Current Urology

2013 Current Urology

doi: 10.1159/000178096

Qayyum, Tahir; Oades, Grenville; Horgan, Paul; Aitchison, Michael; Edwards, Joanne

2013 Current Urology

doi: 10.1159/000343534pmid: 24917738

Background: Renal cancer is a frequently occurring malignancy with over 270,000 new cases diagnosed and it being responsible for 110,000 deaths annually on a global basis. Incidence rates have gradually increased whilst mortality rates are starting to plateau. Objective: To review epidemiology and risk factors for renal cancer. Methods: The current data is based on a thorough review of available original and review articles on epidemiology and risk factors for renal cancer with a systemic literature search utilising Medline. Results: The prevalence of associated risk factors such as genetic susceptibility, smoking, hypertension and obesity are changing and could account for the changes in incidence whilst the role of diet and occupational exposure to carcinogens requires further investigation. Conclusion: Despite the evidence of various associated risk factors, further work is required from well designed studies to gain a greater understanding of the etiology of renal cancer.

Gill, Harcharan; Wu, Jonathan

2013 Current Urology

doi: 10.1159/000343535pmid: 24917739

Aim: To review current data available on use of prostate specific antigen for screening healthy men for prostate cancer. Methods: Literature was reviewed and the guidelines from, American cancer Society, American Urologic Association was reviewed. Results: Current screening protocols lead to over diagnosis of prostate cancer. This often results in unnecessary biopsy procedures and treatments. Conclusion: We must consider the benefit of screening and treatment with the harms of over diagnosis and over treatment. Newer imaging modalities like magnetic resonance imaging have to be evaluated further.

Patra, Phani B.; Patra, Sayani

2013 Current Urology

doi: 10.1159/000343536pmid: 24917740

Sexual dimorphism is not only noticed in the prevalence of many diseases, but also in multiple physiological functions in the body. This review has summarized findings from published literature on the sex differences of the pathophysiology and pharmacology of the lower urinary tract (LUT) of humans and animals. Sex differences have been found in several key areas of the LUT, such as overactive bladder, expression and function of neurotransmitter receptors in the bladder and urethra, and micturition patterns in humans and animals. It is anticipated that this review will not only evoke renewed interest for further research on the mechanism of sex differences in the pathophysiology of the LUT (especially for overactive bladder), but might also open up the possibilities for gender-based drug development by pharmaceutical industries in order to find separate cures for men and women with diseases of the LUT.

Qayyum, Tahir; McArdle, Peter; Hilmy, Mustafa; Going, James; Orange, Clare; Seywright, Morag; Horgan, Paul; Underwood, Mark; Edwards, Joanne

2013 Current Urology

doi: 10.1159/000343537pmid: 24917741

Introduction: To examine the role of inflammation in bladder cancer, we assessed the relationship between a systemic inflammation prognostic score (modified Glasgow Prognostic Score, mGPS), the tumor inflammatory cell infiltrate as measured by the Klintrup-Makinen score and tumor necrosis with cancer specific survival in patients with bladder cancer. Materials and Methods: The cohort consisted of 68 bladder cancer patients, 47 with localised disease and 21 with muscle invasive disease. The mGPS response was constructed by measuring C-reactive protein and albumin concentrations and the Klintrup-Makinen score was evaluated histologically for the local inflammatory response. Pathological parameters such as grade, T stage and tumor necrosis were also assessed. Results: Median follow was 47 months and 24 patients died of their disease. On univariate analysis, T stage (p < 0.001), grade (p < 0.001) and mGPS (p = 0.002) were significant predictors of cancer specific survival. On multivariate analysis, T stage (hazard ratio 5.98, 95% confidence interval 3.18–11.24, p < 0.001) and mGPS (hazard ratio 1.78, 95% confidence interval 1.09–2.9, p = 0.02) were significant independent predictors of cancer specific survival. Conclusion: A preoperative systemic inflammatory response is an independent predictor of poor cancer specific survival in patients with bladder cancer.

Brede, Christopher M.; Douville, Nicholas J.; Jones, Stephen

2013 Current Urology

doi: 10.1159/000343538pmid: 24917742

Purpose: Transperineal template prostate biopsy has been proposed to facilitate systematic biopsy in patients undergoing repeat biopsy who are at high risk for cancer. Advocates tout the reliability of the grid to define biopsy location compared to hand-held transrectal ultrasound guided biopsy. However, accuracy of the biopsy needle depends on bevel position, tissue deformity, and technique. Due to this potential for error, we sought to determine whether the use of transperineal template biopsy would assure reproducibly accurate needle placement. Materials and Methods: A standard 0.5 cm brachytherapy grid was utilized for transperineal biopsy. A single grid hole was used to obtain biopsies. The bevel of the needle was rotated to a different position with each biopsy, and the angle of the needle was varied to test the ability of the grid to “map” the prostate. Results: We observed wide variation of needle location through a single brachytherapy grid hole. We are able to show that at 5 cm depth, an area of 2.47 mm² is possible to biopsy and at a depth of 25 cm; approximately 7.56 mm² is possible to biopsy. This gives a precision of biopsy of at the most shallow depth 22% and at the deepest 7%. Conclusion: There is potential for technical and equipment associated error with transperineal template guided prostate biopsy. The grid alone can account for substantial sources of error, so technique remains critical if the grid coordinates are to be used to predict presence or extent of cancer.

Kandzari, Stanley J.; Riggs, Dale; Jackson, Barbara; Luchey, Adam; Oliver, Claire; Zaslau, Stanley

2013 Current Urology

doi: 10.1159/000343539pmid: 24917743

Background: Inositol Hexaphosphate (IP6) is a naturally occurring polyphosphorylated carbohydrate that is found in food sources high in fiber content. We hypothesized that IP6 would inhibit the cell growth rate of bladder cancer in vitro. Methods: T24 and TCCSUP bladder cancer cell lines were treated with titrating doses of IP6 (0.3, 0.6 and 0.9 mM/well). Cell viability and vascular endothelial growth factor levels were measured. Results: Significant reductions (p < 0.001) in cellular growth were noted in both cell lines at all doses and time points tested, with the exception of 0.3 mM IP6 at 24 hours in the T24 cell line. The percent inhibition of vascular endothelial growth factor was significantly higher than that observed in the TCCSUP cell line at 48 and 72 hours with 0.3 mM IP6 (p < 0.001). The T24 cells exhibited the same level of inhibition at 24 and 48 hours with 0.6 m<smlcap>M</smlcap> dose of IP6 and at 72 hours with the 0.3 mM dose (p < 0.001). Conclusions: In vitro treatment of bladder cancer with the common dietary polyphosphorylated carbohydrate IP6 significantly decreased cellular growth by anti-angiogenic mechanisms. We feel that this data warrants further investigation and consideration for initiation of clinical trials to evaluate the safety and clinical utility of this agent.

Biewenga, Eric D.; Choe, Chong; Chang, Joseph; Rhee, Eugene Y.

2013 Current Urology

doi: 10.1159/000343540pmid: 24917744

Objective: We demonstrate an innovative use of a barrier surgical wound retractor/protector system for use in a variety of prosthetic urologic procedures (penile prosthetics, artificial urinary sphincters, male slings). Materials and Methods: We demonstrate the use of a self-retaining ring wound retractor in a multitude of prosthetic urological procedures: insertion of an inflatable penile prosthesis through an infrapubic approach as well as penoscrotal approach, placement of a transperineal artificial urinary sphincter, and placement of a male urethral sling. Results: The self-retaining ring wound retractor facilitated a more rapid setup and takedown, provided 360 degrees of atraumatic retraction as well as 360 degrees of wound protection, allowed for maximum exposure with a minimum incision size, significantly shortened the operating wound depth thus maximizing exposure, and isolated the surgical field minimizing prosthesis to skin contact. Conclusion: Our experience shows that prosthetic urologic surgeries can be enhanced with the use of the self-retaining ring wound retractor as it provides better surgical exposure, lowers wound infection risks, sets up more quickly as a safer retraction system with substantial cost savings.

Sasagawa, Isoji; Hirose, Yuko; Matsuda, Kaori; Hoshi, Kiyotsugu; Ohta, Shoichiro

2013 Current Urology

doi: 10.1159/000343541pmid: 24917745

We describe the effective use of the bipolar vessel-sealing device: LigaSure for the division of the internal spermatic vessels in a laparoscopic varicocelectomy. A total of 52 males with varicocele (left-side n = 49, and bilateral n = 3) were included in this study. Blunt dissection was used to isolate the packet of spermatic vessels. The packet of spermatic vessels was divided using a bipolar diathermy system, the LigaSure Precise. It was clear that the operative time was significantly reduced compared to the method using clips, which was done before the development of this kind of device. In another experiment to examine the effect of vessel sealing, it was confirmed that the LigaSure has performance comparable to the clips. Despite the result that the Harmonic scalpel was less effective in vessel sealing, our study found it difficult to determine which is superior, LigaSure or clips, in terms of operative time, relapse rate and complication.

Altobelli, Emanuela; Bove, Alfredo M.; Sergi, Federico; Buscarini, Maurizio

2013 Current Urology

doi: 10.1159/000343542pmid: 24917746

Objective: To report a case of severe hydronephrosis 20 years after bladder exstrophy (BE) repair, managed by bilateral ureteral tapering and secondary ureteroneocystostomy. Case Presentation: A 21-year-old woman with a history of BE and ureteral reimplantation, presented with hematuria-dysuria syndrome and recurrent febrile urinary tract infections. After counselling, she elected to undergo bilateral ureteral tapering and second ureteroneocystostomy. Conclusion: Hydronephrosis secondary to ureteralvesical stricture in BE patients can be successfully managed with ureteral reimplantation associated to ureteral tapering even after a prior reimplantation.

Coyle, D.; Flaherty, R.A.; Kelly, B.D.; Hynes, S.O.; Colesky, F.; Quinlan, M.R.; Corcoran, M.O.; Rogers, E.

2013 Current Urology

doi: 10.1159/000343543pmid: 24917747

Paratesticular liposarcoma is a very rare cause of scrotal mass. It is thought that they arise from spermatic cord lipomas most commonly. While well differentiated tumors tend to share many histological similarities with dedifferentiated tumors, the latter has a much more aggressive phenotype. We present an unusual case of a 69-year-old male with synchronous prostate adenocarcinoma and unilateral renal cell carcinoma who was found to have a dedifferentiated paratesticular liposarcoma. Treatment was with radical resection, preserving the testis, followed by radiotherapy. Unusually recurrence did not occur until 4 years following initial treatment. This case demonstrates the high propensity of dedifferentiated liposarcoma to recur locally and examines the most frequently employed management strategies.

2013 Current Urology

doi: 10.1159/000336056

2013 Current Urology

doi: 10.1159/000207454

2013 Current Urology

doi: 10.1159/000236235