Current Urology

Öztürk, Hakan

2014 Current Urology

doi: 10.1159/000365670pmid: 26195945

Coronary artery disease is one of the most common diseases today and the primary cause of sudden death. The development of atherosclerosis and the incidence of symptomatic heart and vascular diseases increase depending on the average life expectancy in the elderly population. Stent applications in the treatment of coronary artery disease are quite widespread and are a standard procedure. Stent applications are applied to approximately 2 million people in the United States every year. Therefore, there is an increase in the number of patients with stents. This increase is an important and complex situation for patients who are planned for urological elective surgery. The necessity of treating the patient with the least morbidity and mortality, and supplying the balance in terms of the dose and duration of antiplatelet agents which are used for patients with stents who are planned for elective urological surgery, is main subject of our review. To whom and what should be the treatment are assessed accompanied by the literature.

Asher, John; Vasdev, Nikhil; Wyrley-Birch, Hugh; Wilson, Colin; Soomro, Naeem; Rix, David; Jaques, Bryon; Manas, Derek; Torpey, Nicholas; Talbot, David

2014 Current Urology

doi: 10.1159/000365671pmid: 26195946

Introduction: With calcineurin inhibitors potentiating damage from ischaemia-reperfusion injury in kidneys from donors after cardiac death we wanted to investigate the role of substituting sirolimus for tacrolimus in the delayed introduction of calcineurin inhibitor regime used in our centre. Method: A prospective randomised paired open-label study was performed taking pairs of kidneys from each donor and randomising one to a tacrolimus-based regime and the other to a similar regime based on sirolimus. Graft function at one year was the primary endpoint. Results: Total 31 pairs of kidneys were randomised to each group, with 19 pairs of recipients available for analysis after post-randomisation study exclusions. Despite a higher incidence of biopsy proven acute rejection in the sirolimus group, renal allograft function was similar in both groups at three-monthly intervals up to one year post-transplant. All episodes of acute rejection in the sirolimus group occurred in the first three months. Graft and patient survival at one year was 100% in the tacrolimus group, with one death with functioning graft in the sirolimus group (95% survival). Unfortunately, 10 of the 19 patients in the sirolimus arm required switch of medication to tacrolimus due to acute rejection or intolerable drug side effects. Conclusions: Graft survival and function were very similar in the two groups despite the higher rate of acute rejection in the sirolimus arm, raising the possibility that the damage done by acute rejection was adequately offset by the nephron-sparing effect of sirolimus compared to tacrolimus. Sirolimus may have a role as a longer-term maintenance immunosuppressant after initial treatment with a different agent such as tacrolimus or belatacept.

Karaköse, Ayhan; Yüksel, Mehmet B.; Aydoğdu, Özgü; Gümüş, Bilal; Ateşçi, Yusuf Z.; Akan, Zafer

2014 Current Urology

doi: 10.1159/000365672pmid: 26195947

Objective: To evaluate the potential effect of bisphosphonates on bone mineral density (BMD) in patients who are treated with anti-androgen drugs and radiotherapy for metastatic prostate cancer. Materials and Methods: The data of 31 patients with metastatic prostate cancer who were treated with anti-androgen drugs and radiotherapy during a 1-year period were retrospectively reviewed. Patients were divided in 2 groups, in which 17 patients in group 1 were treated with zoledronic acid (4 mg/month, intravenous) and 14 patients in group 2 who did not receive zoledronic acid. BMD was measured before the treatment and at the end of the 1st year by dual energy X-ray absorptiometry. Statistical analyses were performed with the T test. Results: Mean age of the patients was 71.42 ± 6.7(range 59-85) years. A significant increase was noted for pelvic bone, femoral neck, and lumbar vertebrae t scores when pretreatment and 1st year measurements were compared in group 1 (p < 0.05). In group 2 a significant decrease was noted for pelvic bone and femoral neck t scores at the end of the 1st year (p < 0.05). A significant increase was noted for pelvic bone and femoral neck follow-up in BMD values at the end of the 1st year compared to initial measurements in group 1. A significant decrease was noted for lumbar vertebrae follow-up in BMD values at the end of the 1st year when compared to initial values in group 2. Conclusion: Zoledronic acid significantly increases BMD and delays unfavorable outcomes for bones in men who are treated with anti-androgen drugs and radiotherapy for metastatic prostate cancer.

Gendy, Hoda El; Madkour, Bothina; Abdelaty, Sara; Essawy, Fayza; Khattab, Dina; Hammam, Olfat; Nour, Hani H.

2014 Current Urology

doi: 10.1159/000365673pmid: 26195948

Background: Galectins are group of proteins found in the cytoplasm, nucleus, cell surface and extracellular matrix. Galectin 3 (Gal-3) displays pathological expression in a variety of processes such as tumorigenesis. Patients and Method: 70 patients classified into the control group, cystitis group, transitional cell carcinoma group, and squamous cell carcinoma group were enrolled in this study which aimed to detect the serum level and the intensity of tissue expression of Gal-3. Results: Both serum level and tissue expression of Gal-3 were statistically higher in bladder cancer patients compared to the other groups. Gal-3 level expression increased from low to high grade urothelial tumors, with a statistically significant increase of its level and expression between muscle invasive and non-muscle invasive Ta urothelial tumors. Conclusion: The serum Gal-3 level is sensitive and specific for the diagnosis of bladder cancer. The prognostic significance of tissue expression is to be confirmed.

Khurgin, Jacob; Garber, Bruce

2014 Current Urology

doi: 10.1159/000365674pmid: 26195949

Background: The use of closed-suction drains after penile implant surgery remains controversial. The use of BioPatch®, a protective disk with chlorhexidine gluconate, may reduce the incidence of drain-related infections, one of the feared complications of drains. The aim of this study is to describe a novel use of BioPatch® in penile implant surgery as well as additional techniques that may potentially minimize infection rates. Methods: A description of operative technique and a review of the literature will be presented. A novel approach to penile implant surgery that may reduce infection rates is described. Results: A simple technique is described for surgeons considering implementation of closed-suction drains after penile implant surgery. Conclusion: Although randomized controlled studies looking at drain placement following penile implant surgery are lacking, the addition of BioPatch® and the implementation of surgical techniques as described are potentially helpful in preventing infection following this surgery.

Cazorla, Arnault; Algros, Marie-Paule; Bedgedjian, Isabelle; Chabannes, Eric; Camparo, Philippe; Valmary-Degano, Séverine

2014 Current Urology

doi: 10.1159/000365675pmid: 26195950

Primary tumors of the epididymis are rare. Adenomatoid tumors are benign, usually found within the wall of fallopian tubes or beneath the uterine serosa. They are most frequently diagnosed as benign tumors of the epididymis and represent 30% of paratesticular tumors. The origin of this tumor is mesothelial cells. Leiomyoma are less common in the paratesticular localization. The origin of this tumor is smooth muscle cells. Clinically, these tumors are indistinctive with a painless mass of the scrotum. Here, we reported a case of combined leiomyoadenomatoid tumor. The histogenesis of this lesion remains unknown. This entity can be the result of a collision of the two tumors, or it can be a subtype of adenomatoid tumors with smooth muscle hyperplasia. This case showed the difficulty that occurs in the identification of this kind of lesion. Only one case of this entity in the epididymis was described in the literature. Leiomyoadenomatoid tumor is a benign neoplasm. In our case, this lesion was surgically removed in toto and no recurrence was observed.

Nozaki, Tetsuo; Kato, Tomonori; Komiya, Akira; Fuse, Hideki

2014 Current Urology

doi: 10.1159/000365676pmid: 26195951

Liver retraction is necessary for optimal exposure during laparoscopic right renal surgery. We described a patient who developed fulminant liver failure as a result of liver retractor-induced excessive ischemic changes in the right lobe of the liver. A 37-year-old male underwent a right side laparoscopic pyeloplasty for ureteropelvic junction obstruction. At the beginning of the operation, a small snake retractor was placed through a 5-mm port under direct vision. The liver was lifted in the appropriate direction to optimize exposure by using the laparoscope holder. The operation was prolonged. However, we achieved significant improvements in the efficiency of liver retraction using the holder. On the first postoperative day, the patient's serum levels of GOT, GPT and LDH had remarkably increased. A computerized tomogram confirmed the presence of excessive ischemic changes of the right lobe of the liver. Our method which used a laparoscope holder device for liver retraction maintained a better surgical field. However, neglecting to make minor adjustments to the positioning of the retractor can cause significant pressure on the liver parenchyma in a single area. As surgical procedures increase in complexity, the surgeon should keep these potential side effects in mind and shift the retraction point at regular intervals. In this report, we discussed various types of retractor-related liver injuries and their management, and highlighted the importance of intermittent release of retraction during prolonged surgery.

Ellimah Mensah, Elsie; Fazili, Zahoor; Nayeb, Lamia; Marsh, Howard

2014 Current Urology

doi: 10.1159/000365677pmid: 26195952

A 74-year-old man presented with a history of collapse and abdominal pain. Initial imaging showed a left sided preirenal collection. The initial working diagnosis was perirenal hematoma secondary to renal trauma. Subsequent patient deterioration led to further imaging which led to the diagnosis of a duodenal perforation with tracking of duodenal contents into the left perirenal space. This important differential should be a consideration in cases of perinephric collections of unknown etiology.

Dubowitch, Elliot; Cahn, David; Ross, Curtis; Husain, Ali; Harkaway, Richard; Metro, Michael; Ginsberg, Philip

2014 Current Urology

doi: 10.1159/000365678pmid: 26195953

Pelvic organ prolapse can affect urinary tract function by reducing flow rates and increasing post void residual urine volumes secondary to outlet obstruction. If the diagnosis is missed or left untreated, pelvic organ prolapse can lead to acute renal injury, chronic renal failure or even end stage renal disease. Herein, we present a case of a patient who presented to Albert Einstein Medical Center in Philadelphia, PA with urinary retention and acute kidney injury secondary to complete uterine prolapse, also referred to as procidentia.

Foote, Christopher; Henderson, Sean; Reddy, Shilpa; Horrow, Mindy; Leighton, John; Cahn, David; Diorio, Greg; Bickell, Michael; Ginsberg, Phillip; Metro, Michael

2014 Current Urology

doi: 10.1159/000365679pmid: 26195954

Non-Hodgkin's lymphoma (NHL) represents 4% of newly diagnosed cancer in 2013 with a 59-82% 5-year survival depending on the tumor location. Primary presentation of lymphoma consists of lymphadenopathy or swelling of the lymph nodes and non-specific systemic symptoms such as fevers, night sweats, and weight loss. Less commonly, NHL arises from non-lymphoid tissue. We report a unique case of NHL arising from the ureteral wall which was visualized via non-contrast CT and direct vision through ureteroscopy.

Sepúlveda, Luis; Gorgala, Tiago; Lage, José; Monteiro, Ana; Rodrigues, Filipe

2014 Current Urology

doi: 10.1159/000365680pmid: 26195955

Most cases of undescended testis are asymptomatic and diagnosed in the first years of life. In some rare cases the diagnosis is established during childhood due to sudden torsion of the spermatic cord. Its presence in adults is rare and its precipitance of an acute abdomen or incarcerated inguinal hernia as first clinical manifestation is seldom described in the literature. In this report, we described a case of an elderly male with undescended testis associated with a reactive inflammatory mass incarcerated at the superficial inguinal ring. To the best of our knowledge, this has not been previously described.

Robinson, Jed C.; DeFranco, John N.; Hollowell, Courtney M. P.

2014 Current Urology

doi: 10.1159/000365681pmid: 26195956

Malignant mesothelioma of the epididymis is a very rare tumor. We report a case of a 33-year old male with a left hydrocele that presented for evaluation of infertility. Scrotal ultrasound revealed a left extratesticular mass. Final pathology revealed malignant mesothelioma involving the epididymis, with well differentiated epithelioid morphology. Metastatic workup was negative.