Current Urology

2011 Current Urology

doi: 10.1159/000334831

Lodde, Michele; Mian, Christine; Trenti, Emanuela; Palermo, Salvatore; Pycha, Armin; Comploj, Evi

2011 Current Urology

doi: 10.1159/000327463

The filed of bladder cancer (BC) tumor markers remains a rapidly evolving area in which newer markers are constantly identified but less frequently evaluated in the every-day clinical practice. We discuss here the use of clinical suitable BC biomarkers that have proved in clinical trials to ameliorate the diagnoses, the follow-up and the BC risk-stratification, in term of recurrence and progression.

Raheem, Omer A.; Casey, Rowan G.; Lynch, Thomas H.

2011 Current Urology

doi: 10.1159/000327464

Historically it was thought that there was an increase in the hemorrhagic complications with regards to performing transrectal ultrasound-guided prostate biopsies on patients receiving anticoagulation/antiplatelet therapy. Current literature supports continuation of anticoagulation/antiplatelet therapy without additional morbidity. We sought to systematically assess the current published evidence regarding the continuation of anticoagulation/antiplatelet therapy during transrectal ultrasound-guided prostate biopsies and comment on their clinical outcomes.

Zhao, Jimao; Bai, Jie; Zhou, Ying; Qi, Guihua; Du, Lindong

2011 Current Urology

doi: 10.1159/000327465

Introduction: To determine whether percutaneous tibial nerve stimulation (PTNS) applied twice a week is effective in female patients with refractory urinary frequency. Patients and Methods: Twenty-two patients with increased daytime urinary frequency and bladder sensation were enrolled in the prospective study undergoing a total of 10 times of PTNS. The response was assessed using a voiding diary, the 36-item short-form health survey (SF-36) quality-of-life questionnaire and the patient’s self-evaluation table. Results: A statistically significant improvement was found in daytime and nighttime voiding frequency, daytime voiding volume and nighttime lowest voiding volume variables. The self-reported health status transition in SF-36 was statistically lower after the treatment. Ten patients, who evaluated the trial as having had some effect, had more significant improvement statistically in nocturia than did the other 12 patients, who evaluated the trial as having had no effect. Conclusions: Intermittent PTNS twice a week might be an alternative treatment for patients with refractory urinary frequency. However, these preliminary impressions should be further confirmed.

Yuksel, Mehmet B.; Ciloglu, Murat; Kar, Aytan

2011 Current Urology

doi: 10.1159/000327466

Aim: To evaluate if ureteroscopic lithotripsy (URSL) is an effective and successful applicable procedure for new and less experienced urologists who first start to work in small provincial state hospitals of Turkey. Patients and Methods: A total of 962 URSL applications in The State Hospital of Mus, Urology Clinic were retrospectively evaluated. URSL was performed by an 8 or 10F semi-rigid ureteroscope and pneumatic lithotriptors under general or regional anaesthesia. On the 1st day after the operation, a urinary system graphy was performed and the presence of residual stones > 4 mm was judged a failure. Results: The sample included 381(39.6%) females and 581 (60.4%) males with a mean age of 38.7 years (range 17–64 years). The success rate of URSL in stones ≤ 10 mm was 95.1% (737/775) and >10 mm was 89.8% (168/187). However, the success rates according to stone localization were 81.9% (59/72) in the proximal ureter, 89.2% (133/149) in the middle ureter, and 96.2% (713/741) in the distal ureter. The overall stone-free rate was 94.1% (905/962). Complications were commonly minor and treated by conservative management modalities. Conclusion: URSL is a safe and successful treatment option in the management of ureteral stones, and it can be performed by new and less experienced urologists in small provincial state hospitals with results similar to the literature.

Pinkawa, Michael; Holy, Richard; Piroth, Marc D.; Klotz, Jens; Pfister, David; Heidenreich, Axel; Eble, Michael J.

2011 Current Urology

doi: 10.1159/000327467

Background: The assessment of a clinical significance of certain quality of life score changes is often controversially discussed. Materials and Methods: The Expanded Prostate Cancer Index Composite questionnaire was completed before and 3 times after treatment for prostate cancer by 756 patients. Two criteria were considered as a clinically relevant change: score change corresponding to at least ‘very small problem’ from the patient’s point of view; score change with significantly increasing incidence of symptoms. These changes were compared to the 50% of standard deviation (SD) threshold. Results: Patients assess mean changes up to 4 points to be ‘no problem’, suggesting a mean change of 5 points to be the minimal important difference. With increasing score changes significant changes were noticed in an increasing number of items: up to 4 items if scores decreased 5–10 points. Additionally, an increasing percentage of patients were affected. These results correlated well with the 50% of SD threshold. Conclusions: The threshold of 5 points (or 5% of the instrument range) can be interpreted as the minimal important difference of clinical significance. The proposed criteria corresponded well to the distributionbased criterion based on the 50% of SD level.

Miyake, Hideaki; Muramaki, Mototsugu; Sakai, Iori; Terakawa, Tomoaki; Kusuda, Yuji; Yamada, Yuji; Yamanaka, Kazuki; Fujisawa, Masato

2011 Current Urology

doi: 10.1159/000327468

Background: This study retrospectively compared cancer control in patients with pT1 renal cell carcinoma (RCC) undergoing either open radical nephrectomy (ORN) or laparoscopic radical nephrectomy (LRN). Patients and Methods: This study included 710 consecutive patients who underwent radical nephrectomy for clinically localized RCC at 21 institutions in Japan between January 2000 and March 2008, and were diagnosed as having pT1 disease. The medical records of all patients were reviewed with emphasis on their oncological outcomes. Results: Of the 710 patients, 436 (61.4%) and 274 (38.6%) were treated with ORN and LRN, respectively. Although patient age in the ORN group was significantly older than that in the LRN group, there were no significant differences in the remaining characteristics, including gender distribution, mode of presentation, pathological stage, grade, micro-venous invasion and histological subtype, between the two groups. None of the patients in the LRN group developed port site metastasis, while renal fossa recurrence occurred in 2 patients in both the ORN and LRN groups. Furthermore, there were no significant differences in the recurrence-free, cancer-specific and overall survival rates between these two groups. Conclusions: LRN had no adverse impact on intermediateterm oncological outcomes compared with that after ORN in patients with pT1 RCC; however, additional prospective trials would be needed to draw definitive conclusions on this issue.

Valentini, Francoise A.; Gilchrist, Alienor; Nelson, Pierre P.; Zimmern, Philippe E.

2011 Current Urology

doi: 10.1159/000327469

Introduction: To compare Q_max and a new index of voiding dysfunction (D) obtained from free flow (FF) and intubated flow (IF) in men before and after trans-urethral resection of prostate (TURP). Material and Methods: Preoperative FF and IF of benign prostatic hyperplasia patients with bladder outlet obstruction were studied for Q_max and D, and compared to a series of post-TURP FF in the same patients obtained at interval follow-ups. Analysis was done in a blinded fashion. D was computed with the VBN® software. Results: From 24 fully studied patients, preoperative D values were similar (p = 0.61) for FF (25.6 ± 7.4) and IF (26.8 ± 7.1). Postoperatively, D values (9.6 ± 8.6) dropped (p = 0.001) and were more stable than Q_max. Range dispersion between D and Q_max for two successive FF postoperatively in a same patient was 4 times larger for Q_max over D. Conclusion: D values from FF or IF were similar preoperatively but markedly reduced after TURP. This more stable index compared to Q_max may offer an alternative approach to gauge the voiding performance of a symptomatic patient with benign prostatic hyperplasia and bladder outlet obstruction.

Zaman, Faruquz; Bach, Christian; Kabir, Mohammad N.; Baithun, Suhail; Masood, Junaid; Buchholz, Noor; Junaid, Islam

2011 Current Urology

doi: 10.1159/000327470

Tumors metastasizing to the glans penis are uncommon and a rare occurrence. The majority of the primary tumors are located in the pelvis and they arise from the genitourinary tract and rectum (>75%). We report a 61-year-old man with known metastatic (lymph nodes and maxilla) esophageal cancer who was treated with chemotherapy and referred to urology with phimosis for circumcision. He did not have any other urological or penile complaints. During circumcision the glans penis looked nodular and a biopsy was taken. The histological examination of the biopsy showed metastasis from esophageal primary adenocarcinoma. The case was discussed in a multi-disciplinary meeting and palliative radiotherapy was recommended and commenced.

Mafeld, Sebastian; Vasdev, Nikhil; Thorpe, Andrew C.; Hasan, Tahseen S.

2011 Current Urology

doi: 10.1159/000327471

Abuse of anabolic-androgenic steroids (AAS) is a widespread problem throughout Western society. The secretive nature of AAS makes it difficult to study the potential consequences with recognised scientific methods. Multiple case reports link AAS to increased thrombogenicity resulting in systemic arterial thrombosis and its complications including acute ischemic limbs infarction, pulmonary embolism, myocardial infarction and hypoxic brain injury. We present the first documented case of an individual who abused AAS and presented with isolated renal infarction.

Karaköse, Ayhan; Yüksel, Mehmet B.

2011 Current Urology

doi: 10.1159/000327472

In daily practice, double-J stent insertion is frequently and successfully applied to manage a variety of urinary tract diseases with potential complications. We report a case of renal parenchymal perforation with no hematoma that occurred after ureteral double-J stenting.