediction of the clinical outcome of bladder carcinoma. This may help in selecting patients for more intensive surgical or chemotherapeutic approaches.

Sugimoto, Koichi; Koike, Hiroyuki; Hashimoto, Kiyoshi; Esa, Atsunobu; Saitou, Yoshitaka; Hatanaka, Yuji; Imanishi, Masaaki; Shimizu, Nobutaka; Tahara, Hideo; de Velasco, Marco; Uemura, Hirotsugu

2011 Current Urology

doi: 10.1159/000327447

Background: Bacillus Calmette-Guerin (BCG) instillation has been considered to be the most effective method of treatment for non-muscle invasive bladder cancer. The objective of the study was to evaluate the efficacy of between 6 and 8 intravesical BCG instillations after transurethral resection of bladder tumor (TUR-Bt) for Grade 3 nonmuscle invasive bladder cancer. Methods: Between January 2000 and December 2007, a total of 68 cases (58 males and 10 females) with nonmuscle invasive bladder cancer (pTa-1 G3, without carcinoma in situ) were used in the study. After TUR-Bt, patients were divided into a non-infusion group (group A) and BCG (Tokyo 172 strain BCG, 80 mg in 40 ml saline or Connaught BCG, 81 mg in 40 ml saline) infusion groups administered weekly for 6 (group B) and 8 weeks (group C). Recurrence rates were used as endpoints for this study. Also, a single variable and multivariable analysis in a T classification (Ta or T1), tumor multiplicity, tumor size (diameter) and presence or absence of concomitant carcinoma in situ was conducted. Results: In group A, one-year recurrence free survival was 59.1%, and three-year recurrence free survival was 45.2%. In group B, one-year recurrence free survival was 63.6%, and three-year recurrence free survival was 53%. In group C, one-year recurrence free survival was 81%, and three-year recurrence free survival was 72%. Conclusion: This study showed that there may be an increased advantage from adjuvant treatment therapy consisting of 8 weekly intravesical administrations of BCG following TUR-Bt for patients suffering from grade 3 non-muscle invasive bladder cancer.

George, Caroline M.; Ismail, Mohammed; Khadra, Abbas

2011 Current Urology

doi: 10.1159/000327448

A 78-year-old man suffered from recurrent episodes of acute urinary retention and failed subsequent trials without catheter. As a result a suprapubic catheter was inserted. Eighteen months later he was referred with overgrowth of granulation tissue around the catheter site. Further investigation uncovered a squamous cell carcinoma of the bladder with extension to the anterior abdominal wall. This is the first case the authors could find of a bladder squamous cell carcinoma associated with suprapubic catheterisation in-situ for such a short length of time.

Casperson, Kelly J.; Myers, Jeremy B.; Donohue, Robert E.

2011 Current Urology

doi: 10.1159/000327449

Angiomyolipoma (AML) is a benign renal lesion with the ‘pathognomic’finding of fat density contained within the tumor, usually identified on CT exam. In rare cases, especially when there is minimal fat density or the presence of calcifications within the mass, tumors may be misdiagnosed as AML and most often represent renal cell carcinoma. We present a case of a 59-year-old man diagnosed with AML who underwent subsequent partial nephrectomy and was found to have a large papillary renal cell carcinoma.

Baynes, Shona; Wang, Bo; Ismail, Mohamed; Khadra, Abbas; Davies, John

2011 Current Urology

doi: 10.1159/000327450

We present a case report of cryoshock phenomenon in a 67year-old man following renal cryotherapy. We review literature and discuss incidence, pathophysiology and management.

Cleary, MaryEllen; Klausner, Adam P.; Jayawardena, Vidya; Gater, David R.

2011 Current Urology

doi: 10.1159/000327451

Introduction: Persistent urethral incontinence occurs in approximately 30% of patients after ileovesicostomy. We report a case of a patient with neurogenic bladder dysfunction due to spinal cord injury managed with ileovesicostomy and an artificial urinary sphincter (AUS) to treat persistent incontinence. Methods: A case report with 2-year follow-up is presented after review of the computerized medical record. Results: Persistent urethral incontinence was eliminated after AUS treatment. However, due to de novo autonomic dysreflexia, nighttime deactivation of the device was required. Conclusions: To our knowledge this is the first case reported of an individual with neurogenic bladder dysfunction managed with an ileovesicostomy to limit elevated detrusor pressures and an AUS to control persistent urethral incontinence. The combination of these procedures appears to be a safe, effective, and less invasive option than an ileovesicostomy followed by bladder neck closure or conversion to ileal conduit. However, the possibility of de novo autonomic dysreflexia must be considered.