Current Urology

Inouye, Brian M.; Hughes,Jr, Francis M.; Sexton, Stephanie J.; Purves, J. Todd

2017 Current Urology

doi: 10.1159/000447196pmid: 29593464

Irritative voiding symptoms (e.g. increased frequency and urgency) occur in many common pathologic conditions such as urinary tract infections and bladder outlet obstruction, and these conditions are well-established to have underlying inflammation that directly triggers these symptoms. However, it remains unclear as to how such diverse stimuli individually generate a common inflammatory process. Jürg Tschopp provided substantial insight into this conundrum when, working with extracts from THP-1 cells, he reported the existence of the inflammasome. He described it as a structure that senses multiple diverse signals from intracellular/extracellular sources and pathogens and triggers inflammation by the maturation and release of the pro-inflammatory cytokines interleukin-1β and interleukin-18. Recently, many of these sensors were found in the bladder and the nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3, has been shown to be a central mediator of inflammation in several urological diseases. In this review, we introduce the nucleotide-binding domain, leucine-rich-containing family, pyrin domaincontaining-3 inflammasome, highlight its emerging role in several common urologic conditions, and speculate on the potential involvement of other inflammasomes in bladder pathology.

Gadelkareem, Rabea A.

2017 Current Urology

doi: 10.1159/000447197pmid: 29593465

Introduction: Surgical never events are preventable harmful non-intentional human errors. Urology is a common surgical specialty for their occurrence. Patients and Methods: A retrospective search of our center's data was done during the period 2006-2016 for surgical never events. Each included case was studied for the primary diagnosis, procedure, and subspecialty, never event type and timing, needed extra-interventions, urologist/procedure proportioning, outcomes, and possible underlying causes of the event. Results: Of more than 55,000 different urological interventions, 61 patients were involved in never events. Wrong procedures represented 75% of the never events, and endourology and urolithiasis subspecialties were more often involved. The main detectable underlying factor was the disproportion between the levels of the procedure class and the qualification of the urologist (41%). Thirty-four cases had extra-procedures. The short-term harm effect represented the final outcome in 42% of all events. Death, permanent organ loss, and long-term harm represented 20, 15, and 23%, respectively. Conclusion: Urological surgical never events are rare, but their final outcomes could be catastrophic, even leading to death.

Singh, Aditya K.; Shukla, Pushpendra K.; Khan, Sartaj W.; Rathee, Vazir S.; Dwivedi, Udai Shankar; Trivedi, Sameer

2017 Current Urology

doi: 10.1159/000447198pmid: 29593466

Purpose: A modified Clavien classification system has been proposed to grade perioperative complications. We share our experience in grading the complications of percutaneous nephrolithotomy (PNL), according to this new classification. Methods: A total of 809 PNLs performed between 2010 and 2014 were reviewed retrospectively. The modified Clavien classification system, which classifies the perioperative complications into 5 grades, was applied. Grade wise comparison of complications between the patients with simple and complex calculi was done. We also carried out a univariate analysis of different predictors of complications after surgery. Results: A total of 253 perioperative complications were observed in 237 (29.29%) patients. Most complications were related to bleeding and urinary leakage. Patients with complex calculi had significantly more number of complications across all Clavien groups. In a univariate analysis, positive preoperative urine culture and multiple access for stone clearance were identified to be the independent predictors of complications. Conclusion: The modified Clavien system is a simplistic grading system for classification of postoperative complications. However, it suffers from various shortcomings. Therefore, till the proposition of a more comprehensive classification system, the modified Clavien system is useful for reporting the complications and short-term outcomes of PNL.

Porcaro, Antonio B.; Mattevi, Daniele; Novella, Giovanni; De Luyk, Nicolò; Corsi, Paolo; Bizzotto, Leonardo; De Marchi, Davide; Sebben, Marco; Tafuri, Alessandro; Inverardi, Davide; Processali, Tania; Cerruto, Maria A.; Brunelli, Matteo; Siracusano, Salvatore; Artibani, Walter

2017 Current Urology

doi: 10.1159/000447199pmid: 29593467

Objectives: To investigate associations of the transitional zone volume (TZV) with intraprostatic chronic inflammatory infiltrate (CII) and prostate cancer (PCa) risk in patients undergoing a first random biopsy set. Materials and Methods: The study included a homogenous population of 596 patients. The volume of the prostate and TZV were separately measured. Independent associations were investigated by multivariate logistic regression analysis. Results: The median TZV was 18 ml, CII was detected in 157 cases (26.3%), and PCa was present in 292 patients (49%). TZV was the only independent clinical factor associated with CII risk (OR = 1.014). After correcting for CII (OR = 0.276; p < 0.0001), independent factors associated with PCa risk included age (OR = 1.066), prostate specific antigen (OR = 1.177), TZV (OR = 0.919), and an abnormal digital rectal exam (OR = 2.024). Conclusion: In a patient population undergoing a first random prostate biopsy set because of suspected cancer, independent associations were detected among TZV, CII, and PCa. The association between TZV and CII was direct, but the relation between TZV and PCa was inverse. The measurement of the volume of the transitional zone was a useful parameter for evaluating chronic intraprostatic inflammation and PCa risk.

Babak, Javanmard; Behruz, Fadavi; Mohammadreza, Yousefi; Morteza, Fallah-Karkan

2017 Current Urology

doi: 10.1159/000447200pmid: 29593468

Introduction: To study the stimulating effect of human chorionic gonadotropin (hCG) on spermatogenesis in patients with varicocele and infertility undergoing varicocelectomy. Materials and Methods: In the study, 188 infertile patients with varicocele were included. Open inguinal varicocelectomy was performed. They were randomized into 2 groups and hCG (91 patients) was administered intramuscularly by dosage of 5,000 international units every week for 3 months. A semen analysis was obtained at 6 months, post-operatively and cases were followed for 2 years for pregnancy report. Results: Semen analysis of the patients shows a significant improvement in all parameters 6 months after varicocelectomy without any superiority between the 2 groups. During the follow-up, 56 couples (61.5%) in hCG treated and 22 couples (22.7%) in the group treated only by varicocelectomy achieved pregnancy. Patients treated with varicocelectomy plus hCG therapy had a significant superior pregnancy rate compared to the other group (P=0.0001). Conclusion: Administration of hCG in this group of infertile patients might be helpful in order to enhance pregnancy rate. However some more conclusive studies are needed to be able to recommend such therapy for infertile men due to varicocele.

Paul, Charles J.; Brooks, Nathan A.; Ghareeb, George M.; Tracy, Chad R.

2017 Current Urology

doi: 10.1159/000447201pmid: 29593469

Background/Aims: Many providers elect to place a stent following ureteroscopy for nephrolithiasis, but little data exists on the optimal duration to leave a stent. We sought to determine whether there are any differences in post-operative outcomes for patients with a 3 versus 7-day stent following ureteroscopy. Methods: We retrospectively reviewed 247 patients who underwent unilateral ureteroscopy with lithotripsy, 79 of whom removed a stent with an extraction string at 3 or 7 days post-operatively. These 2 groups were compared with regard to demographic information, pre-operative variables, and post-operative outcomes. Results: Of all patients, 33% experienced a post-procedure related event (phone call, extra clinic visit, and emergency department visit) within 30 days of their procedure, 39% of 3-day stent patients compared to 21% of 7-day patients (p = 0.11). Within the 3 days following stent removal, 3-day stent patients were significantly more likely to have a post-procedure related event than 7-day patients (23 vs. 3%, p = 0.026). Conclusion: One third of patients with a post-operative ureteral stent will seek medical care in the 30 days following ureteroscopy. Leaving a stent for 3 versus 7 days may lead to worse outcomes with regard to post-operative events and fank pain.

Rai, Priyanka; Srivastava, Alok; Dhayal, Ishwar R.; Singh, Sanjeet

2017 Current Urology

doi: 10.1159/000447202pmid: 29593470

Objectives: To compare bipolar vaporization of prostate (BPVP) with photoselective vaporization (PVP) of prostate in the surgical management of benign prostatic hyperplasia in terms of safety, efficacy and cost effectiveness. Methods: Data was analyzed retrospectively for patients who underwent either PVP or BPVP between August 2012 to July 2014 for prostate size ≤ 80 ml. Preoperative and postoperative period values along with details like operative time, blood loss, hospitalization days, catheter removal time, blood transfusion and etc., were noted down. International prostatic symptom score, quality of life scores, post void residue, and maximum flow rate were recorded preoperatively and postoperatively at each follow-up visit. Follow-up was performed at 1, 3, 6 ,12 and 18 months. Results: Similar preoperative characteristics were observed in all the study arms. Hemoglobin drop, transfusion rate, catheter time and hospital days were similar in both the groups. The follow-up data indicates sustainable significant improvement in international prostatic symptom score, quality of life, post void residue and maximum flow rate in both the groups. As expected the cost of the procedure was significantly more in PVP group as compared to BPVP group (p < 0.01). Neither group had severe perioperative complications and no blood transfusion was required in both the groups. Conclusion: Both PVP and BPVP were safe and effective alternatives in men requiring surgery for benign prostatic hyperplasia including patients who were on anticoagulants. Additionally, BPVP has the advantage of being significantly cheaper and therefore it can be more useful in developing countries.

Karaman, Umar; Serkin, Faye B.; Taylor, Jennifer M.; Constantinescu, Michael

2017 Current Urology

doi: 10.1159/000447203pmid: 29593471

Testicular yolk sac tumor (YST) is a nonseminomatous germ cell tumor that predominantly affects prepubescent boys. Pure endometrioid variant YST is rare, with only 1 report in the literature. We present the first reported case of en-dometrioid variant YST with mature teratoma in the retro-peritoneal specimen.