Current Urology

Vasdev, Nikhil; Chadwick, David; Thomas, David

2012 Current Urology

doi: 10.1159/000343509pmid: 24917714

Both pediatric and adult urologists frequently evaluate pediatric patients with an acute scrotum. We present a detailed review on the acute pediatric scrotum highlighting the clinical presentation, differential diagnosis and management of this common clinical condition. It is important to highlight that a testicular torsion is the most important differential diagnosis and the main priority in each case is to diagnosis and treat a potential testicular torsion is of the essence. The aim of our extensive review is to update/review the appropriate evaluation and management of the acute scrotum and to guide the clinician in distinguishing testicular torsion from the other conditions that commonly mimic this surgical emergency. This review is useful for trainees in UK and Europe who plan to take the FRCS (Urol) examination.

Tobu, Shohei; Noguchi, Mitsuru; Hatada, Teppei; Mori, Ken-ichi; Matsuo, Manabu; Sakai, Hideki

2012 Current Urology

doi: 10.1159/000343510pmid: 24917715

Introduction: The aim of this study was to investigate angiotensin II type 1 (AT1) receptors in rat bladder smooth muscle cells and alterations of AT1 receptors by diabetes mellitus and diuretic states. Materials and Methods: Diabetes and diuresis were induced in adult female rats by a single intraperitoneal injection of streptozotocin and feeding 5% sucrose in water. Cystometry was performed on control, diuretic, and diabetic rats at 2 and 8 weeks after treatment. Immunohistochemical staining was used to detect expression of AT1 receptors in the bladder smooth muscle cell membrane. Results and Conclusions: In diabetic rats, expression of AT1 receptors in the bladder smooth muscle cell membrane increased at 2 weeks and further increased at 8 weeks. The local renin-angiotensin system in the rat bladder might be activated by the continuous hyperglycemia caused by intraperitoneal injection of streptozotocin administration.

Safwat, Ayman; Al-Adl, Ahmed M.; El-Karamany, Tarek

2012 Current Urology

doi: 10.1159/000343511pmid: 24917716

Objective: To compare the results of Snodgrass repair with single versus double vascularized dartos pedicle flap for neouretheral coverage. Patients and Methods: Fifty-eight pediatric patients with mean age 41.5 ± 21 months (range 9–96 months) underwent primary hypospadias repair, 39 uncircumcised and 19 circumcised, classified into 2 groups according to coverage of the neourethra. Single layer coverage (Group I) was performed in 28 (48.3%) while double layers coverage (Group II) was done in 30 (51.7%) cases. Results: After mean follow-up 8.6 ± 5.4 months (range 3–24 months), good cosmetic results with vertical slit like meatus at the tip of conical shaped glans were obtained in 53 cases (91.4%). Totally 5 cases occurred postoperative complications, of which 4 cases in Group I [2 (7.1%) with urethrocutaneous fistula, 1 (3.6%) with meatal stenosis and 1 (3.6%) with skin necrosis], 1 case in Group II [glanular dehiscence (3.3%)]. No fistula was observed in Group II. Conclusion: The Snodgrass tubularized incised-plate repair in conjunction with double layer coverage of the neourethra could be considered the procedure of choice for distal hypospadias with low complications rate especially urethrocutaneous fistula.

Guner, Bayram; Gurbuz, Cenk; Canat, Lutfi; Caskurlu, Turhan

2012 Current Urology

doi: 10.1159/000343512pmid: 24917717

Purpose: To search the place of non contrast abdominal computed tomography to detect the stone-free rate after percutaneous nephrolithotomy (PNL) and the clinical importance of its superiority against to plain film radiography (KUB). Materials and Methods: Between February 2006 and July 2010, 62 patients including 27 women had no stone detected peroperative fluoroscopy and nephroscopy during PNL were included. Patients whom stone was not detected under 5 mm section upper abdomen non contrast spiral CT and KUB control in postoperative day 3 were defined as Group 1; patients whom stone was detected in a single slice CT were defined as clinically insignificant fragment (CIF)(Group 2) and patients whom stone was detected at least in two slice were defined as rest fragment (Group 3). Results: Median stone size were 22.3 mm (19–37 mm). Preoperative stone localization of groups were upper calyx, middle calyx, pelvis, lower calyx and 2.1, 14.9, 25.5 and 57.4%, respectively. CIF was detected in postoperative CT control of 12 (25.5%) patients whom stone was not followed in KUB and rest fragment was detected in 6 (12.8%) patients. Three of patients whom rest fragment was detected required an additional intervention for stone. Conclusion: KUB which is routinely used to determine stone-free ratio after PNL operation is not sufficient to detect rest calculi and/or CIF existence in 38.3% patients. But when it is considered that most of rest stones detected were CIF and only 6.3% patients had additional intervention required rest calculi. We can think that CT follow-up is not absolutely required.

Pérez-Utrilla Pérez, Manuel; Aguilera Bazán, Alfredo; Alonso Dorrego, José M.; Vitón Herrero, Rebeca; Cisneros Ledo, Jesús; de la Peña Barthel, Javier

2012 Current Urology

doi: 10.1159/000343514pmid: 24917718

Introduction: It is not unusual for bladder tumors to appear following transitional cell carcinoma of the upper urinary tract (UUT), with involvement of the UUT, following invasive bladder cancer, being less common. The synchronous presence of transitional cell carcinoma of the bladder and of the UTT is exceptional. Methods: Fifteen simultaneous cystectomies with nephroureterectomies were performed due to synchronous UUT and invasive bladder cancers (1997–2009). Surgery was performed using an open approach in 10 patients, while the last 5 procedures were performed laparoscopically. Results: The mean age was 68.7 years. Mean surgery time was 348.6 minutes. Mean blood loss was 816 ml. Acute renal failure was the most frequent postoperative complication being present in 5 patients (33%). There was 1 case of a leak in the ureter-intestinal anastomosis (open approach), which required placement of a left-sided percutaneous nephrostomy. There were 2 cases of postoperative mortality, both in the open approach series and with intestinal neobladder. Mean follow-up time for the whole series was 21.25 months. Eight cases experienced metastatic progression of the disease (mean follow-up 17 months). Conclusion: Though multi-site studies with longer follow-up and a greater numbers of patients are needed, the moment at which urothelial tumors appear seems to influence their prognosis, with lower survival rates for tumors that synchronically appear.

Tyson, Mark D.; Hurd, Kimberly J.; Nunez, Rafael N.; Wolter, Christopher E.; Humphreys, Mitchell R.

2012 Current Urology

doi: 10.1159/000343515pmid: 24917719

Background/Aims: To evaluate the usefulness of a temporary prostatic urethral stent to determine which complex surgical patients would benefit from definitive surgical management of their benign prostatic hyperplasia. Methods: We retrospectively analyzed our benign prostatic hyperplasia database and identified all patients that received at least one temporary prostatic urethral stent between April 2008 and December 2010. Results: Forty Spanner^TM stents were placed in 20 patients. Mean age was 78.1 years and prostate size was 62.1 cm³. Urinary retention was present in 60% (12/20) of patients. No statistically significant changes in mean maximal flow rate, average flow rate, and post void residual was noted. Seven patients (35%) did well with the stent and progressed to definitive surgical management whereas 10% of the cohort (2/20) leaked urine with the stent in place and subsequently went back to catheter management. Another 30% (6/20) were unable to tolerate the stent while 1 patient passed away unrelated to the stent. Conclusions: The use of the temporary prostatic urethral stent provided a good provocative test that enabled patients to experience what their voiding status would be if they were to undergo definitive surgical management.

Chertin, Leonid; Mimouni, Francis B.; Chertin, Boris

2012 Current Urology

doi: 10.1159/000343516pmid: 24917720

Purpose: The aim of this study was to determine the trends in urological publications from 1996 to 2010. Methods: We retrieved as many urology-related articles as possible from Medline articles between 1 January 1996 and 31 December 2010, and attempted to retrieve as many urology articles as possible from all Medline recorded journals (urology-specific and non-urology-specific journals indiscriminately), using the key words: ‘‘urology”, “pediatric urology”, “bladder”, “kidney”and others. The search was limited to ‘‘all adults’’(i.e. adult urology), ‘‘all children’’ (i.e. pediatric urology) as well as female and male urology. We repeated the search by using a certain limit each time according to the publication types as classified by Medline, and collected the total number of publications per year for the 15 years of the specified period. Regression analysis was used to determine the effect of the publication year upon the number of publications of each type. Results: There was a steady increase over time in the number of total publications both in pediatric and adult urology, with a sharper rise in the number of meta-analysis publications. At the same time there was a decrease in the number of case reports over the last years. Conclusions: New medical information available to urology and pediatric urology specialists increases over time and thus increases

Raymond, Ijabla; Vasdev, Nikhil; Ferguson, Jill; Haskin, Marion; Davis, Liz; Hasan, Tahseen S.

2012 Current Urology

doi: 10.1159/000343517pmid: 24917721

Objective: Painful bladder syndrome/interstitial cystitis (PBS/IC) and recurrent urinary tract infections (UTI) are clinically challenging conditions to manage in patients. We evaluate the clinical use of intravesical sodium hyaluronate (Cystistat®) in both these patient groups who have completed treatment. Patients and Methods: Thirteen patients with recurrent UTIs (Group I) and 8 patients with PBS/IC (Group II) received intravesical sodium hyaluronate (Cystistat®). Preinstallation demographic parameters were statically comparable in both groups. The mean age of presentation was 54.6 years in Group I and 57.5 years in Group II (p = 0.9). All 13 patients in Group I were on low dose antibiotics. The mean number of installations completed in both groups was 9 (range 4–21). Results: Data was collected prospectively using a standard pre- and post-treatment questioner with the pelvic pain and urinary/frequency patient symptom scale. At a mean follow-up of 21 months a significant improvement in bladder pain (p = 0.05), daytime frequency (p = 0.03) and quality of life (p = 0.02) was noted in patients in Group I. Two patients had breakthrough UTIs during treatment. Within Group I, 7 (53%) patients responded well to treatment. Patients in Group II had a significant improvement in bladder pain (p = 0.02), urgency (p = 0.01), nocturia (p = 0.01) and quality of life (p = 0.04). Within Group II, 6 patients (75%) responded to treatment. Conclusion: Intravesical sodium hyaluronate (Cystistat®) can be used with minimal side effects and good compliance in both groups of patients with PBS and recurrent UTIs. Longer follow-up and larger patient numbers in both groups will be required to confirm the long-term efficacy of these two clinically challenging groups of patients.

Nozaki, Tetsuo; Iida, Hiroaki; Morii, Akihiro; Fujiuchi, Yasuyoshi; Komiya, Akira; Fuse, Hideki

2012 Current Urology

doi: 10.1159/000343518pmid: 24917722

Purpose: During laparoscopy, as in open surgery, exposure is critical. Here, we describe the use of a laparoscope holder to facilitate the liver lift during urological laparoscopic surgery. Materials and Methods: Laparoscopic right radical nephrectomy (n = 3), partial nephrectomy (n = 1), and adrenalectomy (n = 2) were performed with 4 ports. At the beginning of the operation, the small snake retractor was placed through the 5-mm port under direct vision and the liver was lifted in the appropriate direction to optimize exposure. Results: The laparoscope holder provided quick, reproducible retraction to facilitate exposure. No complications occurred with its use. The device reduced the need for a dedicated second assistant to stand bedside. Conclusions: We achieved significant improvements in the safety and efficiency of liver retraction during urological laparoscopic surgery using the laparoscope holder.

Kawahara, Takashi; Ito, Hiroki; Terao, Hideyuki; Ogawa, Takehiko; Uemura, Hiroji; Kubota, Yoshinobu; Matsuzaki, Junichi

2012 Current Urology

doi: 10.1159/000343519pmid: 24917723

Complete staghorn calculi are typically managed with percutaneous nephrolithotomy (PCNL). However, dilating nephrostomy and inserting a nephro access sheath can be difficult to perform without hydronephrosis. We reported the procedure of ureteroscopy-assisted retrograde nephrostomy (UARN) during PCNL. UARN is effective without dilating the renal collecting system in cases of complete staghorn calculi. A 63-year old female with a left complete staghorn renal calculus was referred to our hospital. Under general and epidural anesthesia, the patient was placed in a modified-Valdivia position. A flexible ureteroscope was inserted and a Lawson retrograde nephrostomy puncture wire was advanced into the flexible ureteroscope. The puncture wire was forwarded along the route from the renal pelvis to the exit skin. Calculus fragmentation was done using a pneumatic lithotripter and the Ho: YAG laser. UARN during PCNL was effective for the treatment of a complete staghorn calculus.

Dhaliwal, Catharine A.; Fineron, Paul W.

2012 Current Urology

doi: 10.1159/000343520pmid: 24917724

Nephrogenic metaplasia (or nephrogenic adenoma) and clear cell adenocarcinoma of the bladder are uncommon lesions that cause diagnostic dilemmas for pathologists due to their similar morphologic features. Nephrogenic metaplasia describes a lesion in the lower urinary tract that is composed of small tubules resembling renal medullary tubules. It has been suggested that nephrogenic metaplasia may progress to clear cell adenocarcinoma but this possibility is not widely accepted. We present a case of clear cell adenocarcinoma of the bladder arising from nephrogenic metaplasia and discuss the evidence behind the association of these two distinct rare lesions.

Masterson, James H.; Bavaro, Mary F.; Cole, Emily E.

2012 Current Urology

doi: 10.1159/000343521pmid: 24917725

We present an interesting case of a 27-year-old male with coccidioidal meningitis who developed permanent erectile dysfunction (ED) and lower urinary tract symptoms 3 months after initiation of therapy. The patient presented to the urology clinic with a complaint of a weak stream, urinary urgency and frequency, as well as enuresis which were only moderately controlled with anti-cholinergics. His ED responded well to phosphodiesterase-5 inhibitors. After an extensive review of the literature, this is the first report of delayed presentation of ED and lower urinary tract symptoms secondary to coccidioidal meningitis.

Ghabili, Kamyar; Shoja, Mohammadali M.; Golzari, Samad E.J.; Ansarin, Khalil

2012 Current Urology

doi: 10.1159/000343522pmid: 24917726