Advances in Urology The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Recent Pathophysiological Aspects of Peyronie’s Disease: Role of Free Radicals, Rationale, and Therapeutic Implications for Antioxidant Treatment—Literature Review Tue, 04 Jul 2017 00:00:00 +0000 Peyronie’s disease (PD) is a chronic inflammation of tunica albuginea of the corpora cavernosa that causes an inelastic plaque resulting in penis deformation. Although its etiology is not completely known, there is general consensus that PD is genetically transmitted and secondary to penile trauma. In recent years, numerous studies demonstrated the role played by oxidative stress in PD pathogenesis, and other studies have described successful use of antioxidants in PD treatment. Oxidative stress is an integral part of this disease, influencing its progression. In the early stages of PD, the inflammatory infiltrate cells produce high quantities of free radicals and proinflammatory and profibrotic cytokines, with consequent activation of transcription factor NF-κB. While conservative therapies commonly used in the early stages of PD include oral substances (Potaba, tamoxifen, colchicine, and vitamin E), intralesional treatment (verapamil, interferon, steroids, and more recently collagenase clostridium histolyticum-Xiaflex), and local physical treatment (iontophoresis, extracorporeal shock wave therapy, and penile extender), the significant results obtained by emerging treatments with the antioxidants cited in this article suggest these therapeutic agents interfere at several levels with the disease’s pathogenetic mechanisms. Antioxidants therapy outcomes are interesting for good clinical practice and also confirm the fundamental role played by oxidative stress in PD. Gianni Paulis, Gennaro Romano, Luca Paulis, and Davide Barletta Copyright © 2017 Gianni Paulis et al. All rights reserved. The Persistence of Silodosin Monotherapy and the Reasons for Withdrawal from Treatment of Previously Untreated Japanese Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia Tue, 13 Jun 2017 00:00:00 +0000 Objectives. The persistence of silodosin and the reasons for withdrawal from treatment of previously untreated Japanese patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) were evaluated in real-life clinical practice. Methods. A total of 81 previously untreated Japanese patients diagnosed with LUTS/BPH were treated with silodosin monotherapy and prospectively followed for 4 years. The persistence rate was estimated using the Kaplan-Meier method. If silodosin had to be terminated or a patient did not come to the hospital, the reason was determined. Results. The 6-month, 1-year, 2-year, 3-year, and 4-year persistence rates were 63.0%, 56.8%, 50.6%, 44.4%, and 35.8%, respectively. The most frequent reason (22.2%) for withdrawal was symptom resolution. After silodosin treatment, the international prostate symptom score and the quality of life index were significantly improved and maintained for 4 years. Conclusions. 35.8% of previously untreated Japanese patients continued silodosin for 4 years. Many patients terminated silodosin for various reasons, the most frequent of which was symptom resolution. The effects of silodosin were maintained when the patients continued treatment. Trial Registration. This study was approved by the institutional review board of Hokkaido Prefectural Esashi Hospital (number 2007-2) and was registered in a public trial registry (UMIN000026910). Yoshinori Tanaka, Yasushi Tanuma, and Naoya Masumori Copyright © 2017 Yoshinori Tanaka et al. All rights reserved. A Study of Patients with Primary Mediastinal Germ Cell Tumors Treated Using Multimodal Therapy Sun, 28 May 2017 09:27:00 +0000 Objectives. Primary mediastinal germ cell tumors (PMGCTs) are rare, which often makes them difficult to treat. Herein, we examined patients with PMGCTs who underwent multimodal treatment. Methods. We examined 6 patients (median age: 25 years, range: 19–27 years) with PMGCTs who underwent multimodal treatment between April 2001 and March 2015. Three patients had seminomas, 2 patients had yolk sac tumors, and 1 patient had choriocarcinoma. The median observation period was 32.5 months (range: 8–84 months). Results. Three of the 6 patients received initial operation followed by 3-4 courses of chemotherapy (bleomycin, etoposide, and cisplatin (BEP) or etoposide and cisplatin (EP)). One patient developed multiple lung metastases 17 months after surgery; received salvage chemotherapy with vinblastine, ifosfamide, and cisplatin; and achieved complete remission. The remaining 3 patients received initial BEP and EP chemotherapy. Multiple lung metastases and supraclavicular lymph node metastases were detected in 2 of these patients at the initial diagnosis. The patients underwent resections to remove residual tumor after treatment, and no viable tumor cells were found. Conclusions. Reliable diagnosis and immediate multimodal treatments are necessary for patients with PMGCTs. The 6 patients treated in our hospital have never experienced recurrence after the multimodal treatment. Yutaro Tanaka, Takehiko Okamura, Takashi Nagai, Daichi Kobayashi, Takahiro Kobayashi, Hidetoshi Akita, Yoshinobu Moritoki, and Takahiro Yasui Copyright © 2017 Yutaro Tanaka et al. All rights reserved. Study of Testicular Structure in Fetuses with Prune Belly Syndrome Sun, 21 May 2017 00:00:00 +0000 Purpose. To compare the structure of the testis in fetuses with prune belly syndrome (PBS) to normal controls. Materials and Methods. We studied 6 testes obtained from 3 fetuses with PBS and 14 testes from 7 male fetuses. The testicular specimens were cut into 5-μm thick sections and stained with hematoxylin and eosin (HE), to observe the seminiferous tubules; Weigert’s solution to observe elastic fibers; and picrosirius red to observe collagen. The images were captured with an Olympus BX51 microscope and Olympus DP70 camera. The stereological analysis was done with the Image Pro and Image J programs. Means were statistically compared using the Mann–Whitney test (). Results. Quantitative analysis documented no differences () in number of seminiferous tubules (ST) in PBS testes (mean = 8.87%, ), when compared to the control (mean = 11.4%, ) and no differences () in diameter of ST in PBS testes (mean = 52.85 μm, ) when compared to the control group (mean = 53.17 μm, ), but we did observe a lower number () of Leydig cells in the PBS testes (mean = 67.03% and ) when compared to the control group (mean = 90.1% and ). Conclusions. Our study showed a lower concentration of Leydig cells in the triad syndrome fetuses. Luciano A. Favorito, Suelen F. Costa, Waldemar S. Costa, Rodrigo Vieiralves, Fabio O. Bernardo, and Francisco J. B. Sampaio Copyright © 2017 Luciano A. Favorito et al. All rights reserved. Do Routine Preoperative and Intraoperative Urine Cultures Benefit Pediatric Vesicoureteral Reflux Surgery? Tue, 11 Apr 2017 10:14:42 +0000 Objective. To determine if routine preoperative and intraoperative urine cultures (UCx) are necessary in pediatric vesicoureteral (VUR) reflux surgery by identifying their association with each other, preoperative symptoms, and surgical outcomes. Materials and Methods. A retrospective review of patients undergoing ureteral reimplant(s) for primary VUR at a tertiary academic medical center between years 2000 and 2014 was done. Preoperative UCx were defined as those within 30 days before surgery. A positive culture was defined as >50,000 colony forming units of a single organism. Results. A total of 185 patients were identified and 87/185 (47.0%) met inclusion criteria. Of those, 39/87 (45%) completed a preoperative UCx. Only 3/39 (8%) preoperative cultures returned positive, and all of those patients were preoperatively symptomatic. No preoperatively asymptomatic patients had positive preoperative cultures. Intraoperative cultures were obtained in 21/87 (24.1%) patients; all were negative. No associations were found between preoperative culture results and intraoperative cultures or between culture result and postoperative complications. Conclusions. In asymptomatic patients, no associations were found between the completion of a preoperative or intraoperative UCx and surgical outcomes, suggesting that not all patients may require preoperative screening. Children presenting with symptoms of urinary tract infection (UTI) prior to ureteral reimplantation may benefit from preoperative UCx. Daniel R. Hettel, Bradley C. Gill, and Audrey C. Rhee Copyright © 2017 Daniel R. Hettel et al. All rights reserved. Incidence of Urethral Stricture in Patients with Adult Acquired Buried Penis Thu, 30 Mar 2017 06:45:36 +0000 Introduction. Concealed-buried penis is an acquired condition associated with obesity, challenging to both manage and repair. Urethral stricture is a more common disorder with multiple etiologies. Lichen sclerosus is a significant known cause of urethral stricture, implicated in up to 30%. We hypothesize that patients with buried penis have a higher rate of urethral stricture and lichen sclerosus than the general population. Methods. We retrospectively reviewed a single surgeon’s (CM) case logs for patients presenting with a buried penis. All patients were evaluated for urethral stricture with cystoscopy or retrograde urethrogram either prior to or at the time of repair for buried penis. Those that had surgical repair or biopsy were reviewed for presence of lichen sclerosus. Results. 39 patients met inclusion criteria. Of these, 13 (33%) had associated stricture disease. The location of the strictures was bulbar urethra (38%), penile urethra (15%), and meatus or fossa navicularis (62%). Five patients had lichen sclerosus and urethral stricture disease, while 3 had lichen sclerosus without stricture. 11/13 stricture patients were treated. Six underwent dilation, 3 underwent meatotomy, and 2 underwent urethroplasty. No significant recurrences of stricture were seen. Conclusion. Patients with a concealed penis are more likely than the general population to have a urethral stricture and/or LS. Patients presenting with concealed penis should also be evaluated for a urethral stricture. Aron Liaw, Lanette Rickborn, and Christopher McClung Copyright © 2017 Aron Liaw et al. All rights reserved. Distribution of Neuroendocrine Cells in the Transition Zone of the Prostate Wed, 01 Mar 2017 09:48:20 +0000 Objectives. To evaluate the distribution of neuroendocrine (NE) cells which may influence the development of benign prostatic hyperplasia (BPH) in the transition zone (TZ). Methods. We reviewed specimens from 80 patients who underwent radical prostatectomy in our institution and evaluated the density of NE cells in the TZ. They were histologically classified into 3 groups: those with no adenomatous nodule in the TZ (group A), those with small nodules with normal epithelium and stroma around them in the TZ (group B), and those with large nodules occupying the TZ (group C). In the patients of group B, intra-adenoma (adenomatous nodules) and extra-adenoma (normal tissue) NE cells in the TZ were separately counted. Results. There were 22, 23, and 35 patients in groups A, B, and C, respectively. The median density of NE cells in the TZ of group B patients, 2.80/mm2, was significantly higher than that of NE cells in group A, 1.43/mm2, and group C, 0.61/mm2 (). In group B, the median density of extra-adenoma NE cells was significantly higher than that of intra-adenoma. Conclusions. Many NE cells exist around small adenoma in the TZ. NE cells may influence the initial growth of BPH in a paracrine fashion. Trial Registration. This study approved by our institutional review board was retrospectively registered (#272-14). Yuki Kyoda, Koji Ichihara, Kohei Hashimoto, Ko Kobayashi, Fumimasa Fukuta, and Naoya Masumori Copyright © 2017 Yuki Kyoda et al. All rights reserved. Percutaneous Nephrolithotomy under Ultrasound Guidance in Patients with Renal Calculi and Autosomal Dominant Polycystic Kidney Disease: A Report of 11 Cases Tue, 21 Feb 2017 07:24:10 +0000 Nephrolithiasis accelerates the renal failure in the patients with ADPKD. In order to evaluate the role of percutaneous nephrolithotomy in management of calculus in these patients, 11 patients with autosomal dominant polycystic kidney disease and renal stones were included in the study. Two patients had bilateral renal stones. All patients were treated by percutaneous nephrolithotomy under ultrasound guidance. 13 percutaneous nephrolithotomy procedures were performed in 1 stage by the urology team under ultrasound guidance. 5 people received second operation with flexible nephroscopy in lateral position. The success rate and morbidity and mortality of the technique and hospital stay were recorded. Results. The puncture procedure was fully successful in all cases. The renal function improved in these patients. 5 patients had moderate fever after the surgery. 5 patients received flexible nephroscopy to take out the residual calculi. 2 persons had ESWL therapy after the surgery. Conclusion. PCNL is an ideal, safe, and effective method to remove the stones from those patients with no definite increase in the risk of complication. The outcome and stone-free rate are satisfactory comparable to the PCNL in the patients without ADPKD. Xiao Wang, Xuecheng Yang, Xiulong Zhong, Zhenlin Wang, Senyao Xue, Weifeng Yu, and Zhen Dong Copyright © 2017 Xiao Wang et al. All rights reserved. Impact Assessment of Urethral Meatus Morphology and Penile Biometry in Transurethral Prostate and Bladder Surgery Sun, 19 Feb 2017 00:00:00 +0000 Objective. To analyze the penile and urethral meatus biometry and its correlation with meatoplasty during endoscopic resections. We also propose a new classification for urethral meatus morphology. Materials and Methods. We prospectively studied 105 patients who underwent prostate and bladder transurethral resections. We performed standardized measurement of penile and urethral meatus biometry followed by penile photo in the front position. The need to perform meatoplasty or dilatation during resectoscope introduction was registered. Data were analyzed comparing the correlation between two groups: without intervention (Group A) and with intervention (Group B). Results. We observed in Group A and Group B, respectively, the average length of urethral meatus of 1.07 cm versus 0.75 cm () and average width of urethral meatus of 0.59 cm versus 0.38 cm (). Considering the morphology of the urethral meatus, we propose a new classification, in the following groups: (a) typical; (b) slit; (c) point-like; (d) horseshoe; and (e) megameatus. The point-like meatus was the one that most needed intervention, followed by the slit and the typical meatus (). Conclusions. Point-like and slit-shaped urethral meatus, as well as reduced length and width of the urethral meatus, are the determining factors. Rodrigo Ribeiro Vieiralves, Paulo Henrique Pereira Conte, Eduardo Medina Felici, Nádia Cristina Pinheiro Rodrigues, Tomás Accioly de souza, Francisco J. B. Sampaio, and Luciano Alves Favorito Copyright © 2017 Rodrigo Ribeiro Vieiralves et al. All rights reserved. The Effect of Obesity and Increased Waist Circumference on the Outcome of Laparoscopic Nephrectomy Sun, 22 Jan 2017 12:10:12 +0000 Introduction. The prevalence of obesity is increasing worldwide. Obesity can be determined by body mass index (BMI); however waist circumference (WC) is a better measure of central obesity. This study evaluates the outcome of laparoscopic nephrectomy on patients with an abnormal WC. Methods. A WC of >88 cm for women and >102 cm for men was defined as obese. Data collected included age, gender, American Society of Anaesthesiologists (ASA) score, renal function, anaesthetic duration, surgery duration, blood loss, complications, and duration of hospital stay. Results. 144 patients were assessed; 73 (50.7%) of the patients had abnormal WC for their gender. There was no difference between the groups for conversion to open surgery, number of ports used, blood loss, and complications. Abnormal WC was associated with a longer median anaesthetic duration, 233 min, IQR (215–265) versus 204 min, IQR (190–210), , and operative duration, 178 min, IQR (160–190) versus 137 min, IQR (128–162), . Patients with an abnormal WC also had a longer inpatient stay, . Conclusion. Laparoscopic nephrectomy is safe in obese patients. However, obese patients should be informed that their obesity prolongs the anaesthetic duration and duration of the surgery and is associated with a prolonged recovery. D. B. Hennessey, E. M. Bolton, A. Z. Thomas, R. P. Manecksha, and T. H. Lynch Copyright © 2017 D. B. Hennessey et al. All rights reserved. Addition of Ceftriaxone and Amikacin to a Ciprofloxacin plus Metronidazole Regimen for Preventing Infectious Complications of Transrectal Ultrasound-Guided Prostate Biopsy: A Randomized Controlled Trial Tue, 10 Jan 2017 00:00:00 +0000 Background. The objective of this study was to evaluate the efficacy of adding single doses of ceftriaxone and amikacin to a ciprofloxacin plus metronidazole regimen on the reduction of infectious complications following transrectal ultrasound-guided prostate biopsy (TRUS Bx). Materials and Methods. Four hundred and fifty patients who were candidates for TRUS Bx were divided into two groups of 225 each. The control group received ciprofloxacin 500 mg orally every 12 hours together with metronidazole 500 mg orally every 8 hours from the day prior to the procedure until the fifth postoperative day. In the second group, single doses of ceftriaxone 1 g by intravenous infusion and amikacin 5 mg/kg intramuscularly were administered 30–60 minutes before TRUS Bx in addition to the oral antimicrobials described for group 1. The incidence of infection was compared between the groups. Results. The incidence of infectious complications in the intervention group was significantly lower than that in the control group (4.6% versus 0.9%, ). Conclusion. The addition of single doses of intramuscular amikacin and intravenously infused ceftriaxone to our prophylactic regimen of ciprofloxacin plus metronidazole resulted in a statistically significant reduction of infectious complications following TRUS Bx. Mohammad-Hossein Izadpanahi, Kia Nouri-Mahdavi, Seyed Mahmood Majidi, Mohammad-Hatef Khorrami, Farshid Alizadeh, and Mehrdad Mohammadi-Sichani Copyright © 2017 Mohammad-Hossein Izadpanahi et al. All rights reserved. Does Leaving the Biopsy Needle in Povidone-Iodine Solution Reduce Infective Complications after Biopsy? Tue, 20 Dec 2016 08:32:46 +0000 Aim. The aim of this study is to evaluate whether leaving the biopsy needle used during prostate needle biopsy in 10% povidone-iodine (betadine) solution affects the infectious complications forming after biopsy. Material and Method. This study retrospectively evaluated the data of 176 patients with prostate biopsy performed between December 2012 and April 2014. Patients in Group 1 () were given ofloxacin as a prophylactic antibiotic before biopsy. Patients in Group 2 () had the biopsy needle left in povidone-iodine solution for 1 minute before each use, in addition to antibiotic prophylaxis. The two groups were compared in terms of infective complications developing after biopsy. Results were analyzed using the Mann–Whitney test and Fisher’s exact test. Results. The distribution of infective complications after biopsy according to group was as follows. Group 1, not using betadine, had 15.7% fever, 13.5% hospital stay, 12.4% urinary retention, 10.1% prostatitis, and 5.6% sepsis. The distribution of the same complications in Group 2 using betadine was identified as 5.7% fever, 4.6% hospital stay, 3.4% urinary retention, 2.3% prostatitis, and 0% sepsis. The use of betadine was found to significantly reduce the infectious complications after biopsy compared to the control group (). Conclusion. At the end of this study leaving the prostate needle in povidone-iodine solution before each use during prostate biopsy was found to reduce the infective complications and hospital stay after biopsy. Erdal Benli, Abdullah Cirakoglu, Ercan Ogreden, Yeliz Cetinkol, Mustafa Kerem Calgin, Ali Ayyildiz, and Ahmet Yüce Copyright © 2016 Erdal Benli et al. All rights reserved. Quality of Health Information on the Internet for Urolithiasis on the Google Search Engine Sun, 04 Dec 2016 09:27:51 +0000 Purpose. To compare the quality of health information on the Internet for keywords related to urolithiasis, to assess for difference in information quality across four main Western languages, and to compare the source of sponsorship in these websites. Methods. Health On the Net (HON) Foundation principles were utilised to determine quality information. Fifteen keywords related to urolithiasis were searched on the Google search engine. The first 150 websites were assessed against the HON principles and the source of sponsorship determined. Results. A total of 8986 websites were analysed. A proportion of HON-accredited websites for individual search terms range between 2.5% and 12.0%. The first 50 websites were more likely to be HON-positive compared to websites 51–100 and 101–150. French websites searched were more likely to be HON-positive whereas German websites were less likely to be HON-positive than English websites. There was no statistically significant difference between the rate of HON-positive English and Spanish websites. The three main website sponsors were from government/educational sources (40.2%), followed by commercial (29.9%) and physician/surgeon sources (18.6%). Conclusions. Health information on most urolithiasis websites was not validated. Nearly one-third of websites in this study have commercial sponsorship. Doctors should recognise the need for more reliable health websites for their patients. Dwayne T. S. Chang, Robert Abouassaly, and Nathan Lawrentschuk Copyright © 2016 Dwayne T. S. Chang et al. All rights reserved. Radiofrequency Ablation-Assisted Zero-Ischemia Robotic Laparoscopic Partial Nephrectomy: Oncologic and Functional Outcomes in 49 Patients Thu, 01 Dec 2016 13:58:15 +0000 Introduction and Objectives. Robotic partial nephrectomy with peritumoral radiofrequency ablation (RFA-RPN) is a novel clampless technique. We describe oncologic and functional outcomes in a prospective cohort. Methods. From May, 2007, to December, 2009, 49 consecutive patients with renal masses <7 cm underwent RFA-RPN. During this period, only the RFA-RPN technique was utilized for all cases of partial nephrectomy. Pre- and postoperative data were analyzed and compared to 36 consecutive patients who underwent LPN. Results. In total, 49 tumors were treated in the RFA-RPN group and 36 tumors in the comparison group. Mean operative time was longer in the RFA-RPN group (370 min versus 293 min, ). There were no significant differences in mean EBL (231 cc versus 250 cc, ), transfusion rate (8.2% versus 11.1%, ), or hospital stay (3.9 versus 4.4 days, ). Two patients in the RFA-RPN (4.1%) and 1 (2.7%) patient in the comparison group had a positive surgical margin (). 17 (34.7%) patients had a postoperative urine leak in the RFA-RPN group versus 2 (5.6%) patients in the comparison group (). Mean follow-up was 54 months versus 68.4 months in the comparison group. There was no significant difference between the two groups regarding change in GFR (). There were 3 recurrences (6.1%) in the RFA-RPN group and 0 recurrences in the RPN group (). There were 3 deaths (6.1%) in the RFA-RPN group (one cancer specific) and 4 deaths (11.1%) in the RPN group (non-cancer specific) over the follow-up period (). Conclusions. Our data suggests that this technique is associated with a similar degree of renal preservation but higher rates of postoperative urine leak and possibly higher rates of recurrence. Kalen Rimar, Aziz Khambati, Barry B. McGuire, David A. Rebuck, Kent T. Perry, and Robert B. Nadler Copyright © 2016 Kalen Rimar et al. All rights reserved. Successful Nonoperative Management of High-Grade Blunt Renal Injuries Sun, 27 Nov 2016 11:43:54 +0000 Current management of high-grade blunt renal trauma favors a nonoperative approach when possible. We performed a retrospective study of high grade blunt renal injuries at our level I trauma center to determine the indications and success of nonoperative management (NOM). 47 patients with blunt grade IV or V injuries were identified between October 2004 and December 2013. Immediate operative patients (IO) were compared to nonoperatively managed (NOM). Of the 47 patients, 3 (6.4%) were IO and 44 (95.6%) NOM. IO patients had a higher heart rate on admission, 133 versus 100 in NOM (). IO patients had a higher rate of injury to the renal vein or artery (100%) compared to NOM group (18%) (). NOM failed in 3 of 44 patients (6.8%). Two required nonemergent nephrectomy and one required emergent exploration resulting in nephrectomy. Six NOM patients had kidney-related complications (13.6%). The renal salvage rate for the entire cohort was 87.2% and 93.2% for NOM. Nonoperative management for hemodynamically stable patients with high-grade blunt renal trauma is safe with a low risk of complications. Management decisions should consider hemodynamic status and visualization of active renal bleeding as well as injury grade in determining operative management. Allison M. May, Oussama Darwish, Brian Dang, John J. Monda, Prajakta Adsul, Johar Syed, and Sameer A. Siddiqui Copyright © 2016 Allison M. May et al. All rights reserved. Guy’s Stone Score (GSS) Based on Intravenous Pyelogram (IVP) Findings Predicting Upper Pole Access Percutaneous Nephrolithotomy (PCNL) Outcomes Thu, 24 Nov 2016 08:56:38 +0000 Objective. To predict the success rate and complications following percutaneous nephrolithotomy via the upper pole using the Guy’s Stone Score (GSS) based on the findings of a preoperative intravenous pyelogram (IVP). Patients and Methods. Two hundred and twenty-seven renal operations, which were carried out using PCNL via the upper pole, were classified according to the GSS assigned. Any complications were classified according to the Clavien classification. The success rates and incidence of any complications were compared between each GSS. Results. The immediate success rates were 87.50% of GSS1, 71.43% of GSS2, 53.62% of GSS3, and 38.46% of GSS4, . There were statistically significant differences between the groups in stone size, overall immediate success rate, operative time, number of access tracts, and frequency of tubeless PCNL. Major complications (a Clavien score of 3–5) were significantly higher in the cases with a higher GSS. Conclusion. A GSS based on an IVP is a simple and reliable tool in predicting the success rate and possible complications following upper pole access PCNL. Bannakij Lojanapiwat, Pattara Rod-Ong, Pruit Kitirattrakarn, and Wilaiwan Chongruksut Copyright © 2016 Bannakij Lojanapiwat et al. All rights reserved. Corrigendum to “HDR Brachytherapy in the Management of High-Risk Prostate Cancer” Mon, 21 Nov 2016 07:37:33 +0000 Susan Masson, Raj Persad, and Amit Bahl Copyright © 2016 Susan Masson et al. All rights reserved. The Single Wire Ureteral Access Sheath, Both Safe and Economical Tue, 15 Nov 2016 06:03:42 +0000 Introduction. Novel disposable products for ureteroscopy are often inherently more expensive than conventional ones. For example, the Cook Flexor© Parallel™ (Flexor) access sheath is designed for ease and efficiency of gaining upper tract access with a solitary wire. We analyze the cost combinations, efficiency, and safety of disposable products utilized for upper tract access, including the Flexor and standard ureteral access sheath. Methods. We performed a retrospective review from January 2014 to October 2014 of patients undergoing URS for nephrolithiasis, who were prestented for various reasons (e.g., infection). Common combinations most utilized at our institution include “Classic,” “Flexor,” and “Standard.” Total costs per technique were calculated. Patient characteristics, operative parameters, and outcomes were compared among the groups. Results. The most commonly used technique involved a standard ureteral sheath and was the most expensive ($294). The second most utilized and least expensive combination involved the Flexor, saving up to $80 per case (27%). All access sheaths were placed successfully and without complications. There were no significant differences in operative time, blood loss, or complications. Conclusions. In prestented patients within this study, the Flexor combination was the most economical. Although the savings appear modest, long-term impact on costs can be substantial. Joan C. Delto, George Wayne, Ajaydeep Sidhu, Rafael Yanes, Akshay Bhandari, and Alan M. Nieder Copyright © 2016 Joan C. Delto et al. All rights reserved. Pharmacological Relaxation of the Ureter When Using Ureteral Access Sheaths during Ureterorenoscopy: A Randomized Feasibility Study in a Porcine Model Thu, 20 Oct 2016 13:27:14 +0000 Objective. High intraluminal pressure during ureterorenoscopy (URS) increases risk of infectious and haemorrhagic complications. Intrarenal pressure may be reduced by the use of ureteral access sheaths (UASs), which on the other hand may cause ureteral damage. We have previously shown that the β-agonist isoproterenol (ISO), when administered topically in the irrigation fluid, is able to inhibit ureteral muscle tone and lower intrarenal pressure during URS. The aim of this study was to examine the effect of ISO on the success rate of UAS insertion in a porcine model. Materials and Methods. 22 pigs in which a UAS could not initially be placed were randomized to endoluminal irrigation with either ISO (0.1 μg/mL) or saline before a new insertion trial. Subsequently, it was registered whether the UAS could be passed without resistance. During extraction of the sheath, any ureteral lesions were characterized ureteroscopically using the PULS classification system. Surgeons were blinded to randomization. Results. In the ISO group, the observed effect of irrigation was 63% successful UAS insertions, compared to 27% in the saline group. No serious lesions (<PULS grade 2) were observed in the ISO group. Conclusions. Endoluminal irrigation with ISO may facilitate UAS insertion and potentially decrease UAS related ureteral lesions. Søren Kissow Lildal, Kim Hovgaard Andreassen, Frederikke Eichner Christiansen, Helene Jung, Malene Roland Pedersen, and Palle Jörn Sloth Osther Copyright © 2016 Søren Kissow Lildal et al. All rights reserved. Unusual Presentation of Duplex Kidneys: Ureteropelvic Junction Obstruction Tue, 18 Oct 2016 06:18:43 +0000 Aim. Ureteropelvic junction obstruction (UPJO) is rarely associated with a duplex collecting system. We review this unusual anomaly in terms of presentation, diagnostic evaluation, and surgical management. Method. We retrospectively reviewed the medical records of patients diagnosed with a duplex system with UPJO. Result. Sixteen patients (6 girls, 10 boys) with 18 moieties were treated surgically and four patients were treated conservatively. The median age at surgery was two years (range, 2 months to 7 years). The lower pole and upper moiety were affected in 12 and two kidneys, respectively, and both were affected in two patients. The anomaly was right-sided in 12 moieties and left-sided in six. The duplication was incomplete in seven patients and complete in nine. The mean renal pelvis diameter at the time of surgery was 25.6 (range 11–48 mm) mm by USG. The mean renal function of the involved moiety was 28.3% before surgery. Management included pyelopyelostomy or ureteropyelostomy in six moieties, dismembered pyeloplasty in eight moieties, heminephrectomy in four cases, and simultaneous upper heminephrectomy and lower pole ureteropyelostomy in one patient. Conclusion. There is no standard approach for these patients and treatment should be individualized according to physical presentation, detailed anatomy, and severity of obstruction. Cemile Başdaş, Süleyman Çelebi, Seyithan Özaydın, Birgül Karaaslan, Elmas Reyhan Alim, Ünal Güvenç, and Serdar Sander Copyright © 2016 Cemile Başdaş et al. All rights reserved. Novel Bioceramic Urethral Bulking Agents Elicit Improved Host Tissue Responses in a Rat Model Mon, 29 Aug 2016 14:06:35 +0000 Objectives. To test the physical properties and host response to the bioceramic particles, silica-calcium phosphate (SCPC10) and Cristobalite, in a rat animal model and compare their biocompatibility to the current clinically utilized urethral bulking materials. Material and Methods. The novel bulking materials, SCPC10 and Cristobalite, were suspended in hyaluronic acid sodium salt and injected into the mid urethra of a rat. Additional animals were injected with bulking materials currently in clinical use. Physiological response was assessed using voiding trials, and host tissue response was evaluated using hard tissue histology and immunohistochemical analysis. Distant organs were evaluated for the presence of particles or their components. Results. Histological analysis of the urethral tissue five months after injection showed that both SCPC10 and Cristobalite induced a more robust fibroblastic and histiocytic reaction, promoting integration and encapsulation of the particle aggregates, leading to a larger bulking effect. Concentrations of Ca, Na, Si, and P ions in the experimental groups were comparable to control animals. Conclusions. This side-by-side examination of urethral bulking agents using a rat animal model and hard tissue histology techniques compared two newly developed bioactive ceramic particles to three of the currently used bulking agents. The local host tissue response and bulking effects of bioceramic particles were superior while also possessing a comparable safety profile. Travis K. Mann-Gow, Benjamin J. King, Ahmed El-Ghannam, Christine Knabe-Ducheyne, Masatoshi Kida, Ole M. Dall, Jan Krhut, and Peter Zvara Copyright © 2016 Travis K. Mann-Gow et al. All rights reserved. A Clinicopathological Profile of Prostate Cancer in Trinidad and Tobago Sun, 17 Jul 2016 13:56:56 +0000 Aim. To conduct a clinicopathological review of all prostate biopsies performed in a tertiary referral centre in Trinidad and Tobago over a period of 30 months. Methods. The records of all patients who had prostate biopsies from January 2012 to July 2014 were reviewed. Clinical and pathologic data were compiled and subsequently analysed using SPSS version 20. Results. From January 2012 to July 2014, 617 transrectal ultrasound guided prostate biopsies were performed. Pathological data were found for 546 patients of whom 283 (51.8%) were confirmed carcinoma of the prostate. Moderately differentiated tumors (Gleason 7) were the most common group. Using the D’Amico risk classification, most cases were found to be high risk (63.1%). Afro-Trinidadians comprised 72.1% of the patients with prostate cancer. Afro-Trinidadians were also more likely to have high risk and high grade disease as well as high PSA values. Conclusion. This study demonstrates that over half of our biopsies are eventually positive for cancer and most cases were high risk. Afro-Trinidadians comprised a disproportionate number of those diagnosed with prostate cancer and had a greater risk of high risk disease. Ian Hosein, Rajendra Sukhraj, Lester Goetz, Nastassia Rambarran, and Satyendra Persaud Copyright © 2016 Ian Hosein et al. All rights reserved. From Inflammation to Prostate Cancer: The Role of Inflammasomes Mon, 27 Jun 2016 06:40:00 +0000 Inflammation-associated studies entice specific attention due to inflammation’s role in multiple stages of prostate cancer development. However, mechanistic regulation of inflammation inciting prostate cancer remains largely uncharacterized. A focused class of inflammatory regulators known as inflammasomes has recently gained attention in cancer development. Inflammasomes are a multiprotein complex that drives a cascade of proinflammatory cytokines regulating various cellular activities. Inflammasomes activation is linked with infection, stress, or danger signals, which are common events within the prostate gland. In this study, we review the potential of inflammasomes in understanding the role of inflammation in prostate cancer. Dev Karan and Seema Dubey Copyright © 2016 Dev Karan and Seema Dubey. All rights reserved. Evaluation of Lymphorrhea and Incidence of Lymphoceles: 4DryField® PH in Radical Retropubic Prostatectomy Thu, 23 Jun 2016 07:49:59 +0000 Purpose. To investigate impact of polysaccharide hemostat 4DryField PH (4DF) applied on lymph node dissection area after radical retropubic prostatectomy (RRP) on lymphorrhea and lymphocele (LC) formation. Methods. 104 consecutive patients underwent RRP, 51 without 4DF treatment (CT-group) and 53 with 4DF treatment (4DF-group). Groups were comparable (age, risk profile, and lymph node numbers). Postoperative drain loss (PDL) and development of early and late LC were analyzed (mean follow-up at 7 months: 100%). Results. PDL was 452.5 ± 634.2 mL without and 308.5 ± 214 mL with 4DF treatment. PDL > 1000 mL only occurred in CT-group (5/51). Overall, 45 LC (26 in CT- versus 19 in the 4DF-group) were diagnosed. At day 8, LC were equally distributed between groups. Incidence of late LC, however, was twice in controls (16/51) versus 4DF-patients (8/53). Symptomatic LC (4 in untreated patients, 2 in 4DF-patients) were treated with percutaneous drainage (duration: 45 days in untreated patients versus 12 days in 4DF-patients). Conclusion. Application of 4DF on lymph node dissection areas lessened total drain loss and significantly lowered high volume drain loss. Furthermore, 4DF reduced frequency of late lymphoceles and lymphoceles requiring treatment by half, as well as duration of percutaneous drainage by more than two-thirds. Johannes-J. Karsch, Martin Berthold, and Jürgen Breul Copyright © 2016 Johannes-J. Karsch et al. All rights reserved. Severity of Lower Urinary Tract Symptoms among Middle Aged and Elderly Nigerian Men: Impact on Quality of Life Sun, 19 Jun 2016 12:27:18 +0000 Objectives. To compare the severity of LUTS among middle aged and elderly Nigerian men and determine the influence of LUTS severity on QoL. Methods. This cross-sectional study was conducted among new patients presenting with LUTS attending Urology clinic between 2011 and 2015. Assessment of symptoms was based on IPSS and bother score completed by the eligible subjects on the same day of their clinic visits. Results. Four hundred patients were studied comprising 229 middle aged and 171 elderly men. Interquartile range (IQR) of IPSS scores for men <65 years and those ≥65 years was 14.0 (16.0) and 19 (15.0), respectively (). Mild LUTS was significantly associated with best, good, and poor quality of life while moderate LUTS was associated with poor QoL. Severe LUTS was significantly associated with all the categories of QoL (Best-Worst). Among the cohort of subjects with poor QoL, elderly patients had a significantly higher median IPSS score (). Conclusions. There is no level of severity of LUTS in which patients’ QoL is not impaired although mild symptomatology may be associated with better QoL and severe symptomatology with poor QoL. Careful attention to QoL may help identify patients who require early and prompt treatment irrespective of the IPSS. Patrick Temi Adegun, Philip Babatunde Adebayo, and Peter Olufemi Areo Copyright © 2016 Patrick Temi Adegun et al. All rights reserved. Transperitoneal Laparoscopic Pyelopyelostomy for Retrocaval Ureter without Excision of the Retrocaval Segment: Experience on Three Cases Tue, 14 Jun 2016 11:21:00 +0000 Introduction. Retrocaval ureter is a rare congenital anomaly. Open surgery was the classic treatment for this condition. Laparoscopy is currently an admitted procedure to treat many urological diseases. The objective of our study is to present our experience and discuss the safety and the feasibility of transperitoneal laparoscopic pyelopyelostomy for treatment of retrocaval ureter (RCU). Materials and Methods. Three symptomatic patients underwent laparoscopic repair for RCU in our department. The diagnosis was suspected on the computed tomography scan (CT) and confirmed on ascending pyelography. After placement of a JJ stent, and, using the transperitoneal approach, the retro peritoneum was exposed; the ureter was identified in both sides of the vena cava. The retrocaval segment was entirely mobilized and pulled from behind of the vena cava after section of renal pelvis. A pyelopyelostomy was done in a normal anatomic position. Results. All operations were achieved laparoscopically without conversion to open surgery. The mean operative time was 140 minutes (110–190). No intraoperative complication occurred. Blood loss was less than 50 mL in all patients. The mean hospital stay was 5 days (4–6 days). All patients were symptom-free after surgery and had reduction of hydronephrosis in control imagery. Conclusion. Laparoscopy seems safe, feasible, and reproducible in managing retrocaval ureter. Y. El Harrech, O. Ghoundale, E. H. Kasmaoui, and D. Touiti Copyright © 2016 Y. El Harrech et al. All rights reserved. Reliability of the Grading System for Voiding Cystourethrograms in the Management of Vesicoureteral Reflux: An Interrater Comparison Wed, 16 Mar 2016 06:25:46 +0000 Aim. Vesicoureteral reflux (VUR) is one of the most common conditions seen in pediatric urology. Fortunately, there are many treatment options for this disorder. The grading system for VUR varies among doctors, and the literature on its reliability is sparse. Here, we assessed the effectiveness of the current VUR grading system. Methods. A series of 40 voiding cystourethrogram (VCUG) studies were selected. Four pediatric urologists (PU) and four pediatric radiologists (PR) independently graded each VCUG and then agreed on a uniform interpretation. For statistical analysis the intraclass correlation coefficient (ICC) was applied to assess interrater agreement. Results. ICC values ranging from 0.82 to 0.88 reflected the strong reliability of VCUG for grading cases of VUR among pediatric urologists and radiologists as separate groups, and the reliability between the two groups was also good, as indicated by an ICC of 0.89. Despite the high ICC, disagreement existed between raters; the lowest agreement was associated with middle grades (III and IV). Conclusions. The interrater reliability of the international grading system for VUR was high but imperfect. Thus, grading differences at middle grades can profoundly influence the type of treatment pursued. Süleyman Çelebi, Seyithan Özaydın, Cemile Beşik Baştaş, Özgür Kuzdan, Cankat Erdoğan, Mehmet Yazıcı, İsmail Caymaz, and Serdar Sander Copyright © 2016 Süleyman Çelebi et al. All rights reserved. Diverticulectomy in the Management of Intradiverticular Bladder Tumors: A Twelve-Year Experience at a Single Institution Tue, 15 Mar 2016 11:28:41 +0000 Purpose. In this retrospective case review we analyze the outcomes of patients treated for intradiverticular bladder tumors (IDT). Materials and Methods. A retrospective case review was done between January 2002 and May 2014 in Hotel-Dieu de France hospital. The series included 17 patients diagnosed with IDT, all males with a mean age of 49.8 years. Results. One patient was treated with tumor resection and adjuvant BCG instillation with no recurrence on follow-up cystoscopies and urine cytologies. 64% of patients were treated by diverticulectomy. Mean follow-up time was 38.7 months. At the end of the follow-up, 81% were disease-free. One patient had a radical cystectomy 6 months after diverticulectomy for recurrent high grade tumor; another one had a nodal metastasis 10 months after diverticulectomy and was managed with chemotherapy. 29% of patients were treated with radical cystectomy. Mean follow-up time was 28.4 months. No recurrence was documented on annual CT scans. Conclusions. Our data support a conservative approach for tumors confined to the bladder diverticulum, even in high grade or in the presence of CIS provided complete removal is feasible and close follow-up is ensured. Ali Bourgi, Elias Ayoub, and Sleiman Merhej Copyright © 2016 Ali Bourgi et al. All rights reserved. Urethral Stricture Disease: Challenges and Ongoing Controversies Mon, 14 Mar 2016 09:15:09 +0000 Miroslav L. Djordjevic, Francisco E. Martins, Vladimir Kojovic, and Dmitry Kurbatov Copyright © 2016 Miroslav L. Djordjevic et al. All rights reserved. Assessment of Potential Live Kidney Donors and Computed Tomographic Renal Angiograms at Christchurch Hospital Thu, 10 Mar 2016 07:53:16 +0000 Aims. To examine the outcome of potential live kidney donors (PLKD) assessment program at Christchurch Hospital and, also, to review findings of Computed Tomographic (CT) renal angiograms that led to exclusion in the surgical assessment. Methods. Clinical data was obtained from the database of kidney transplants, Proton. Radiological investigations were reviewed using the hospital database, Éclair. The transplant coordinator was interviewed to clarify information about PLKD who did not proceed to surgery, and a consultant radiologist was interviewed to explain unfavorable findings on CT renal angiograms. Results. 162 PLKD were identified during the period January 04–June 08. Of those, 65 (40%) proceeded to have nephrectomy, 15 were accepted and planned to proceed to surgery, 13 were awaiting further assessment, and 69 (42.5%) did not proceed to nephrectomy. Of the 162 PLKD, 142 (88%) were directed donors. The proportion of altruistic PLKD who opted out was significantly higher than that of directed PLKD (45% versus 7%, ). Conclusions. This audit demonstrated a positive experience of live kidney donation at Christchurch Hospital. CT renal angiogram can potentially detect incidental or controversial pathologies in the kidney and the surrounding structures. Altruistic donation remains controversial with higher rates of opting out. Thamer Alsulaiman, Stephen Mark, Sarah Armstrong, and David McGregor Copyright © 2016 Thamer Alsulaiman et al. All rights reserved.