Penile Cancer: Contemporary Considerations in Management of Local DiseaseO’Neil, Brock; Brant, William O.; Slack, Sean D.; Tward, Jonathan D.; Myers, Jeremy B.
2011 Current Urology
doi: 10.1159/000327453
Introduction: Traditional treatment for penile cancer involved wide excision resulting in both poor cosmesis, as well as poor sexual and urinary function. Contemporary approaches emphasize tissue preservation and reconstruction while maintaining comparable oncological outcomes. In this review, we summarize modern trends in the management of penile cancer, emphasizing contemporary minimally invasive techniques, reconstructive methodologies, and their effect on quality of life (QoL) and sexual function. Methods: PubMed search for publications on the management options and functional outcomes of penile cancer. Results: Contemporary treatment modalities for local penile cancer include microscopically guided surgery, laser therapy, radiotherapy, penile-sparing surgery, reconstruction after glansectomy, partial and total penectomy. Sexual ability can be preserved or restored in many patients treated for penile cancer, although overall QoL for most does not necessarily relate to erectile function. Conclusion: Increasing evidence suggests that sexual function can be restored and QoL maintained despite treatment for penile cancer.
Characterising Stent Symptoms Associated with a Segmental Thermo-Expandable Metallic Stent Using a Validated Stent Symptoms QuestionnairePatel, Dharmesh; Maan, Zafar; El-Husseiny, Tamer; Moraitis, Konstantinos; Junaid, Islam; Buchholz, Noor; Masood, Junaid
2011 Current Urology
doi: 10.1159/000327454
Background: We use the Memokath 051TM, a segmental nickel-titanium alloy ureteric stent in patients with strictures and aim to characterize symptoms following stent insertion and evaluate its tolerability using a validated questionnaire. Methods: We mailed the validated ureteral stent symptom questionnaire to all patients who had undergone insertion of a ureteric Memokath 051TM stent over a one-year period. Responses were analyzed to evaluate the frequency and severity of symptoms in all 6 domains tested by the questionnaire. Results: Eighteen out of 23 patients completed the ureteral stent symptom questionnaire. In patients with unilateral stents; dysuria, severe frequency, nocturia, severe urgency and urge incontinence were seen in 28.6, 43, 72, 43 and 43% respectively. Severe frequency, urgency and dysuria in patients with bilateral stents were reported by 66, 25, and 50% respectively. Frank hematuria was reported by 29% of patients with unilateral stents. Lethargy was experienced by 23 and 25% of patients with unilateral and bilateral stents respectively with 75% of patients enjoying their social life. Conclusion: Although the study population is small, our results indicate that Memokath 051TM stents are well tolerated by patients in terms of quality of life. This study provides important information about stent related symptoms in patients undergoing this procedure.
BTA Stat: A Useful or an Unnecessary Urinary Marker in the Diagnosis of Primary Bladder Cancer?Efthimiou, Ioannis; Ferentinos, Georgios; Kavouras, Diamantis; Katsanis, Spyridon
2011 Current Urology
doi: 10.1159/000327455
Objectives: Use of urinary bladder markers in daily practice is still under debate. Our study assessed the diagnostic yield of the BTA stat test in comparison to histology, in patients presenting with hematuria. Methods: One hundred and twenty-two consecutive patients who presented with painless macroscopic hematuria and were evaluated for primary bladder cancer from November 2006 to November 2008 were retrospectively studied. Patients with a history of bladder cancer, pelvic irradiation or malignancies were excluded from the study. Patients with obvious or suspicious lesions were treated with transurethral resection of the bladder tumor and bladder biopsy was done. The test’s specificity, sensitivity, negative predictive value, positive predictive value and sensitivity in relation to tumor macroscopic features and histology were calculated. Results: Mean age was 68.1 years. Bladder cancer was diagnosed in 34 (27.8%) patients. In 30 patients (24.5%) the cause was undefined and 58 (48.3%) had benign causes of hematuria. The test was positive in 16/34 cases with bladder cancer, 12/30 with no visible cause and 12/58 of the cases with benign causes. Sensitivity was 47% and specificity 72.7%. Positive predictive value and negative predictive value were 40 and 75.6% respectively. Sensitivity was increased for high grade, nodular and invasive lesions (66, 80 and 75%, respectively). Two patients with an initial negative diagnostic work-up were later proved to have bladder cancer. The most common cause of a false positive test was cystitis. Conclusions: BTA stat, has low sensitivity for the diagnosis of bladder cancer and is not useful for the diagnosis of bladder cancer in patients with hematuria. False positive results can be minimised if patients with known or obvious benign conditions are excluded de novo from the test.
Percutaneous Nephrolithotomy: Assessment of a Lower Volume PracticeBrown, James A.; Rhee, Audrey C.
2011 Current Urology
doi: 10.1159/000327456
Background: High volume percutaneous nephrolithotomy (PCNL) surgeons (>25 cases annually) historically report stone-free rates of 80–90%. We investigated whether a lower volume primary PCNL practice (<10 cases annually) yields comparable results. Methods: Charts of 42 PCNL procedures performed by one surgeon over 4.5 years (9 cases per year average) were reviewed; 37 complete records were analyzed. Body mass index (BMI), stone burden, estimated blood loss (EBL), operative time, intraoperative assessment of stone-free status, outcomes and complications were recorded. Results: Average patient BMI was 31 (range 18–57). Average operative time was 163 minutes (range 55–375 minutes) and EBL was 139 ml (range 5–400 ml). Twenty-eight patients (76%) were ‘stone free’ post-PCNL (residual fragments = 4 mm), 21 of whom (57%) had no residual fragments identified. Patients not rendered stone-free had greater average BMI (35 vs. 30), EBL (180 vs. 137 ml), operative time (208 vs. 149 minutes) and >2.5 cm stone burden rate (89 vs. 61%). Eleven percents with intraoperative concern for residual stone burden were rendered stone-free. Complications included urinary extravasation (n = 2), blood transfusion (n = 2), pneumothorax (n = 1) and urinary tract infection (n = 1). Conclusions: A lower volume PCNL practice may yield stone-free and complication rates approaching those of higher volume referral practices.
A Novel Technique of the Retroperitoneoscopic Radical Nephrectomy for a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis to Preserve the Peritoneal BoundaryNozaki, Tetsuo; Fuse, Hideki
2011 Current Urology
doi: 10.1159/000327458
Background: We herein presented the simple technique, which preserves the peritoneal boundary during the retroperitoneoscopic radical nephrectomy (RRN) for patient receiving continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods: A 61-year-old male who was receiving CAPD underwent RRN for a right renal mass. The RRN was performed using a balloon dissector in 2 different retroperitoneal spaces, in order to avoid the potential risk of peritoneal rupture. The wound used to retrieve the specimen was as posterior as possible to avoid being infected by the peritoneal dialysis catheter. Results: The RRN was successful and the patient did not develop either a peritoneal tear or require conversion to an open nephrectomy. The postoperative course was uneventful and the CAPD was reinitiated 8 days after surgery. No difficulties were associated with the transition to CAPD, and no complications occurred after the reinstatement of the regular CAPD regimen. Conclusion: This novel technique provides a safe dissection and ensures the preservation of the peritoneal boundary during RRN. The patient may continue CAPD with only a minimal interruption in treatment, while prevent the possible postoperative complication.
Huge Retroperitoneal Hemorrhage due to Adrenal Artery Injury without Visceral Organ InjuryShin, Yu Seob; Kim, Ji Yong; Park, Ho Gyun; Ko, Oh Seok; Kim, Dong Gon; Cha, Jai Seong; Kim, Myung Ki; Jeong, Young Beom; Kim, Hyung Jin
2011 Current Urology
doi: 10.1159/000327459
We report a case of huge retroperitoneal hemorrhage with active contrast extravasation due to right adrenal artery injury without visceral organ injury. A 67-year-old woman was involved in an out car traffic accident. She sustained multiple traumatic injuries and right adrenal artery injury without visceral organ injury. Abdominal computed tomography scan showed huge retroperitoneal hemorrhage with active contrast extravasation. But, there is no evidence of renal injury. Renal angiography confirmed contrast media extravasation from right adrenal artery. Selective embolization of adrenal artery was attempted but, adrenal arterial lumen was spontaneously obstructed due to arterial spasm. To our knowledge, isolated adrenal artery injury occurring huge retroperitoneal hemorrhage have not been described previously. Awareness of this possible cause of retroperitoneal hemorrhage may assist in immediate diagnosis and appropriate treatment.
Isolated Tuberculous Epididymitis: A Rare Complication after Intravesical Bacillus Calmette-Guerin TherapyNelson, Hilary L.; Wallis, Christopher J.D.; Pommerville, Peter J.
2011 Current Urology
doi: 10.1159/000327461
Intravesical instillation of Bacillus Calmette-Guerin (BCG) is the most commonly used immunotherapeutic adjuvant therapy for superficial bladder carcinoma. BCG is a live attenuated vaccine of Mycobacterium bovus which has been shown to decrease tumor recurrence rate, delay tumor progression, and improve overall survival. Intravesical BCG is well tolerated, with a complication rate under 5%. A literature review revealed tuberculous epididymitis to be a rare adverse event following intravesical BCG therapy. We report the case of an 82-year-old male undergoing BCG therapy for superficial transitional cell carcinoma of the bladder who presented with a painless right testicular mass. The patient had no previous history of tuberculosis. He successfully underwent a right orchiectomy and histopathology confirmed M. bovis as the etiological agent.
Hyperammonemic Encephalopathy Approximately 40 Years after Urinary Diversion for Bladder Exstrophy: A Case ReportMcKenzie, Gemma; Chapple, Christopher; Yates, David
2011 Current Urology
doi: 10.1159/000327462
Urinary diversion using intestine is a common surgical procedure applied in a variety of clinical situations. Patients are prone to metabolic complications due to the inherent differences between bowel and urothelium, which lead to altered absorption of solutes. A rare yet serious metabolic consequence is hyperammonemia, which can present with agitation and coma secondary to encephalopathy. Herein, we report the acute presentation of hyperammonemia in a patient with a ureterosigmoidostomy, highlighting the need for rapid recognition and appropriate management to prevent the development of an encephalopathic coma and possible death. A 39-year-old white male presented acutely unwell, having had a ureterosigmoidostomy for bladder exstrophy as an infant. He deteriorated rapidly on the second day of admission, necessitating sedation and intubation, and was found to have a significantly elevated serum ammonia level of 151 µmol/l (normal 9–35 µmol/l). A diagnosis of hyperammonemic coma was made and he was appropriately treated with a combination of antibiotics, neomycin, lactulose, sodium bicarbonate and rectal catheter drainage. Unusually, his liver function was normal and he had no clinical or microbiological evidence of a urinary tract infection. We discuss our hypothesis for the etiology of hyperammonemia in this case. The above case presentation illustrates a rare yet potentially fatal complication of what is a well-established and commonly performed surgical procedure, namely urinary diversion. It should alert the readers to consider the diagnosis of hyperammonemia in any patient with a urinary diversion who presents acutely unwell, particularly if they have signs of confusion, agitation, stupor and decreased levels of consciousness. Rapid recognition and treatment can prevent serious complications such as encephalopathic coma and death.