Current Urology

Pandey, Anand; Gangopadhyay, Ajay N.; Kumar, Vijayendra; Sharma, Shiv P.; Gupta, Dinesh K.; Gopal, Saroj C.

2011 Current Urology

doi: 10.1159/000327473

Background: To assess two different operative techniques in hypospadias with special emphasis on urinary flow with the help of uroflowmetry. Material and Methods: In this prospective study, all patients underwent either Snodgrass or Mathieu urethroplasty. Preoperative uroflowmetry was done in every patient. Postoperative uroflowmetry was done 2 weeks after stitch removal only in those patients who were not having urethral fistula. Postoperative dilation was done only in those patients who had decreased urinary flow as compared to preoperative values. Results: Fifty patients were included in this 2-year study. Uroflowmetry was performed in 37 patients. Twenty-two patients underwent Snodgrass urethroplasty and the other 15 had Mathieu urethroplasty. Pre- and postoperative Q_max values were 6.57 ± 2.67 and 7.36 ± 3.90 ml/s, respectively. Q_avg values were 4.16 ± 1.87 and 4.52 ± 2.50 ml/s, respectively. Although statistically insignificant, the Snodgrass technique appeared to be relatively better than Mathieu’s technique. Conclusion: Uroflowmetry can predict the need for dilation in hypospadias. The Snodgrass technique appears to be functionally better than Mathieu’s technique. With avoidance of unnecessary trauma due to dilation, the cooperation of pediatric patients can be achieved.

Raheem, Omer A.; Casey, Rowan G.; D’Arcy, Frank T.; Lynch, Thomas H.

2011 Current Urology

doi: 10.1159/000327474

Introduction: There is paucity of data regarding the safety and efficacy of the valve catheters (VC). We aimed to prospectively evaluate our experience in regards to the safety and efficacy of the VC and compared it to patients with nonvalve catheters (NVC). Methods: Total 76 male patients were included in both the VC and NVC groups. The type of catheters was standardized by using Bard® manufacturer, United Kingdom. Patients were evaluated 4–6 weeks following catheterization by filling out a non-validated quality of life (QoL) questionnaire at their scheduled clinic visit. Results: Mean age was 75 years (range 62–85 years) and 77 years (range 66–88 years) in the VC and NVC groups respectively. There were comparable results of the VC and NVC groups. However, observed benefits were found in regards to the ease (4/5-point scale: 64% in VC and 53% in NVC), comfort of usage (4/5-point scale: 59% in VC and 54% in NVC), patient’s confidence (very confident: 95% in VC and 82% in NVC) (p > 0.05). Three bladder spasms were recorded in the VC group, compared to 2 in the NVC group. In contrast, only 1 urinary tract infection observed in the VC group, compare to 2 in the NVC group (p > 0.05). Conclusions: This study demonstrates that VC is a viable and patient friendly alternative. This may be partly explained by the functional mechanism of the VC mimicking the urinary bladder sphincters. Future research should aim to further improve its mechanical functionality.

El-Assmy, Ahmed; Abou-El-Ghar, Mohamed E.; Mosbah, Ahmed; El-Refaie, Huda; El-Diasty, Tarek

2011 Current Urology

doi: 10.1159/000327475

Purpose: To assess efficacy, complications and long-term outcome of selective arterial embolization (SAE) for treatment of symptomatic giant angiomyolipoma larger than 10 cm. Materials and Methods: The surgical records of 9 patients with giant angiomyolipoma managed by SAE between 1990 and 2010 were reviewed. Results: The study included 4 men and 5 women, 5 of them (55.5%) had tuberous sclerosis complex. Indication for SAE was to stop severe hematuria in all patients. Among 9 patients, early complications occurred in 55.5% including post embolization syndrome in 1 patient, recurrent hematuria necessitating repeat embolization and nephrectomy in 3 and acute renal failure in 1 patient. During a mean follow-up of 2 years, 1 patient on hemodialysis was subjected to elective nephrectomy and 5 patients (55.5%) preserved their kidneys in whom radiology showed a decrease of size of the lesions by about 1/3 of its original size and all had a stable serum creatinine level. Conclusions: SAE of giant renal angiomyolipomas can be safely done to stop active bleeding in 2/3 of cases. Additional treatment may be necessary in 1/3 of patients and preservation of kidneys is amenable in 1/2 of cases.

Umemoto, Yukihiro; Tozawa, Keiichi; Kojim, Yoshiyuki; Yasui, Takahito; Kawai, Noriyasu; Sasaki, Shoichi; Hayashi, Yutaro; Kohri, Kenjiro

2011 Current Urology

doi: 10.1159/000327476

Purpose: The aim of this study was to clarify risk factors related to postoperative urinary incontinence after laparoscopic radical prostatectomy (LRP). Patients and Methods: Outcomes of 214 consecutive patients who underwent LRP at our institute between April 2001 and January 2009 were reviewed. Patients were divided into 2 groups, continent patients (group A: n = 172), who used one or fewer urinary pads per day 6 months after LRP, and incontinent patients (group B: n = 42), who used two or more pads per day 6 months after LRP. Patient age, prostate specific antigen before LRP, blood loss, duration of indwelling urethral catheter, and the positive margin rate between the 2 groups were compared. In addition, surgical videos were reviewed with attention paid to surgical procedures. We examined the correlation between the occurrence of urinary incontinence and the rate of patients with intra-operative damage to the pelvic diaphragm musculature and difficulty in exposure of the urethra during LRP. Results: There were no significant differences in patient age, prostate specific antigen before LRP, blood loss, duration of indwelling urethral catheter, positive margin rate between groups A and B. However, significant differences were found in the rate of patients with damage to the pelvic diaphragm musculature (16.3 and 73.8%, respectively) and difficulty in exposure of the urethra (20.9 and 83.3%, respectively) during LRP. Conclusions: Intra-operative damage to the pelvic diaphragm musculature and difficulty in exposure of the urethra during LRP are risk factors of urinary incontinence after LRP.

Soga, Norihito; Nishikawa, Kouhei; Yamada, Yasushi; Arima, Kiminobu; Sugimura, Yoshiki

2011 Current Urology

doi: 10.1159/000327477

Purpose: To evaluate the predictors for survival in non-metastatic renal cell carcinoma (non-mRCC) associated with tumor thrombus following surgical resection. Patients and Methods: Between February 1983 and December 2009, a total of 40 patients with a diagnosis of non-mRCC (23 with pT3a pN0M0, 15 with pT3b pN0M0 and 2 patients with pT3c pN0M0) were enrolled. Various preoperative and postoperative parameters were assessed as prognostic factors. Results: In the multivariate analysis, a low level of preoperative albumin less than 35 g/l [hazard ratio (HR) 8.06] and high postoperative C-reactive protein (CRP): CRP nadir greater than 2 mg/l (HR 1.78) were identified significant risk factors for cause-specific survival. For the risk of progression-free survival, 3 factors proved to be significant independent predictors: a low preoperative albumin (HR 25.5), a high postoperative CRP nadir (HR 18.71) and low preoperative hemoglobin (HR 17.4). In 24 cases with the high preoperative CRP (> 2 mg/l), the progression-free survival rates in the low postoperative CRP nadir group achieved a significant better survival rate than the high CRP nadir group after nephrectomy (p = 0.048). Conclusion: In non-mRCC with tumor thrombus after surgical resection, a low preoperative albumin level and an elevated postoperative CRP nadir were significant independent predictors of survival.

Raheem, Omer A.; Kamel, Mohamed H.; Leung, Peter; Shields, William P.; Connolly, Stephen S.; Zimmerman, Antonio J.; Mohan, Ponnusammy; Hickey, David P.

2011 Current Urology

doi: 10.1159/000327478

Introduction: Radical cystectomy is the treatment of choice for infiltrating non-metastatic bladder cancer. However there is reluctance to perform this surgery in the elderly due to morbidities associated. We sought to examine our institutional experience regarding radical cystectomy in the octogenarians. Patients and Methods: A total of 23 were 80 years or older in age (19 males and 4 females). Overall mortality, early and late morbidity were analyzed. Length of hospital stay, intensive therapy unit admissions, re-hospitalization and overall survival were assessed. Results: Median age at time of cystectomy was 83.5 years (range 80–90 years). Median follow-up time was 7.5 years (range 8–120 months). All patients had standard radical cystectomy. Median operative time was 3 hours (range 3–5 hours). Median number of blood transfusion units was 9 (range 4–14). Median preoperative and postoperative hemoglobin level was 12.5 (range 9.9–14) and 10.8 g/dl (8.7–12.2 g/dl) respectively. Admission to the intensive therapy unit was needed in 3 patients. Median number of hospitalization days following the cystectomy procedure was 23 days (range 5–90 days). Median survival time was 16 months and the actuarial survival at 1, 2 and 3 year was 66.7, 47.6 and 12% respectively. Conclusion: This study highlights the safety and feasibility of radical cystectomy in the treatment of bladder cancer in the octogenarians. It provides palliation of local symptoms and local cancer control. Future research should be directed towards comparing with the non-octogenarian cohorts with particular emphasis on oncological, functional and survival outcomes as end points.

Wu*, Jieying; Zhu*, Baoyi; Ye, Chunwei; Wang, Yu; Huang, Wentao; Gao, Xin; Wen, Xingqiao

2011 Current Urology

doi: 10.1159/000327479

Purpose: To summarize the common pathological types of ureters and their clinical characteristics, which increase operative difficulties and risks during rigid ureteroscopic procedures. Methods: Between January 2001 and May 2011, a total of 126 rigid ureteroscopic procedures performed in ureters were enrolled into this study. Pathological characteristics of ureters were summarized. The manipulation time, intraoperative complications and conditions of surgical conversion were evaluated. Operative tips and tricks to overcome manipulated difficulties were also introduced. Results: High risk ureters were classified into 5 types in terms of their pathological characteristics: type I, calculous strictured ureters; type II, neoplastic strictured ureters; type III, non-congenital benign strictured ureters; type IV, congenital strictured or tiny ureters; type V, dilated and tortuous ureters. The mean manipulation time was 75.7 ± 4.8 minutes. Intraoperative complications appeared in 19 procedures, and 22 procedures were converted to other surgical techniques. Conclusion: These 5 pathological ureter types can increase operative difficulties and risks of rigid ureteroscopic procedures. These tips and tricks may be of value for junior urologists in clinical practice.

Lehana, Yeo; Rajindra, Singh; Jhumur, Pati

2011 Current Urology

doi: 10.1159/000327480

Introduction: Vesicourethral anastomosis is a technically challenging aspect of the retropubic radical prostatectomy. We describe 2 novel methods that may be used to facilitate anastomosis of the urethral stump to the bladder neck. Materials and Methods: The first technique we describe involves the use of a dental mirror, and the second involves the insertion of a flexible cystoscope per urethra, both of which allow visualization of the urethral stump. Results: Both these techniques were utilized successfully to allow accurate suture placement in situations where vision of the urethral stump was restricted. Conclusion: These 2 methods that are described are simple and inexpensive, and the equipment required is readily available in theaters.

Puche-Sanz, Ignacio; Vázquez-Alonso, Fernando; Lora, Vicente C.; Martín, Jose F.F.; Julio, Hernani G.; Olmo, Jose M.C.

2011 Current Urology

doi: 10.1159/000327481

There are reports of renal cell carcinoma (RCC) metastases in almost every part of the body. Skin metastases due to RCC are a rare condition. Only 3.4% of all RCCs give rise to metastases in the skin. We present a 73-year-old man who developed a solitary cutaneous metastasis 21 years after radical nephrectomy. A computed tomography scan also revealed two nodules in the lungs and a mid-pole mass in the right kidney. Complete local excision of the lesion was performed. The patient was started on oral treatment with sunitinib. At the 24-month review a control computed tomography revealed that the lung lesions had completely disappeared but the size of the renal mass had not changed. To our knowledge this is the only reported case of cutaneous metastasis appearing more than 20 years after radical treatment.

Erdal, Ebru; Mahmalji, Wasim; Fazili, Zahoor; Marsh, Howard P.; Masood, Shikohe

2011 Current Urology

doi: 10.1159/000327482

Transrectal ultrasound-guided prostate biopsy is widely used for the diagnosis of prostate cancer. Although considered a safe procedure it is associated with complications which can be hemorrhagic (hematuria, hematospermia and hematochezia) or infective (bacteremia, bacteriuria, urinary tract infection, pyrexia and sepsis). We present a previously unreported complication of transrectal biopsy of the prostate, cerebral abscess in an otherwise healthy 54-year-old male with suspected prostate cancer. This case report highlights the need for awareness of infective complications in this seemingly safe procedure.