Current Urology

2015 Current Urology

doi: 10.1159/000443294

Giannitsas, Konstantinos; Athanasopoulos, Anastasios

2015 Current Urology

doi: 10.1159/000365711pmid: 30263021

Objective: The purpose of this study was to summarize developments during the last decade in intravesical treatments for radiation cystitis. Radiation used to treat pelvic malignancies inadvertently damages the urinary bladder leading to acute as well as chronic symptoms. Late sequelae may take years to develop and include storage symptoms and hematuria, which may be life-threatening in severe cases. Conservative measures, surgical interventions, and systematically or intravesically administered agents represent treatment choices. Methods: MEDLINE and PubMed were searched to retrieve clinical data on the subject, published in peer-reviewed journals from 2002 onwards. Results: Historically referenced intravesical treatments such as aluminium salts and formalin, were not investigated in recent studies. The replenishment of the glycosaminoglycan layer of the bladder mucosa shows promise in reducing acute symptoms and possibly long-term bladder damage, but needs further investigation. Botulinum toxin also represents a new alternative treatment for radiation cystitis but its mechanism of action and efficacy should be evaluated in future trials. Conclusion: There is a paucity of data in recent literature regarding the management of radiation cystitis, at least by means of intravesical agents. The replenishment of the glycosaminoglycan layer of the bladder mucosa and the administration of botulinum toxin show promise, but need further investigation.

Alsinnawi, Mazen; Egan, Sean; Groarke, Emma; McCullagh, Eddie; Fennell, Jerome; Flynn, Robert; McDermott, Ted; Grainger, Ronald; Thornhill, John

2015 Current Urology

doi: 10.1159/000365712pmid: 30263022

We assessed patients who had pre-operative urine that grew gentamicin-resistant bacteria but were given gentamicin prophylaxis because urine result was not available. Our aim was to identify postoperative-sepsis rates, risk factors to acquire resistant-bacteria, and to optimize our prophylactic regime. Total 4,933 pre-operative urine-samples were reviewed and those positive for E.coli, Klebsiella or Proteus (n = 979) were analysed. Forty-four (4.4%) had gentamicin-resistant bacteria. Of those, 8 were immunosuppressed, 38 (86%) had a recent urological procedure and 29 (66%) had received recent antibiotics. Eighteen (41%) had a urinary catheter and 11 (25%) had double J stent. Three patients (7%) developed post-operative sepsis/febrile urinary tract infection. Although the majority of gentamicin-resistant samples represent colonization, the incidence of post-operative sepsis was significant. Amikacin may be a superior alternative. Our new protocol aims to pre-operatively identify patients at risk of prophylaxis failure with gentamicin and select amikacin as an alternative.

Wood, Lauren N.; Souders, Colby E.; Freedman, Andrew L.

2015 Current Urology

doi: 10.1159/000365713pmid: 30263023

Objective: The mercaptoacetyltriglycine-3 (MAG-3) diuretic renal scan is frequently used to diagnose obstruction in children with hydronephrosis. However, it remains unclear whether a reassuring MAG-3 diuretic scan in the presence of high-grade hydronephrosis accurately predicts the absence of obstruction. We sought to determine if a reassuring nuclear scan can accurately identify patients with high-grade hydronephrosis that can be safely observed. Materials and Methods: We retrospectively reviewed the course of 22 children (25 renal units) ages 0-3 months with significant hydronephrosis (Society of Fetal Urology grade 3-4) detected prenatally. All patients underwent a MAG-3 diuretic nuclear renal scan. Results: Twenty-two patients with 25 renal units were included, 19 with grade 3 and 6 with grade 4 hydronephrosis on ultrasound. Sixteen renal units had a reassuring nuclear scan (T ½ < 10 minutes, average 5.9, range 2-9). Nine renal units had indeterminate scans (T ½ 10-20 minutes, average 12.8, range 10-17). Fifteen of 16 (94%) kidneys with a reassuring nuclear scan had complete resolution of their hydronephrosis. One patient with an initially reassuring nuclear scan underwent pyeloplasty after persistent grade 4 hydronephrosis one year later prompted a repeat MAG-3 indicating obstruction. Eight of 9 (89%) patients with an indeterminate T ½ of 10-20 minutes had complete resolution of their hydronephrosis. One patient was lost to follow up. Average length of follow up and time to resolution was 23.6 months (range 4-61 months). Conclusion: In pediatric patients with persistent antenatally detected hydronephrosis, a reassuring MAG-3 can allow for safe observation in the vast majority. Only one of 24 renal units with follow-up progressed to obstruction. All patients treated without surgery had complete resolution of their hydronephrosis. Observation with serial ultrasounds may be an appropriate alternative to operative management, even in patients with moderate to severe hydronephrosis in the presence of a reassuring or indeterminate MAG-3 diuretic scan.

James, Katherine; Vasdev, Nikhil; Mohan-S, Gowrie; Lane, Tim; Adshead, James M.

2015 Current Urology

doi: 10.1159/000365714pmid: 30263024

We present the largest reported consecutive series on robotic partial cystectomy in the management of patients with primary urachal adenocarcinoma. Eight patients with primary urachal adenocarcinoma of the urinary bladder underwent a robotic partial cystectomy. The mean operative time, including trocar placement as well as robotic docking and closure was 184 minutes (range 130-240 minutes). The mean console time was 120 minutes (range 70-170 minutes). The mean estimated blood loss was 50 ml. There were no conversions to open surgery. The mean hospital stay was 4 days (range 3-7 days). Drain removal was performed at postoperative day 2.5 (range 2-3 days). Each patient underwent postoperative cystography on day 10 postoperatively and no patients had evidence of extravasation. There were no major complications. Histological analysis of all tumors confirmed primary urachal adenocarcinoma of the urinary bladder. There were no positive surgical margins. At a mean follow up of 32 months none of the patients have had a disease recurrence with any evidence of disease recurrence. Our initial data indicates that with robotic partial cystectomy for primary urachal adenocarcinoma of the urinary bladder is a safe surgical and oncological procedure. However, longer follow up and larger patient numbers are required to validate this further.

Pence, Sadrettin; Ikizceli, Ibrahim; Ozbek, Emin; Tiryakioglu, Necip Ozan; Eren, Hilal; Polat, Emre Can; Pence, Halime Hanım

2015 Current Urology

doi: 10.1159/000365715pmid: 30263025

Introduction: Lower bone mineral density (BMD) and reduced Oxalobacter formigenes colonization are common findings in urolithiasis patients. But none of the studies conducted investigated the relationship between decreased bone mineral density and reduced Oxalobacter colonization. Here we evaluated the relation between BMD and O. formigenes colonization in urolithiasis patients. Materials and Methods: 50 stone formers (48.9 ± 11.9 years) and 50 control (47.2 ± 13.4 years) adult male subjects were included in the study. Alterations in O. formigenes colonization were determined as absolute O. formigenes count from fecal samples by real time polymerase chain reaction using species specific primers. BMD was evaluated from t- and z- scores calculated by using dual energy absorptiometry in the total femoral neck and lumbar spine (L2-L4). Results: Low BMD was observed in 18 (36%) urinary stone forming patients and in 7 (14%) control subjects in the lumbar area (p < 0.05). The mean O. formigenes count in stone formers and control subjects were 19,257 (5,791 ± 1,117.93) and 143,850 (2,815,725 ± 3,946,044.7) (p < 0.05) respectively. We observed a correlation between decreased lumbar BMD and O. formigenes colonization and testosterone levels in stone formers. Our results indicated that diminished O. formigenes colonization in the gut of urinary stone forming subjects was associated with reduced BMD.

Ohta, Shoichiro; Kamoshida, Shingo; Tashiro, Akito; O-ono, Kei-ichi; Yasuno, Nobuhiro; Kamakura, Yasuo; Yasuda, Masanori

2015 Current Urology

doi: 10.1159/000365716pmid: 30263026

Thymidylate synthase (TS), a key enzyme in DNA synthesis, is over-expressed in a variety of cancer cells. 5-Fluorouracil, an anticancer agent clinically used against various cancers, including prostate cancer, inhibits DNA synthesis by binding TS. In this study, we investigated expression of TS in prostate cancer and its prognostic significance. Seventy-five prostatic tissue specimens were obtained from patients who had undergone prostate biopsy for diagnosis of prostate cancer. We analyzed the cancerous tissue specimens for TS expression using immunohistochemistry. TS expression was significantly increased in patients with bone metastasis. No relationship was found between expression of TS and the other clinicopathological findings. Because TS expression could be used as a prognostic parameter in patients with prostate cancer, an accurate prediction of prognosis might help to select patients for more intensive surgical, hormonal, or chemotherapeutic approaches, including 5-fluorouracil. Additional prospective studies are warranted to define the role of TS in selecting patients for adjuvant therapy for prostate cancer.

Barqawi, Al; Krughoff, Kevin; Li, Hongli; Patel, Nayana U.

2015 Current Urology

doi: 10.1159/000365717pmid: 30263027

Introduction: To develop and evaluate a technique of 3.0 Tesla magnetic resonance (MR) guided laser ablation based on 3-dimentional mapping biopsy (3DMB) for low risk prostate cancer. Materials and Methods: The study was approved by the institutional review board and was the Health Insurance Portability and Accountability Act compliant. The prospective study was performed on seven 3DMB proven low risk prostate cancer patients. In the first phase of the procedure the patient's prostate was aligned to a position concordant with prior 3DMB using the transperineal grid and fiduciary golden marker coordinates. In the second phase ablation was performed using MR thermometry to determine the ablation endpoint and lesion coverage. Immediately after treatment dynamic contrast-enhanced MR imaging was done. Prostate-specific antigen testing was performed 3 and 12 months after the treatment and compared by ANOVA test. A follow up biopsy was done one year following ablation. Results: The entire procedure took less than 2 hours and all patients tolerated the procedure well. There was a significant difference in prostate-specific antigen value before and 3 months after the treatment (p = 0.005). Four out of 6 patients had positive follow up biopsy for cancer. Conclusion: This study verifies the feasibility and safety of treating low risk prostate cancer with laser therapy guided by 3.0T MR imaging based on 3DMB.

Lacefield, Evan; Raheem, Omer A.; Cox, Roni; Davis, Rodney; Kamel, Mohamed H.

2015 Current Urology

doi: 10.1159/000365718pmid: 30263028

Paraganglioma of the urinary bladder is an uncommon clinical entity. Neuroblastoma of the urinary bladder is another rare tumor with only 7 reported cases, all in children. This report presents the case of a composite paraganglioma and neuroblastoma in a 45 year-old male who presented with dysuria and flank pain. On the computerized tomography scan, the bladder wall overlying the tumor was smooth and the mass had a large exophytic component. The initial diagnosis was paraganglioma on transurethral resection. Following partial cystectomy and bilateral pelvic lymph node dissection, pathology confirmed a composite tumor consisting of paraganglioma and neuroblastoma. To our knowledge, this is the first report of such a composite tumor involving the bladder.

O´Kelly, John; Nason, Gregory J.; Shilling, Christine; Redmond, Maeve; Little, Dilly M.

2015 Current Urology

doi: 10.1159/000365719pmid: 30263029

Introduction: Non-islet-cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome encountered in the setting of a wide variety of benign and malignant tumors. Case presentation: A 46 year old lady was referred to our unit, with a large left sided retroperitoneal mass found on surveillance imaging on a background of renal sarcoma 6 years previously, for which she had a left nephrectomy. She had initially presented with symptoms of hypoglycaemia which was a result of tumor secretion of insulin like growth factor 2. She was counselled regarding the recurrence and listed for excision. On the day of surgery she developed symptomatic hypoglycaemia. The tumour was completely resected from the nephrectomy bed. The tumour was histologically identical to the initial tumor. Conclusion: We report a rare case of recurrent non-islet cell hypoglycaemia in a lady with recurrent malignancy. Her hypoglycaemic episodes fully resolved on each occasion following resection. There have been reports of NICTH associated with recurrent retroperitoneal tumours and synchronous thyroid tumours and uterine leiomyomata. NICTH should be considered in patients with a known malignancy who present with recurrent hypoglycaemia. This is, to the best of our knowledge at the time of writing, the first case in the literature of recurrent NICTH secondary to recurrent renal sarcoma.