ISRN Urology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Does Male Circumcision Protect against Sexually Transmitted Infections? Arguments and Meta-Analyses to the Contrary Fail to Withstand Scrutiny Tue, 13 May 2014 13:09:22 +0000 We critically evaluate a recent article by Van Howe involving 12 meta-analyses that concludes, contrary to current evidence, that male circumcision increases the risk of various common sexually transmitted infections (STIs). Our detailed scrutiny reveals that these meta-analyses (1) failed to include results of all relevant studies, especially data from randomized controlled trials, (2) introduced bias through use of inappropriate control groups, (3) altered original data, in the case of human papillomavirus (HPV), by questionable adjustments for “sampling bias,” (4) failed to control for confounders through use of crude odds ratios, and (5) used unnecessarily complicated methods without adequate explanation, so impeding replication by others. Interventions that can reduce the prevalence of STIs are important to international health. Of major concern is the global epidemic of oncogenic types of HPV that contribute to the burden of genital cancers. Meta-analyses, when well conducted, can better inform public health policy and medical practice, but when seriously flawed can have detrimental consequences. Our critical evaluation leads us to reject the findings and conclusions of Van Howe on multiple grounds. Our timely analysis thus reaffirms the medical evidence supporting male circumcision as a desirable intervention for STI prevention. Brian J. Morris, Catherine A. Hankins, Aaron A. R. Tobian, John N. Krieger, and Jeffrey D. Klausner Copyright © 2014 Brian J. Morris et al. All rights reserved. Comparative Study of Snodgrass and Mathieu’s Procedure for Primary Hypospadias Repair Sun, 27 Apr 2014 13:29:12 +0000 Objective. Present study was undertaken to compare the results of two single stage hypospadias repairs, namely, Tubularized Incised Plate (TIP) repair and Mathieu’s repair. Methods. The study included 100 patients of distal penile hypospadias, from January, 2008 to January, 2013. After a detailed history, local examination was performed with reference to the site of meatus, shape of glans, and presence of chordee. TIP repair was performed in 52 patients and Mathieu’s repair in 48 patients. On follow-up, the patients were examined for the position of meatus, shape of meatus, urinary stream, urethrocutaneous fistula, and stricture formation. Results. The mean age of presentation was 6.2 ± 3.2 years (range 1.5–15years). The mean operative time was 63.7 ± 14.3 (45–90) minutes and 95.0 ± 19.1 (70–125) minutes in TIP and Mathieu’s repair, respectively.Complications after surgery were urethero cutaneous fistula in 3(5.76%) and 7 (14.5%), meatal stenosis in 3(5.33%) and 4(8.33%), wound infection in 19.2% and 8.3% cases in TIP repair and Mathieu repair, respectively. The shape of meatus was slit-like and vertically oriented in 48(92.3%) patients who had undergone TIP repair. Conclusion. The Snodgrass repair is significantly faster, with more natural cosmetic appearance of the meatus than the Mathieu’s repair. Raashid Hamid, Aejaz A. Baba, and Altaf H. Shera Copyright © 2014 Raashid Hamid et al. All rights reserved. Outcomes of Dorsal and Ventral Buccal Graft Urethroplasty at a Tertiary Hospital in Uganda Thu, 17 Apr 2014 10:11:35 +0000 Purpose. Although the use of buccal mucosa in substitution urethroplasty has been practiced for some years, it has not been free of controversy over which surgical technique is the most appropriate to use. There is paucity of data in Sub-Saharan Africa about its success; this study presents the outcomes of dorsal and ventral buccal graft urethroplasty at a sub-Saharan tertiary hospital. Methods. This is a prospective study in which buccal mucosa was used for ventral and dorsal grafts; followup was up to two years. All patients provided informed written consent for the procedures. Results. Seventy-two patients with bulbar urethral strictures underwent buccal graft one-stage urethroplasty. Mean age was 55 years; etiology of the strictures was postinflammatory due to urethritis from sexually transmitted infections 97% (70/72) and trauma 3% (2/72). Buccal mucosa grafts were harvested from the cheek using a two-team approach. Grafts were placed on the ventral and dorsal urethral surfaces in 32 and 40 cases, respectively; the success rate was 84 and 80%, respectively. Repeated urethroplasty was successfully done among 10% (7/72) and patients reported resolution of symptoms in the follow-up period. Conclusion. There was no difference between dorsal and ventral onlay buccal graft outcomes for bulbar urethral strictures. The success rate was 80 to 84%. S. Kaggwa, M. Galukande, H. Dabanja, and H. Luweesi Copyright © 2014 S. Kaggwa et al. All rights reserved. Alpha 1-Adrenoceptor Blocker May Improve Not Only Voiding But Also Storage Lower Urinary Tract Symptoms Caused by 125I Brachytherapy for Prostate Cancer Sun, 30 Mar 2014 12:04:25 +0000 Purpose. To assess changes in lower urinary tract symptoms (LUTS) within 1 year after brachytherapy in patients receiving alpha 1-adrenoceptor antagonists. Methods. We retrospectively evaluated 116 patients who underwent 125I prostate brachytherapy in our institute. Seventy-one patients were treated with a combination of external beam radiation therapy and brachytherapy. Alpha 1-adrenoceptor antagonists were prescribed to all patients after brachytherapy. International Prostate Symptom Score (IPSS) forms and postvoid residual urine volume were recorded at all follow-up visits. Results. Forty-nine patients were given tamsulosin hydrochloride, 32 were given silodosin hydrochloride, and 35 were given naftopidil for up to 6 months after seed implantation. Patients given tamsulosin or naftopidil tended to show a higher peak IPSS and slower recovery to baseline values than those given silodosin. The patients given naftopidil showed an insufficient recovery in storage symptoms in naftopidil group in comparison with tamsulosin group at 3 months and with silodosin group at 6 and 9 months. Conclusions. In the management of LUT after brachytherapy, silodosin may provide a more favorable improvement. Silodosin and tamsulosin may have an advantage in improving not only voiding but also storage lower urinary tract symptoms after brachytherapy. Nobuyuki Oyama, Yoshitaka Aoki, Hideaki Ito, Yoshiji Miwa, Hironobu Akino, Yoshitaka Sato, Hiroki Shioura, Hirohiko Kimura, and Osamu Yokoyama Copyright © 2014 Nobuyuki Oyama et al. All rights reserved. Neutrophil-Lymphocyte Ratio in Small Renal Masses Wed, 12 Mar 2014 08:48:24 +0000 Introduction. To evaluate the association between preoperative neutrophil-lymphocyte ratio (NLR) and clinicopathologic characteristics in patients with small renal masses (SRM). Methods. Retrospective chart reviews of patients with renal masses ≤4 cm who underwent nephrectomy from January 2007 to July 2012 were conducted. Multivariable linear regression was used to examine the association between preoperative NLR and clinicopathologic variables. Results. In 1001 patients, we noted higher mean preoperative NLR in men ( versus in women, ) and Caucasians ( versus in African Americans, ) but no significant differences in patients with low (I-II) versus high (III-IV) American Society of Anesthesiologists (ASA) scores ( versus , ) or benign versus malignant pathology ( versus , ). Spearman correlation analysis () showed preoperative NLR significantly correlated with age (, ) and preoperative serum creatinine (Crea) [, ]. On multivariable linear regression analysis older age, male gender, Caucasian race, and preoperative Crea were predictive of higher preoperative NLR, but ASA score and tumor pathology were not. Conclusions. In patients with SRM, we found no association between preoperative NLR and tumor pathology. Wassim M. Bazzi, Sheila Z. Dejbakhsh, Melanie Bernstein, and Paul Russo Copyright © 2014 Wassim M. Bazzi et al. All rights reserved. Retrograde Robotic Radical Prostatectomy: Description of a New Technique and Early Perioperative Outcomes Mon, 10 Mar 2014 11:48:30 +0000 Objectives. This research was conducted to describe a novel technique for performing robotic-assisted laparoscopic prostatectomy (RALP) using a retrograde approach that mimics the classic open surgical technique. Methods. From June 2009 to March 2011, we performed 18 nonconsecutive RALPs using a novel retrograde approach. Patients were initially selected with D’Amico low to intermediate risk disease. Pre-, intra-, and postoperative data were analyzed in all patients. Results. All 18 patients had successful surgery without any intraoperative complications. Mean preoperative PSA was 6.0 ng/mL. Nine patients had biopsy Gleason score (GS) 6, seven patients had GS 7, and two patients had GS 8. Fourteen patients had clinical stage T1c and four patients had stage T2a. Mean operative time was 198 minutes, with a mean robotic console time of 168 minutes. Fifteen patients had T2 disease on the final pathology and three had T3 disease. With a median follow-up of 11 months, 10 patients had an undetectable PSA. Conclusions. Our early experience with retrograde robotic-assisted laparoscopic prostatectomy demonstrates the feasibility of this approach with early outcomes comparable to the contemporary antegrade approach. Long-term study with a greater number of patients will be necessary to fully evaluate the oncologic and functional outcomes using this technique. Gino J. Vricella, Zachary Klaassen, Martha K. Terris, and Rabii Madi Copyright © 2014 Gino J. Vricella et al. All rights reserved. Novel Closing Method Using Subcutaneous Continuous Drain for Preventing Surgical Site Infections in Radical Cystectomy Mon, 10 Mar 2014 00:00:00 +0000 To reduce the incidence of surgical site infection (SSI) after radical cystectomy, a new closing method using subcutaneous continuous aspiration drain was developed and compared to the conventional closing method. The new method involved (a) closed aspiration with an indwelling aspiration drain without suture of the subcutaneous fat and (b) covering with hydrocolloid wound dressing after suture of the dermis with 4-0 absorbable thread and reinforcement using strips. The incidence of SSI was significantly improved by using the new method. Furthermore, univariate and multivariate analysis associated with SSI revealed that the new closing method was statistically correlated with 85% reduction of SSI (odds ratio: 0.15, 95% confidence interval: 0.03–0.69).Our new method using continuous aspiration with subcutaneous drain is useful for preventing SSI through removal of effusions and reduction of dead space by apposition of the subcutaneous fat. Yasuhiko Hirose, Taku Naiki, Ryosuke Ando, Akihiro Nakane, Toshiki Etani, Keitaro Iida, Hidetoshi Akita, Takehiko Okamura, and Kenjiro Kohri Copyright © 2014 Yasuhiko Hirose et al. All rights reserved. Colicin E2 Expression in Lactobacillus brevis DT24, A Vaginal Probiotic Isolate, against Uropathogenic Escherichia coli Tue, 04 Feb 2014 08:53:02 +0000 Novel therapeutic approaches are needed to combat the urinary tract infection in women. During menstruation elevated protein concentration and increase in oxygen and carbon dioxide concentrations with decrease in vaginal Lactobacilli all together contribute to urinary tract infections. Lactobacillus species are a predominant member of the vaginal microflora and are critical in the prevention of a number of urogenital diseases. In order to increase antimicrobial potential of vaginal Lactobacilli, bacteriocin colicin E2 which has specific activity against uropathogenic Escherichia coli has been overexpressed in vaginal probiotic Lactobacillus brevis DT24. Recombinant Lactobacillus brevis DT24 expressing colicin E2 showed much higher inhibitory activity against uropathogenic Escherichia coli than wild type L. brevis DT24 in vitro. Efficacy of probiotic Lactobacillus brevis DT24 expressing colicin E2 protein is required for further in vivo evaluation. Disha Trivedi, Prasant Kumar Jena, and Sriram Seshadri Copyright © 2014 Disha Trivedi et al. All rights reserved. Can Tumor Necrosis Factor-α and Interleukin-6 Be Used as Prognostic Markers of Infection following Ureteroscopic Lithotripsy? Thu, 30 Jan 2014 10:03:51 +0000 Introduction. Ureteroscopic lithotripsy (URS) although highly effective for the treatment of ureteral stones is associated with certain complications, the more common of which are postoperative fever and infection. In the present study we aimed to evaluate the levels of serum cytokines in patients undergoing ureteroscopic lithotripsy and investigate any possible correlation between levels of cytokines and infectious complications after URS. Materials and Methods. Thirty patients (19 males, 11 females), with a mean age of 47 (range: 26–68) that underwent URS lithotripsy for ureteral stones, and 10 healthy volunteers serving as the control group were enrolled in this study. Serum samples for TNF-α and IL-6 were obtained before surgical intervention and after 1, 24, and 48 hours and 2 , 24, and 48 hours, respectively. The preoperative and postoperative levels were compared and correlated with the possible complications after URS. Results. Serum TNF-α levels were statistically significant, increased 1 hour () and 48 hours () after operation. IL-6 levels were found statistically significant, elevated after 2 and 24 hours from the URS (). In 2 patients we observed postoperative fever (>38.5°C). These two patients had high preoperative values of TNF-α and IL-6 ( 30 and 50 pg/mL, resp.) and these values increased postoperatively. Conclusion. High preoperative levels of serum TNF-α and IL-6 may indicate a predisposition for postoperative inflammation and infection following URS lithotripsy. Athanasios Bantis, Georgios Tsakaldimis, Athanasios Zissimopoulos, Stilianos Giannakopoulos, Christos Kalaitzis, Michail Pitiakoudis, Alexandros Polichronidis, and Stavros Touloupidis Copyright © 2014 Athanasios Bantis et al. All rights reserved. Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma: A Review of the Historical Literature and Its Role in the Era of Targeted Molecular Therapy Thu, 23 Jan 2014 07:08:26 +0000 Renal cell carcinoma presents with metastatic disease in approximately 30% cases. While surgical intervention remains the standard of care for organ confined disease, its role is limited in the management of metastatic disease. Over the last decade, cytoreductive nephrectomy prior to immunotherapy has demonstrated significant improvement in overall survival for appropriately selected patients. This review summarizes the evidence for the role of cytoreductive nephrectomy in combination with immunotherapy and discusses its potential role in the current era of targeted molecular therapy. Muhammad Z. Aslam and P. N. Matthews Copyright © 2014 Muhammad Z. Aslam and P. N. Matthews. All rights reserved. Sarcomatoid Variant of Urothelial Carcinoma (Carcinosarcoma, Spindle Cell Carcinoma): A Review of the Literature Wed, 22 Jan 2014 13:59:32 +0000 Background. Sarcomatoid variant of urothelial carcinoma (SVUC) was added to the WHO classification in 2004. Aims. To review the literature. Materials and Method. Various internet databases were used. Result. SVUCs are rare biphasic malignant neoplasms exhibiting morphologic/immunohistochemical evidence of epithelial and mesenchymal differentiation with the presence or absence of heterologous elements. Some cases of SVUC have been associated with radiation therapy and cyclophosphamide treatment. Patients’ ages range from 50 to 77 years (mean age 66). Patients tend to be younger and they more commonly presented with high-grade histology and advanced stage disease, in comparison with patients who had conventional urothelial carcinoma (CUC). Results of molecular/genetic studies strongly argue for a common monoclonal cell origin of both the epithelial and mesenchymal components in SUVC. The cancer specific survival of SVUC is poor in comparison with CUC. Radical surgical excision and chemoradiation may be associated with improved prognosis; chemoradiation as an organ preserving alternative to radical excision may be associated with improved outcome. There is no consensus opinion on the best treatment modalities for SUVC. Conclusions. SVUC is rare and is associated with inferior outcome compared with CUC. A multicentre trial of various treatment options is required. Cases of SVUC should be reported. Anthony Kodzo-Grey Venyo and Sami Titi Copyright © 2014 Anthony Kodzo-Grey Venyo and Sami Titi. All rights reserved. Mini-Arc for the Treatment of Female Stress Urinary Incontinence: Long-Term Prospective Evaluation by Patient Reported Outcomes Mon, 20 Jan 2014 07:03:49 +0000 Single-incision slings were introduced in the surgical treatment of female stress urinary incontinence (SUI) to lessen the morbidity associated with traditional midurethral slings. However, long-term reports on patient satisfaction are still scarce. This study describes the outcome of women treated with Mini-Arc at a mean follow-up of 45 months. In a previous report on 105 women with 15-month mean follow-up, 84 (80%) were found cured and 12 (11%) improved. Now, with a mean follow-up of 45 months, cured/improved patients were reassessed by telephone and completed Patient Global Impression of Improvement (PGI-I), Patient Global Impression of Severity (PGI-S), rated their improvement in a 0–100 scale, and answered if they would recommend the procedure. At 45-month follow-up, 73 women cured/improved were available for evaluation. Over 80% of the cured patients rated the improvement of SUI by the PGI-I as “very much better” or “much better,” reported their urinary tract condition to be “normal” on PGI-S, and described their improvement >70%. Ninety percent would recommend this procedure to a friend. The improved-patient population is very small . This study shows that the majority of patients cured/improved after Mini-Arc placement maintain a high degree of satisfaction at a long-term evaluation. Rui Oliveira, Alexandre Resende, Carlos Silva, Paulo Dinis, and Francisco Cruz Copyright © 2014 Rui Oliveira et al. All rights reserved. Noninvasive Electromagnetic Detection of Bladder Cancer Thu, 16 Jan 2014 09:27:24 +0000 Objectives. Normal and neoplastic human tissues have different electromagnetic properties. This study aimed to determine the diagnostic accuracy of noninvasive electromagnetic detection of bladder cancer (BC) by the tissue-resonance interaction method (TRIM-prob). Patients and Methods. Consecutive patients were referred for cystoscopy because of (i) microscopic or gross hematuria and/or irritative voiding symptoms and (ii) bladder ultrasounds and urinary cytology findings negative or just suspicious of malignancy. Patients were first submitted to TRIM-prob bladder scanning by a single investigator and then to cystoscopy by another investigator blind to TRIM-prob data. Results. In 125 evaluated patients cystoscopy was positive for BC in 47 and negative in the remaining 78; conversely, TRIM-prob bladder scanning was positive for BC in 53 and negative in 72. In particular, TRIM-prob scanning yielded 7 false positives and only one false negative; therefore, its overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 97.9%, 89.9%, 86.8%, 98.6%, and 93.6%, respectively. Conclusions. TRIM-prob bladder scanning was a simple and quite accurate method for non-invasive electromagnetic detection of BC. If the elevated positive and negative predictive values will be replicated in further well-designed studies, it could be used to screen asymptomatic patients at high risk of BC. Luigi Cormio, Clarbruno Vedruccio, Giorgio Leucci, Paolo Massenio, Giuseppe Di Fino, Vincenzo Cavaliere, and Giuseppe Carrieri Copyright © 2014 Luigi Cormio et al. All rights reserved. Buried Penis: Evaluation of Outcomes in Children and Adults, Modification of a Unified Treatment Algorithm, and Review of the Literature Sun, 29 Dec 2013 11:32:23 +0000 Introduction. Buried penis is a difficult condition to manage in children and adults and conveys significant physical and psychological morbidity. Surgery is often declined due to morbid obesity, forcing patients to live in disharmony for years until the desired weight reduction is achieved. No single operative technique fits all. We present our experience and surgical approach resulting in an improved algorithm unifying the treatment of adults and children. Methods. We conducted a retrospective analysis of patients treated for buried penis between 2011 and 2012. All patients underwent penile degloving and basal anchoring. Penile shaft coverage was achieved with skin grafts. Suprapubic lipectomies were performed on adult patients. Results. Nine patients were identified: four children and five obese adults. Average postoperative stay was three days for children and five for adults. Three adults were readmitted with superficial wound problems. One child had minor skin breakdown. All patients were pleased with their outcomes. Conclusion. Buried penis is a complex condition, and treatment should be offered by services able to deal with all aspects of reconstruction. Obesity in itself should not delay surgical intervention. Local and regional awareness is essential to manage expectations in these challenging patients aspiring to both aesthetic and functional outcomes. I. C. C. King, A. Tahir, C. Ramanathan, and H. Siddiqui Copyright © 2013 I. C. C. King et al. All rights reserved. Protective Effects of Resveratrol against Chronic Immobilization Stress on Testis Wed, 06 Nov 2013 09:01:11 +0000 Objective. The aim of this study was to investigate protective effects of resveratrol, a strong antioxidant, against possible negative effects of chronic immobilization stress on testes of male rats histochemically, immunohistochemically, ultrastructurally, and biochemically. Material and Methods. Male Wistar rats were divided into 4 groups (). Group I, control group (C), was not exposed to stress. Group II, stress group (S), was exposed to chronic immobilization stress. In Group III, low dose resveratrol + stress group (LRS), rats were given 10 mg/kg/day resveratrol just before the stress application. In Group IV, high dose resveratrol + stress group (HRS), rats were given 20 mg/kg/day resveratrol just before the stress application. For chronic immobilization stress application animals were put in the plastic tubes (6 cm in diameter, 15 cm in length) during 32 days for 6 hours. All animals were sacrificed 18 hours after the last stress application. Results. Histochemical and ultrastructural investigations showed that in stress group there was germ cell deprivation in seminiferous tubules and increase of connective tissue on interstitial area. No significant changes were seen in low and high dose resveratrol groups. After immunohistochemical investigations, TUNEL (+) and Active Caspase-3 (+) cells were increased in seminiferous tubules of stress group compared with those control group, but they were decreased in low and high dose resveratrol groups. According to biochemically results, MDA, GSH, and testosterone levels in stress group showed no significant difference when compared with those of the other groups. Conclusion. The chronic immobilization stress increases oxidative stress and apoptosis and causes histological tissue damages; resveratrol can minimize the histological damage in testes significantly. Gulsah Bitgul, Isil Tekmen, Didem Keles, and Gulgun Oktay Copyright © 2013 Gulsah Bitgul et al. All rights reserved. The Effect of Varicocelectomy on Sperm Parameters in Subfertile Men with Clinical Varicoceles Who Have Asthenozoospermia or Teratozoospermia with Normal Sperm Density Mon, 21 Oct 2013 15:22:57 +0000 Background. To compare preoperative and postoperative sperm parameters such as sperm count, motility, and morphology in patients with normal sperm concentration with teratozoospermia and asthenozoospermia. Materials and Methods. Hundred and six patients with varicocele associated with male infertility over a 5-year period were included into the study. Pre- and postvaricocelectomy seminal fluid parameters evaluation according to the World Health Organization (WHO) criteria was performed at 4–6-month intervals. Results. One hundred and six patients met the criteria. The mean age of patients was 24.53 ± 8.13. The mean duration of infertility was 3.6 years (range: 1.5–6.3). Only the sperm motility of patients with normospermia showed a significant improvement postoperatively. Conclusions. No significant improvement in sperm morphology may be obtained in patients with clinical varicocele and preoperative normospermia. Basri Cakiroglu, Orhun Sinanoglu, and Ramazan Gozukucuk Copyright © 2013 Basri Cakiroglu et al. All rights reserved. Insulin Deprivation Decreases Caspase-Dependent Apoptotic Signaling in Cultured Rat Sertoli Cells Wed, 09 Oct 2013 18:16:27 +0000 Insulin is essential for the regulation of glucose homeostasis. Insulin dysfunction occurs in several pathologies, such as diabetes mellitus, which is associated with fertility problems. Somatic Sertoli cells (SCs) not only metabolize glucose to lactate, which is the central energy source used by developing germ cells, but also determine the germ cell population size. If a deregulation in SCs apoptosis occurs, it will affect germ cells, compromising spermatogenesis. As SCs apoptotic signaling is a hormonally regulated process, we hypothesized that the lack of insulin could lead to alterations in apoptotic signaling. Therefore, we examined the effect of insulin deprivation on several markers of apoptotic signaling in cultured rat SCs. We determined mRNA and protein expression of apoptotic markers as well as caspase-3 activity. SCs cultured in insulin deprivation demonstrated a significant decrease on mRNA levels of p53, Bax, caspase-9, and caspase-3 followed by a significant increase of Bax and decrease of caspase-9 protein levels relatively to the control. Caspase-3 activity was also decreased in SCs cultured in insulin deprivation conditions. Our results show that insulin deprivation decreases caspase-dependent apoptotic signaling in cultured rat SCs evidencing a possible mechanism by which lack of insulin can affect spermatogenesis and fertility. T. R. Dias, L. Rato, A. D. Martins, V. L. Simões, T. T. Jesus, M. G. Alves, and P. F. Oliveira Copyright © 2013 T. R. Dias et al. All rights reserved. ERG Protein Expression Is of Limited Prognostic Value in Men with Localized Prostate Cancer Mon, 19 Aug 2013 08:19:09 +0000 Background. The prognostic significance of ERG expression in prostate cancer (PCA) has generated mixed results. We sought to investigate the prognostic significance of ERG expression in a localized cohort of men with PCA. Material and Methods. We investigated ERG protein expression in a cohort of 198 men with localized PCA. ERG expression was correlated with patients' clinical outcome and several pathological parameters, including Gleason score (GS), pathological stage, surgical margin, and extra-capsular extension. Results. ERG expression was detected in 86/198 (43.4%) patients exclusively in neoplastic epithelium. Overall, ERG mean expression intensity was versus in acinar PCA compared to foamy type PCA (). In HGPIN, ERG intensity levels were comparable to those in foamy type PCA () but significantly lower than those in acinar PCA (). ERG expression was significantly associated with extra-prostatic extension and higher pathological stage and showed a trend toward seminal vesicle invasion. Herein, ERG expression was documented in 50/131 (38.1%) patients with pT2 versus 30/55 (54.5%) patients with pT3 (). ERG association with higher pathological stage was more pronounced in patients with . Grouping patients into those with versus 7, there was no significant association between ERG expression and GS. Similarly, no association was present in relation to either surgical margins or postsurgical serum PSA levels. Conclusion. We report significant association between ERG protein levels and extra-prostatic extension and higher pathological stage. ERG expression is not associated with adverse clinical outcome and is of limited prognostic value in localized PCA. Liang Hong Teng, Cheng Wang, Michael Dolph, Bryan Donnelly, and Tarek A. Bismar Copyright © 2013 Liang Hong Teng et al. All rights reserved. Fournier's Gangrene as Seen in University of Maiduguri Teaching Hospital Mon, 12 Aug 2013 13:43:07 +0000 Background. Fournier’s gangrene is uncommon but increasingly being seen over the last two decades probably due to increasing socioeconomic problems including an upsurge in HIV infection especially in the tropics. Patients and Methods. The study retrospectively reviewed all patients with Fournier’s gangrene managed in UMTH between January 2007 and December 2012. Results. Thirty-eight males aged 2 weeks to 80 years (mean 37.82) were reviewed, with most aged 30–39 years (13 (34.21%)). Clinical features were scrotal pain and swelling, 36 (94.74%), fever, 19 (50.00%), and discharging scrotal wound, 19 (50.00%). The predisposing conditions were UTI secondary to obstructive uropathy in 11 (28.95%), perianal suppuration, and HIV, in 8 (21.05%) patients each. Wound biopsy culture revealed mixed organisms in 27 (71.05%). Twenty-six (68.42%) had blood transfusions. Thirty-seven (97.37%) patients had wound debridement. Twenty (52.63%) had flap rotation for skin cover. There were 6 (15.79%) mortalities, of which 4 (10.53%) were HIV positive, 1 (2.63%) was diabetic, and 1 (2.63%) was both diabetic and HIV positive. Conclusion. Fournier’s gangrene is a fulminant synergistic necrotising fasciitis of the perineum and genitalia with poor prognosis especially when associated with HIV and diabetes, requiringprompt and aggressive management for good outcome. S. Aliyu, A. G. Ibrahim, N. Ali, and A. M. Waziri Copyright © 2013 S. Aliyu et al. All rights reserved. Should Finasteride Be Routinely Given Preoperatively for TURP? Mon, 29 Jul 2013 08:40:24 +0000 Objective. The aim of the review was to compare the use of finasteride to placebo in patients undergoing TURP procedures. Material & Methods. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966–November 2011), EMBASE (1980–November 2011), CINAHL,, Google Scholar, reference lists of articles, and abstracts from conference proceedings without language restriction for studies comparing finasteride to placebo patients needing TURPs. Results. Four randomised controlled trials were included comparing finasteride to a placebo. A meta-analysis was not conducted due to the disparity present in the results between the studies. Three of the studies found that finasteride could reduce either intra- or postoperative bleeding after TURP. One study found finasteride to significantly lower the microvessel density (MVD) and vascular endothelial growth factor (VEGF). None of the studies reported any long-term complications related to either the medication or the procedure. Conclusion. finasteride reduces bleeding either during or after TURP. O. M. Aboumarzouk, M. Z. Aslam, A. Wedderburn, K. Turner, O. Hughes, and H. G. Kynaston Copyright © 2013 O. M. Aboumarzouk et al. All rights reserved. Adverse Effects of Androgen Deprivation Therapy for Prostate Cancer: Prevention and Management Thu, 25 Jul 2013 13:59:56 +0000 The prostate is an androgen-dependent organ. The increase, growth, homeostasis, and function of the prostate largely depend upon the intraprostatic and serum concentrations of androgens. Therefore, androgens are essential for the physiologic growth of prostatic epithelium. Prostate cancer, the second leading cause of death for men, is also androgen dependent, and androgen suppression is the mainstay of treatment for advanced and metastatic disease. In the state of metastatic disease, androgen suppression is a palliative treatment leading to a median progression-free survival of 18–20 months and an overall survival of 24–36 months. Theoretically, the majority of patients will develop hormone-refractory disease provided that they will not die from other causes. Although androgen suppression therapy may be associated with significant and sometimes durable responses, it is not considered a cure, and its potential efficacy is further limited by an array of significant and bothersome adverse effects caused by the suppression of androgens. These effects have potentially significant consequences on a variety of parameters of everyday living and may further decrease health-related quality of life. This review focuses on the aetiology of these adverse effects and provides information on their prevention and management. Petros Sountoulides and Thomas Rountos Copyright © 2013 Petros Sountoulides and Thomas Rountos. All rights reserved. Emergent Intervention Criterias for Controlling Sever Bleeding after Percutaneous Nephrolithotomy Wed, 24 Jul 2013 11:23:02 +0000 Objectives. To determine when emergent intervention for bleeding after percutaneous nephrolithotomy (PCNL) is required. Methods. We reviewed analysis data of 850 patients who had undergone PCNL in our center. Blood transfusion was needed for 60 (7%) patients during and/or after surgery. We routinely performed followup of the urine output per hour, blood pressure, and hemoglobin levels after PCNL. Five (0.6%) of them had severe bleeding that emergent intervention was needed. Results. The mean age of the 5 patients who had emergent surgery due to severe bleeding was 42.2 (19–56) years. Mean duration of surgery was 44.75 (25–65) minutes. Mean stone size was 27 (15–38) mm. Mean decrease of hemoglobin was 4.8 (3.4–5.8) ng/dL, and unit of transfused blood was 4.4 (3–6). Mean blood pH was 7.21. There were metabolic acidosis and anuria/oliguria in all these patients. One of 5 patients suffered from cardiopulmonary arrest because of massive bleeding four hours after the PCNL, and despite cardiac resuscitation, he died. Hemorrhaging was controlled by open surgery in the other 4 patients. Two patients experienced cardiac arrest during the open surgery but they responded to cardiac resuscitation. There were no metabolic asidosis and anuria/oliguria, and bleeding was managed only with blood transfusion for the other 55 patients. Conclusion. Severe bleeding after PCNL is rare and can be mortal. If metabolic asidosis and anuria/oliguria accompanied the drop of hemoglobin, emergent surgical intervention should be performed because vascular collapse may follow, and it may be too difficult to stabilise the patient. Ural Oguz, Berkan Resorlu, Mirze Bayindir, Tolga Sahin, Omer Faruk Bozkurt, and Ali Unsal Copyright © 2013 Ural Oguz et al. All rights reserved. Radical Cystectomy after BCG Immunotherapy for High-Risk Nonmuscle-Invasive Bladder Cancer in Patients with Previous Prostate Radiotherapy Wed, 17 Jul 2013 10:51:21 +0000 Purpose. Intravesical Bacillus Calmette-Guerin (BCG) immunotherapy is indicated for high-grade nonmuscle-invasive bladder cancer (NMIBC). The efficacy of BCG in patients with a history of previous pelvic radiotherapy (RT) may be diminished. We evaluated the outcomes of radical cystectomy for BCG-treated recurrent bladder cancer in patients with a history of RT for prostate cancer (PC). Methods. A retrospective chart review was performed to identify patients with primary NMIBC. We compared the outcomes of three groups of patients who underwent radical cystectomy for BCG-refractory NMIBC: those with a history of RT for PC, those who previously underwent radical prostatectomy (RP), and a cohort without PC or RT exposure. Results. From 1996 to 2008, 53 patients underwent radical cystectomy for recurrent NMIBC despite BCG. Those with previous pelvic RT were more likely to have a higher pathologic stage and decreased recurrence-free survival compared to the groups without prior RT exposure. Conclusion. Response rates for intravesical BCG therapy may be impaired in those with prior prostate radiotherapy. Patients with a history of RT who undergo radical cystectomy after failed BCG are more likely to be pathologically upstaged and have decreased recurrence-free survival. Earlier consideration of radical cystectomy may be warranted for those with NMIBC who previously received RT for PC. Manoj V. Rao, Marcus L. Quek, Gautam Jayram, Chandy Ellimoottil, Timothy Sondej, Cory M. Hugen, Robert C. Flanigan, and Gary D. Steinberg Copyright © 2013 Manoj V. Rao et al. All rights reserved. Efficacy of Extracorporeal Shock Wave Therapy for the Treatment of Chronic Pelvic Pain Syndrome: A Randomized, Controlled Trial Wed, 17 Jul 2013 09:04:29 +0000 Objectives. To investigate the effectiveness of extracorporeal shock wave therapy (ESWT) for symptoms alleviation in chronic pelvic pain syndrome (CPPS). Materials and Methods. 40 patients with CPPS were randomly allocated into either the treatment or sham group. In the first group, patients were treated by ESWT once a week for 4 weeks by a defined protocol. In the sham group, the same protocol was applied but with the probe being turned off. The follow-up assessments were done at 1, 2, 3, and 12 weeks by Visual Analogue Scale (VAS) for pain and NIH-developed Chronic Prostatitis Symptom Index (NIH-CPSI). Results. Pain domain scores at follow-up points in both treatment and sham groups were reduced, more so in the treatment group, which were significant at weeks 2, 3, and 12. Urinary scores became significantly different at weeks 3 and 12. Also, quality of life (QOL) and total NIH-CPSI scores at all four follow-up time points reduced more significantly in the treatment group as compared to the sham group. Noticeably, at week 12 a slight deterioration in all variables was observed compared to the first 3 weeks of the treatment period. Conclusions. our findings confirmed ESWT therapy as a safe and effective method in CPPS in short term. Babak Vahdatpour, Farshid Alizadeh, Amir Moayednia, Masoud Emadi, Mohammad Hatef Khorami, and Saeid Haghdani Copyright © 2013 Babak Vahdatpour et al. All rights reserved. Transurethral Resection of Prostate Abscess: Is It Different from Conventional Transurethral Resection for Benign Prostatic Hyperplasia? Tue, 11 Jun 2013 11:43:52 +0000 Purpose. To present our experience of prostate abscess management by modified transurethral resection (TUR) technique. Methods. Seventeen men with prostate abscess undergoing TUR between 2003 and 2011 were retrospectively analyzed. Details of demography, surgical procedures, complications, and followup were noted. Results. With a mean age of 61.53 ± 8.58 years, all patients had multifocal abscess cavities. Initially, 6 men underwent classical TUR similar to the technique used for benign prostatic enlargement (group 1). Next, 11 men underwent modified TUR (group 2) in which bladder neck and anterior zone were not resected. The abscess cavities resolved completely, and no patient required a second intervention. One patient in group 1 and three in group 2 had postoperative fever requiring parenteral antibiotics . Three patients in group 1 had transient urinary incontinence, whereas none of the patients in group 2 had this complication (). Four and five men in group 1 and 2 reported retrograde ejaculation, respectively . Conclusion. The modified technique of prostate resection edges over conventional TURP in the form of reduced morbidity but maintains its high success rate for complete abscess drainage. It alleviates the need for secondary procedures, having an apparent advantage over limited drainage techniques. Use of this technique is emphasized in cases associated with BPH and lack of proper preoperative imaging. Neeraj Kumar Goyal, Apul Goel, Satyanarayan Sankhwar, and Divakar Dalela Copyright © 2013 Neeraj Kumar Goyal et al. All rights reserved. Efficacy and Safety of Enoxaparin for Preventing Venous Thromboembolic Events following Urologic Laparoscopic Surgery Sun, 02 Jun 2013 08:52:28 +0000 There is a paucity of definitive evidence that supports the use of enoxaparin to prevent venous thromboembolism (VTE) after urologic laparoscopic surgery. The purpose of this study was to evaluate the efficacy and safety of postoperative subcutaneous enoxaparin injection in patients who underwent urologic laparoscopic surgery. A total of 63 patients were evaluated from June 2010 to December 2012. All patients received postoperative prophylaxis with enoxaparin (2000 IU twice daily for 5 days). None of the patients treated with enoxaparin developed symptomatic VTE, but two cases (3.2%) of pulmonary embolism were noted before initial enoxaparin administration. Statistically significant differences were observed between the prothrombin time (PT) and activated partial thromboplastin time (APTT) values and D-dimer levels obtained at baseline and on day 7 after surgery; however, the PT and APTT values did not exceed the normal range. In addition, signs of any adverse events were not encountered in any of the patients treated with enoxaparin. The use of enoxaparin immediately after a surgery may confer valuable thromboprophylaxis benefits for urologic laparoscopic surgery. Takeo Nomura, Mika Takahashi, Kazunori Iwasaki, Tomoya Oribe, Mayuka Shinohara, Yuko Fukuda, Shinsuke Mizoguchi, Fuminori Sato, and Hiromitsu Mimata Copyright © 2013 Takeo Nomura et al. All rights reserved. The Effect of In Vitro Oxidative Stress on the Female Rabbit Bladder Contractile Response and Antioxidant Levels Thu, 30 May 2013 08:00:20 +0000 Introduction. There are several bladder dysfunctions that are associated with oxidative stress to the urinary bladder. Two experimental models are known to cause this type of bladder damage. The first is direct oxidative damage caused by hydrogen peroxide (H2O2). The second is oxidative damage caused by ischemia followed by reperfusion (I/R). The specific aim of this study is to directly compare these two models of oxidative stress. Methods. Six adult female NZW rabbits were divided into two groups of three rabbits each. Eight full thickness strips from three rabbit bladders were taken for in vitro ischemia/reperfusion physiological analysis, while eight strips from three rabbit bladders were taken for in vitro H2O2 physiological analysis. All tissue was analyzed for total antioxidant activity (AA) and malondialdehyde (MDA) levels. In addition, samples of the water baths were also analyzed for AA. Results. In vitro I/R reduced the response to field stimulation (FS) to a significantly greater extent than the inhibition of the response to carbachol. In vitro H2O2 decreased all responses to approximately the same degree. Total AA levels at higher concentrations of H2O2 for all bath fluids were significantly higher than controls. MDA levels were significantly elevated in both models of oxidative stress. Lisa Malone, Catherine Schuler, Robert E. Leggett, and Robert M. Levin Copyright © 2013 Lisa Malone et al. All rights reserved. Dipping Technique for Ureteroileal Anastomosis in Orthotopic Ileal Neobladder: 20-Year Experience in 670 Patients—No Stenosis with Preservation of the Upper Tract Sun, 26 May 2013 16:49:15 +0000 Objectives. Many techniques were described for ureteroileal anastomosis in orthotopic bladder substitution, ranging from nonrefluxing to refluxing techniques, all aiming at preservation of the upper tract. We describe our technique of dipping the ureter into the ileal pouch, which is simple and had no complications. Patients and Methods. Our technique implies dipping the ureter in the lateral side of the pouch, in right and left corners, with two rows of four sutures fixing the seromuscular layer of the ureter to the seromuscular layer of the ileal pouch. The procedure was applied in both normal ureteric calibre and dilated ureter. Total number of procedures done was 1,340 ureters in 670 patients after radical cystectomy for invasive carcinoma of the bladder of urothelial and nonurothelial cancer. Results. Followup of patients every six months and onward did not show stenosis in the ureteroileal anastomotic site. Filling of the ureter with contrast dye on ascending pouchogram was observed in patients who had considerably dilated ureters at the time of cystectomy. Normal ureter did not show clinical reflux but radiological filling of the ureter when the intravesical pressure exceeded the leak point pressure. Time to perform the dipping technique was 5–7 minutes for each site. Conclusion. Dipping technique for ureteroileal anastomosis in orthotopic ileal neobladder avoids the incidence of stenosis, preserves the upper tract, is a fast procedure, stands the evaluation in long-term followup, and was practiced successfully for twenty years. Mohamed M. Wishahi, Hosam Elganzoury, Amr Elkhouly, and Ahmed Mehena Copyright © 2013 Mohamed M. Wishahi et al. All rights reserved. Evaluating PSA Density as a Predictor of Biochemical Failure after Radical Prostatectomy: Results of a Prospective Study after a Median Follow-Up of 36 Months Thu, 16 May 2013 16:11:45 +0000 Purpose. To evaluate the predictive ability of PSA density for biochemical relapse after radical prostatectomy in patients operated for clinically localized disease and to compare its predictive strength with preoperative PSA and Gleason score. Patients and Methods. The study evaluated 244 patients with localized disease who underwent an open retropubic radical prostatectomy between February 2007 and April 2011. PSA was measured every 3 months after surgery with a mean follow-up period of 36 months. Two consecutive rises >0.2 ng/mL were considered as biochemical relapse. Results. Biochemical recurrence was observed in 71 (29.1%). A great correlation was found between relapse and PSA (), PSA density (), Gleason score (), pathological stage (), positive surgical margins (), and invasion of seminal vesicles () and lymph nodes (). We also found that PSA density was associated with adverse pathological findings. In univariate and multivariate analysis both PSA () and PSA density () were found to be significant predictors for relapse in contrast to tumor grade. Conclusion. PSA density is a valuable parameter in estimating the danger of biochemical failure and it may increase predictive potential through the incorporation in preoperative nomograms. Stavros Sfoungaristos and Petros Perimenis Copyright © 2013 Stavros Sfoungaristos and Petros Perimenis. All rights reserved. Assessment of the Effects of Access Count in Percutaneous Nephrolithotomy on Renal Functions by Technetium-99m-Dimercaptosuccinic Acid Scintigraphy Wed, 08 May 2013 14:05:51 +0000 Objective. To determine the effects of percutaneous nephrolithotomy on renal functions by using DMSA scintigraphy while considering access counts. Material and Methods. A total of 37 patients who had undergone percutaneous nephrolithotomy were included. Preoperative DMSA scans were performed a day before the surgery, whereas postoperative scans were randomized by evaluating them before () and after () the 6th postoperative month. Twenty-six of 37 cases underwent percutaneous nephrolithotomy with a single access site and 11 with multiple access sites. Results. There were no significant changes of total renal functions in the whole study group (). In the single access group, total functions were significantly elevated () In the multiple access group, while treated site functions were significantly decreased (), total functions did not change significantly (). There was an insignificant decrease in those evaluated before the 6th postoperative month () and an insignificant increase in the others (). Conclusion. We could not find a superiority of single access over multiple accesses. There is a temporary functional loss in the treated site. Abdullah Demirtaş, Mehmet Caniklioğlu, Mustafa Kula, Mustafa Sofikerim, Emre Can Akınsal, Mehmet Ali Ergül, Numan Baydilli, and Oğuz Ekemekçioğlu Copyright © 2013 Abdullah Demirtaş et al. All rights reserved.