We investigate the ability of physical exam to diagnose urethral diverticula with or without magnetic resonance imaging (MRI) and exclusive of invasive modalities. A retrospective chart review of all women undergoing urethral diverticulectomy at our institution since 1999 was performed. We identified 28 female patients with a mean age at diagnosis of 42.6 years (range 18&#8211;66). Common presenting symptoms included dyspareunia, urgency, and frequency. Physical exam revealed a suspected urethral diverticulum in 26 (92.9&#37;) patients, which was confirmed postoperatively in 17 of the 20 (85&#37;) women who underwent surgical resection. Noninvasive imaging modalities (MRI or CT) were available for review in 20 (71&#37;) cases and made the correct diagnosis of urethral diverticulum (presence or absence) in 19 (95&#37;) patients. In those patients with symptoms of stress or urge incontinence (11, 39&#37;), voiding cystourethrogram (VCUG) was performed. Urethral diverticula are often easily diagnosed on physical exam. MRI can be a useful adjunct for defining diverticular extent in surgical planning, especially for proximal and complex diverticula, and should be the modality of choice if clinical suspicion is high based on patient symptoms and physical exam.

Sima Porten

Stephanie Kielb

Diagnosis of Female Diverticula Using Magnetic Resonance Imaging

Iatrogenic ureteric injury is a well-recognised complication of radical hysterectomy. Bilateral ureteric injuries are rare, but do pose a considerable reconstructive challenge. We searched a prospectively acquired departmental database of ureteric injuries to identify patients with bilateral ureteric injury following radical hysterectomy. Five patients suffered bilateral ureteric injury over a 6-year period. Initial placement of ureteric stents was attempted in all patients. Stents were placed retrogradely into 6 ureters and antegradely into 2 ureters. In 1 patient ureteric stents could not be placed and they underwent primary ureteric reimplantation. In the 4 patients in which stents were placed, 2 were managed with stents alone, 1 required ureteric reimplantation for a persistent ureterovaginal fistula, and 1 developed a recurrent stricture. No patient managed by ureteric stenting suffered deterioration in serum creatinine. We feel that ureteric stenting, when possible, offers a safe primary management of bilateral ureteric injury at radical hysterectomy.

Matthew B. K. Shaw

Mark Tomes

David A. Rix

Trevor J. Dorkin

 Lakkur N. S. Murthy

Robert S. Pickard

The Management of Bilateral Ureteric Injury following Radical Hysterectomy

There are many ongoing controversies surrounding vesicoureteral reflux (VUR). These include variable aspects of this common congenital anomaly. Lack of evidence-based recommendations has prolonged the debate. Systematic reviews (SRs) and meta-analysis (MA) are considered high-level evidence. The purpose of this review article is to summarize and critically appraise the available SR/MA pertaining to VUR. We also discuss the strength and pitfalls of SR/MA in general. A thorough literature search identified 9 SRs/MAs relevant to VUR. Both authors critically reviewed these articles for contents and methodological issues. There are many concerns about the quality of the studies included in these SRs. Clinical heterogeneity stemming from different patient selection criteria, interventions, and outcome definitions is a major issue. In spite of major advances in understanding different aspects of VUR in the last few decades, there is a paucity of randomized controlled trials in this field.

K. Afshar

A. E. MacNeily

Strengths and Pitfalls of Meta-Analysis Reports in Vesicoureteral Reflux

Purpose. The goal of this review is to present current indications, injectable agents, techniques, success rates, complications, and potential future applications of endoscopic treatment for vesicoureteral reflux (VUR) in children. Materials and Methods. The endoscopic method currently achieving one of the highest success rates is the double hydrodistention-implantation technique (HIT). This method employs dextranomer/hyaluronic acid copolymer, which has been used in pediatric urology for over 10 years and may be at present the first choice injectable agent due to its safety and efficacy. Results. While most contemporary series report cure rates of greater than 85&#37; for primary VUR, success rates of complicated cases of VUR may be, depending on the case, significantly lower. Endoscopic treatment offers major advantages to patients while avoiding potentially complicated open surgery. As the HIT method continues to be applied to complex cases of VUR and more outcome data become available, the indication for endoscopic treatment may exceed the scope of primary VUR. Conclusions. Endoscopic injection is emerging as the treatment of choice for VUR in children.

Wolfgang H. Cerwinka

Hal C. Scherz

Andrew J. Kirsch

Endoscopic Treatment of Vesicoureteral Reflux with Dextranomer/Hyaluronic Acid in Children

Vesicoureteral reflux (VUR) is simply described as incompetence of the unidirectional valve at the ureterovesical junction (UVJ), leading to backflow of urine to the kidney. Today, it is clear that VUR is not only related to the UVJ function but also to a combination of processes including immunity, bladder and pelvic floor function, dysfunctional voiding, and constipation. Although our surgical aims directed towards improving the valve coaptation at the UVJ, we understand today the importance of the diagnosis and treatment of constipation and dysfunctional voiding adjunctively.

Sarel Halachmi

Walid A. Farhat

Interactions of Constipation, Dysfunctional Elimination Syndrome, and Vesicoureteral Reflux

One must demand an accurate, safe, radiation-free, and noninvasive method for reflux examination as the ideal possibility for reflux screening. Of course the available different imaging modalities are far from this ideal situation, but minimal radiation exposure is indeed a permanent objective. Additionally since all of these studies might be quite stressful to the child and the family, a specially designed and equipped environment is obligatory for the comfort of all involved. An absolute ideal modality in the diagnosis of VUR would be the definition of a certain marker in serum or urine that could identify children with VUR without the need for any interventional screening modality. Therefore more and more efforts have to be made in the future to investigate different markers for this purpose. Since reflux is one of the most frequent congenital conditions pediatric urologist have to deal with potential risks that might lead to renal insufficiency, noninvasive and radiation-free modalities should become the methods of choice, hopefully in the near future.

Christian Radmayr

Radiation Safety and Future Innovative Diagnostic Modalities

Priapism is a urological emergency with multiple aetiologies including drug induced. Currently, there have been no reports of priapism induced by the combination of ecstasy and marijuana. We speculated on the potential mechanisms for acute drug-induced priapism resulting from ingestion of these two common illicit drugs.

Quan T. Tran

Robyn A. Wallace

Esther H. A. Sim

Priapism, Ecstasy, and Marijuana: Is There a Connection?

Renal cell carcinomas are known to metastasise to the bones in the form of lytic lesions. However, not all osteolytic lesions in patients with renal cell carcinoma are metastatic in nature. The report describes the case of a 68-year old lady who was diagnosed with a renal cell carcinoma 3 and half years back and treated with radical nephrectomy along with excision of an inferior vena cava tumour thrombus. The tumour was completely excised and she remained disease free till date. Subsequently, multiple lytic lesions were detected incidentally on the cranial vault, which on biopsy demonstrated intraosseous hemangioma. Though it is well known that renal cell carcinomas can metastasise to the bones in the form lytic lesions, it is important for clinicians to remember a few other differentials, one of which would be an intraosseous hemangioma, which is a benign pathology. Many times patients would be treated as having metastatic disease merely on radiological findings. In this case report, there was a high index of radiological suspicion for metastases, however establishing diagnosis by biopsy prevented overtreatment in this instance.

Rohit Malde

Tim Moss

George Malcolm

Tim Whittlestone

Amit Bahl

Multiple Intraosseous Calvarial Hemangiomas Mimicking Metastasis from Renal Cell Carcinoma

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Advances in Urology provides a forum for urologists, nephrologists, and basic scientists working in the field of urology. The journal publishes articles focusing on the male and female urinary tract and the male reproductive organs.

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Advances in Urology - Table of contents 2008

title

Advances in Urology provides a forum for urologists, nephrologists, and basic scientists working in the field of urology. The journal publishes articles focusing on the male and female urinary tract and the male reproductive organs.

Advances in Urology