Current Urology

Tonyali, Senol; Yilmaz, Mehmet

2017 Current Urology

doi: 10.1159/000447186pmid: 29463969

Background/Aims: Interstitial cystitis (IC)/bladder pain syndrome (BPS) is a debilitating disease characterized with urgency, frequency, and pelvic pain affecting especially women. Sexual dysfunction in female patients with IC/BPS consists of dyspareunia, altered sexual desire and orgasm frequency and insufficient lubrication is reported to negatively affect the patient's quality of life. In the present study, we aimed to determine the association between IC/BPS and sexual dysfunction and improvement in sexual dysfunction related to given treatments. Methods: A PubMed/Medline and EMBASE search was conducted using keywords: “interstitial cystitis”, “sexual dysfunction”, and “bladder pain syndrome”. Conclusion: Several studies have been conducted to determine the relation between IC/BPS and sexual dysfunction. And also limited studies focusing on IC/BPS specific treatments reported significant improvements in sexual function after either oral or intravesical treatment. However, given the used different questionnaires, study protocols, patient characteristics, previous treatments and follow-up period, it is not possible to make a head-to-head comparison of the treatment effects on sexual function. Further, randomized controlled studies are needed to confirm these results and make a comparison between effects of various treatment modalities on sexual functioning in IC/BPS.

Yucel, Cem; Keskin, Mehmet Zeynel; Peskircioglu, Cetin Levent

2017 Current Urology

doi: 10.1159/000447187pmid: 29463970

Objective: This study aimed to evaluate the effects of transdermal testosterone administration on lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). Materials and Method: Sixty-two male patients with Ageing Male Symptom Questionnaire (AMS-Q) scores over 27 and a total serum testosterone level below 350 ng/dl (12.1 nmol/l) who presented to our urology clinic with complaints of LUTS and ED, were enrolled in this study. Uroflowmetry and the International Prostate Symptom Scale were used to evaluate the severity of LUTS. The International Index of Erectile Function was used to detect the severity of ED. In addition, the AMS-Q was used to quantify the severity of hypogonadism. We randomly divided patients into 2 groups. Thirty-one patients in the first group had transdermal testosterone administered at a daily dose of 50 mg (a sachet of 5 g) on the skin for 3 months. In the second group, 31 patients had a placebo administered for 3 months. The scales were recompleted based on interviews and uroflowmetry was repeated during checks of the patients performed in the first and third months. Results: We detected a decrease in AMS-Q scores and an increase in maximum uroflow rate values and the International Index of Erectile Function scores in the first group compared with the placebo group. Although a decrease was detected in post-treatment International Prostate Symptom Scale scores in the first group, it was not regarded as statistically significant. Conclusion: This study revealed that testosterone replacement therapy is effective in improving LUTS and ED symptoms.

Hannick, Jessica H.; Adams, William; Sandhu, Jasmin; Kliethermes, Stephanie; Mazur, Daniel J.; Meeks, Joshua J.; Sobek, Sabine; Coogan, Christopher L.; Sadaf, Aliyah; Quek, Marcus L.; Schulwolf, Elizabeth

2017 Current Urology

doi: 10.1159/000447188pmid: 29463971

Background/Aims: The morbidity of radical cystectomy remains high. A multidisciplinary approach utilizing hospitalist comanagement may improve outcomes. It is unclear what factors should be considered to determine which patients might benefit from this approach. We sought to determine if there are differences between the perceived need for co-management between urologists and hospitalists. Preoperative variables were analyzed to determine which factors might be associated with need for comanagement. Methods: A case-based survey was emailed to urologists and hospitalists at 3 academic institutions to investigate perceptions regarding need for inpatient medical comanagement of fictitious patients following cystectomy. Decisions were rated based on patient comorbidities, age, race, sex, cancer stage, neoadjuvant therapy, alcohol intake, performance status, and English literacy. A Wilcoxon rank sum test assessed each question for differences. A Mantel-Haenszel chi-square test was used to assess whether the proportion of respondents who advocated for comanagement increased as Charlson comorbidity score increased. Results: The most significant determinant of need for postoperative comanagement was patients' comorbidities. Urologists and hospitalists did not differ significantly in beliefs regarding need for comanagement. Conclusion: The most important determining factor for comanagement was presence of comorbidities. Further studies are needed to evaluate the impact of this multidisciplinary approach.

Strassberg, Donald S.; Zavodni, Suzanne M.; Gardner, Paul; Dechet, Christopher; Stephenson, Robert A.; Sewell, Kelsey K.

2017 Current Urology

doi: 10.1159/000447189pmid: 29463972

Objectives: To compare robotic-assisted laparoscopic prostatectomy with conventional retropubic radical prostatectomy in maintaining pre-surgery levels of urinary and sexual functioning and to evaluate the efficacy of nerve sparing in prostatectomies in protecting urinary functioning. Material and Methods: Patients (n = 385) receiving both surgical procedures were surveyed prior to surgery. Multiple measures, including the Expanded Prostate Cancer Index Composite, the Sexual Health Inventory for Men, and the International Prostate Symptom Score, assessed sexual and urinary function at an average of 12 months post-surgery. Results: Across multiple measures, while controlling for pre-surgical sexual functioning, robotic-assisted surgery did not offer an advantage in maintaining sexual or urinary function an average of a year following the prostatectomy. Bilateral nerve sparing offered a strong and reliable advantage in the maintenance of sexual function, but not so regarding urinary function. Conclusion: While robotic-assisted prostatectomies may offer a number of medical advantages over open procedures, we found no significant effect on important quality of life outcomes associated with the technique.

O'Connor, Eabhann M.; Nason, Gregory J.; Kiely, Eamon A.

2017 Current Urology

doi: 10.1159/000447190pmid: 29463973

Introduction: The absence of guidelines in the management of extramural malignant ureteric obstruction leads to confusion in decision making and in the interaction between urology and other clinical disciplines. In this study, we surveyed consultant urologists with the goal of achieving a better consensus on optimal management options. Methods: A multiple choice survey was sent via the online survey tool “SurveyMonkey” to all consultant urologists practicing in the Republic of Ireland. Results: There was a response rate of 57.5% (n = 23). Twenty-two (96%) consultants consider the use of percutaneous nephrostomy with placement of antegrade ureteric stent but only 22% (n = 5) would consider using a metallic stent. Eleven (48%) respondents favor retrograde stenting in the first instance with an equal proportion choosing an antegrade method. Nine (39%) consultants perform the initial stent change at 4-6 months, 8 (35%) at 2-4 months, and 1 at < 2 months and 6-10 months respectively. Total 59% (n = 13) of respondents felt that the duration of expected patient survival influenced their decision and agreement to stent with 42% (n = 8) saying this survival would need to be > 6 months and 82% (n = 18) were generally happy with the level of ongoing communication between urology and the primary service managing the patient. Conclusion: There is a lack of consensus regarding the management of this challenging problem, particularly with regard to timing of first stent change and whether to initially use an antegrade or retrograde approach. This reflects the heterogeneous patient cohort and the important factors of life expectancy and patient co-morbidities.

Adam, Ahmed; Ras, Reuben; Bhattu, Amit S.; Raman, Avi; Perera, Marlon

2017 Current Urology

doi: 10.1159/000447191pmid: 29463974

Background: To perform the first comparative bibliometric analysis of the “Top 100 (T100) cited articles in prostate cancer (PCa)”. Materials and Methods: A comprehensive search using the Web of Science Database (v 5.21) covering the Web of Science™ Core Collection, BIOSIS Previews, Central Contents Connect, KCI-Korean Journal Database, MEDLINE, SciELO Index (February 2016) was performed, for all articles relevant to PCa. Results: The T100 were cited 582 to 3,387 times, and were published from 1966 to 2012. The top 3 subcategories associated with PCa included: genetics/biomarkers (n = 34), management (n = 25), and physiology (n = 11). T100 contributions from USA (n = 86), were most prominent. If the regional citation was corrected for percentage on research (citation record/percentage gross domestic product on research) a variation in the ranking was noted. Conclusion: The first bibliometric analysis in the field of PCa is presented. Regions that predominate the T100, include the United States and Europe. Articles published in higher impact factor journals, in English medium and content related to PCa research associated with genetics/bio-markers have the highest citation potential.

Luciani, Lorenzo Giuseppe; Mattevi, Daniele; Mantovani, William; Cai, Tommaso; Chiodini, Stefano; Vattovani, Valentino; Puglisi, Marco; Tiscione, Daniele; Anceschi, Umberto; Malossini, Gianni

2017 Current Urology

doi: 10.1159/000447192pmid: 29463975

Background: To compare the surgical outcomes of radical prostatectomy (RP) performed via 3 different approaches: retropubic (RRP), laparoscopic-assisted (LRP), and robot-assisted (RARP), in a single non-academic regional center by a single surgeon. Materials and Methods: The data of patients undergoing RP from 2005 to 2014 were reviewed. The standard approach changed through the years: RRP (n = 380, years 2005 to 2008), LRP (n = 240, years 2009 to 2011), and RARP (n = 262, years 2012 to 2014). Our analysis included the last consecutive 100 RP for each surgical technique by a single surgeon. A logistic regression model adjusted for pre-and postoperative variables was done to evaluate whether transfusion, conversion, and post-operative complication rates were influenced by the approach. Results: RARP was associated with significantly lower blood loss (400 vs. 600 and 600 ml, respectively), transfusion (6 vs. 21 and 21%, respectively), and shorter hospital stay (6 vs. 7 and 8 days, respectively), compared to LRP and RRP, and a lower conversion rate (1 vs. 12%) compared to LRP. Multivariate analysis adjusted for confounders confirmed that the risk of transfusion and conversion was significantly lower in the RARP group compared to the LRP and RRP groups. The RARP group was also associated with a significantly lower risk of complications compared to the RRP group and with a trend in favor of the RARP group compared to the LRP group. The 1-year continence rate was significantly higher in the RARP group compared to the RRP and LRP groups (80 vs. 72 and 68%, respectively). Conclusion: The surgical approach affected the operative outcomes in a regional setting. The advantages of RARP over RRP (complications, transfusion, conversion, hospital stay, 1-year continence) were over LRP as well, with the only exception being complications.

Adam, Ahmed

2017 Current Urology

doi: 10.1159/000447193pmid: 29463976

Objective: To describe a simple, novel method to achieve ureteric access in the Cohen crossed reimplanted ureter, which will allow retrograde working access via the conventional transurethral method. Materials and Methods: Under cystoscopic vision, suprapubic needle puncture was performed. The needle was directed (bevel facing) towards the desired ureteric orifice (UO). A guidewire (with a floppy-tip) was then inserted into the suprapubic needle passing into the bladder, and then easily passed into the crossed-reimplanted UO. The distal end of the guidewire was then removed through the urethra with cystoscopic grasping forceps. The straightened ureter then easily facilitated ureteroscopy access, retrograde pyelogram studies, and JJ stent insertion in a conventional transurethral method. Results: The UO and ureter were aligned in a more conventional orthotopic course, to allow for conventional transurethral working access. Conclusion: A novel method to access the Cohen crossed reimplanted ureter was described. All previously published methods of accessing the crossed ureter were critically appraised.

Löhmann, Christian; Sparwasser, Christoph; Hackenbroch, Carsten; Martinschek, Andreas

2017 Current Urology

doi: 10.1159/000499267

An ileal conduit is a frequently used urinary diversion following cystectomy. Common complications include urinary tract infections, hydronephrosis due to stenosis of ureter and hernias. Hemodynamic-relevant bleeding from the conduit is a very rare occurrence. We report on a patient with massive bleeding from her ileal conduit due to intra-abdominal varices and portal hypertension and its diagnostic and therapeutic management by varices sclerotherapy. Even though bleeding from the conduit is very rare, the urologist should know how to manage this life-threatening complication.

Dikmen, Ayse V.; Guneri, Cagri; Yalcin, Serdar; Acikgoz, Onur; Ak, Esat; Cetiner, Sadettin

2017 Current Urology

doi: 10.1159/000447194pmid: 29463977

A 74-year-old male patient with prostate cancer under remission was admitted with left inguinoscrotal swelling. He underwent scrotal ultrasound demonstrating a giant in-guinoscrotal hernia. Contrast-enhanced computerized tomography of the abdomen and pelvis demonstrated a left pelvic kidney associated with severe hydroureteronephrosis secondary to a ureteral inguinoscrotal hernia. Upon exploration with left inguinal incision, a paraperitoneal ureteral in-guinoscrotal hernia and a hypertrophic left spermatic cord were observed. The elongated and tortuous left ureter, being pulled down to the scrotum by the hernia, was released from the herniating tissues fullfilling left hemiscrotum. The ureter was tapered followed by ureteroureterostomy. The accompanying left spermatic cord was excessively elongated and curled, necessitating cordectomy. The hernia was repaired with prolene mesh after removal of herniating peritoneal tissue. This is a rare case of a paraperitoneal ureteral inguinoscrotal hernia of the left pelvic kidney.

Alexandrov, Philip; Tan, Wei Phin; Elterman, Lev

2017 Current Urology

doi: 10.1159/000447195pmid: 29463978

Dermatillomania is a rare disease that seldom affects the genitals. Genital dermatillomania has not yet been recognized as a separate entity within the disease. The purpose of the report is to highlight a new facet of dermatillomania and inform urologists that dermatillomania could be a potential reason for genital ulcers. This report documents 2 cases of genital dermatillomania which vary in severity from mild (case 1), where the patient's ulcers healed after extensive counseling, to extremely dire (case 2), where the patient lost his penis after recurring ulcers and multiple reconstructive surgeries. Clinicians should be aware of the characteristics of dermatillomania to ensure that appropriate therapy can be promptly initiated to prevent morbidity.