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   Table of Contents - Current issue
April-June 2019
Volume 11 | Issue 2
Page Nos. 119-233

Online since Thursday, April 4, 2019

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New treatment modalities with vaccine therapy in renal cell carcinoma p. 119
Mehmet Giray Sonmez, Leyla Öztürk Sönmez
DOI:10.4103/UA.UA_166_17  PMID:31040593
The aim of implementing vaccine therapy is to activate immune response against malignant cells by overcoming the tolerance triggered by the tumor. These treatments are effective using the immune response against cancer. Not every type of cancer is suitable for vaccine therapies. For a vaccine therapy to be implemented, cancer should be immunogenic and contain tissue-specific proteins, should have a slow progression, and treatments should be feasible. For that reason, studies regarding urological cancers are mostly focused on the kidneys and the prostate. Vaccine therapies used in renal cell carcinoma (RCC) can be categorized under the following titles: autologous tumor cells, dendritic cells, genetically modified tumor cells, and protein/peptide. Although there are old studies on the implementation of vaccine therapies in RCC, researches have only been intensified recently. In addition to their effective potential for lengthening general survival, decreasing tumor burden and cancer development in long term, vaccine treatments are especially effective in metastatic RCC patients. We think that vaccine treatments would be applied more in near future since RCC are immunogenic. In this compilation, we will discuss vaccine therapies used in RCC, which urologists are not so familiar with, in the light of the up-to-date literature.
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Guideline on writing a case report Highly accessed article p. 126
Basim Saleh Alsaywid, Nada Mansour Abdulhaq
DOI:10.4103/UA.UA_177_18  PMID:31040594
Research is an important competency that should be mastered by medical professionals. It provides an opportunity for physicians to develop numerous skills including communication, collaboration, time management, and teamwork. Case report, as a research design, describes important scientific observations that are encountered in a clinical setting to expand our knowledge base. Preparing a case report is far easier than conducting any other elaborative research design. Case report, with its main components, should be focused and delivers a clear message. In this article, the key components of a case report were described with the aim of providing guidance to novice authors to improve the quality of their reporting.
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Lower urinary tract symptoms and feeling of incomplete emptying in Saudi Arabian men and its correlation with postvoid residual urine p. 132
Reem Aldamanhori
DOI:10.4103/UA.UA_133_18  PMID:31040595
Purpose: This study was conducted to assess the clinical value of postvoid residual (PVR) urine measurement and associate it with the feeling of incomplete emptying in men with lower urinary tract symptoms. Methods: Two hundred men were surveyed in the King Fahd Hospital of the University. Patients who had previous urological surgery and patients who are currently on urology treatment were excluded. Information from the remaining 181 patients was analyzed. International Prostate Symptom Score (IPSS) sheets were filed, and then, the PVR was measured. Results: Data from IPSS sheets were evaluated: 45 patients (24.8%) were characterized as experiencing no symptoms (Score: 0 and 1), 87 (48%) as mild-to-moderate symptoms (Score: 2 and 3), and 49 (27%) as severe symptoms (Score: 4 and 5). The PVR measurement showed no statistical difference in all three categories (being 10, 13, and 12, respectively). Feeling of incomplete emptying despite little PVR was frequently observed. Conclusion: The study concluded that the feeling of incomplete emptying was poorly correlated with PVR urine volume measurement. This feeling was significantly associated with worsening of both voiding and storage symptoms.
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Incidence of prostate cancer among patients with prostate-related urinary symptoms: A single institution series in 10 years p. 135
Khalid M Alotaibi
DOI:10.4103/UA.UA_151_18  PMID:31040596
Purpose: The aim of the study is to correlate between the value of digital rectal examination (DRE), serum prostate-specific antigen (PSA), and transrectal ultrasound (TRUS) as predictors for diagnosing prostate cancer in patients with voiding symptoms. Materials and Methods: A total of 1610 male patients seen over a period of 10 years in a single institution had prostate-related voiding problems. Routine studies including DRE and serum PSA were done to all patients. TRUS and TRUS biopsy were performed for patients with suspected prostatic cancer based on abnormal DRE findings and/or serum PSA levels. Results: TRUS biopsy revealed prostate cancer in 206 out of 1610 patients with prostate-related voiding problems (13%), 40% had abnormal PSA and 28% had abnormal DRE. Combined abnormal PSA and DRE revealed cancer in 63% of patients. This percentage increased to 90% when TRUS was also abnormal, but dropped to 54% when TRUS was normal. Conclusions: DRE together with serum PSA and TRUS have the highest predictable values for diagnosis of prostate cancer among patients with voiding symptoms. In the absence of abnormal TRUS, PSA and DRE together are more predictable than either alone. Serum PSA alone is more predictable than DRE. Random prostate biopsies should be performed in the presence of high serum PSA, and/or abnormal findings by DRE in male patients with urinary symptoms suggestive of the prostate disease.
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Pain and anxiety assessment during cystourethroscopy in males using voiding instruction: A prospective, randomized controlled study p. 139
Debansu Sarkar, Kunal Kapoor, Dilip Kumar Pal
DOI:10.4103/UA.UA_196_17  PMID:31040597
Introduction: Office cystourethroscopy is one of the common and most frequent urological procedures. Pain and anxiety during the procedure might lead to noncompliance and incomplete cystoscopic examination. Negotiating cystoscope through external sphincter is the most painful and uncomfortable distressing part of cystoscopy. To overcome this, manual compression of irrigation bag during cystoscopy has been used and found to be helpful. Numerous other methods were also studied. Despite these, cystoscopy is still painful and causes anxiety in patients. External sphincter gets relaxed naturally during the act of micturition. Based on this principle, pain and anxiety were studied with voiding instruction during cystourethroscopy. Objective: To study the effect of voiding instruction on anxiety and pain during cystourethroscopy using the Hamilton Anxiety Rating Scale (HAM-A) and visual analogue scale (VAS), in a well-matched Eastern Indian male patient population in a prospective, randomized pattern. Methods: A total of 100 male patients were recruited from those who underwent cystourethroscopy examination in SSKM Hospital and were prospectively randomized into two groups: cystoscopy with or without voiding instruction. Pre- and postprocedure HAM-A score and postprocedure VAS score were recorded. Results: The mean postprocedural pain (VAS) score between voiding instructed and noninstructed groups reached statistical significance: 3.06 ± 1.98 (Range, 2–5) and 5.16 ± 2.86 (Range, 4–8), respectively (P < 0.001). Preprocedure HAM-A score was similar between both groups. Postprocedure median HAM-A score was statistically significantly lower (mean 17.86 ± 2.8 vs. 19.76 ± 3.12; P < 0.001) in voiding instructed group. Conclusion: Pain and anxiety level during cystourethroscopy examination in males can be significantly reduced when the patient is instructed to void during cystourethroscopy examination.
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Effectiveness of bladder tumor antigen quantitative test in the diagnosis of bladder carcinoma in a schistosoma endemic area p. 143
Abubakar Sadiq Muhammad, Ismaila Arzika Mungadi, Nnaemeka Ndodo Darlington, Garba Diffa Kalayi
DOI:10.4103/UA.UA_192_17  PMID:31040598
Introduction: Bladder carcinoma is the most common male cancer in our environment due to endemicity of schistosomiasis. Squamous-cell carcinoma is the most common histological type and patients present at an advanced stage. The objective of this study is to compare the sensitivity, specificity, and predictive values of the bladder tumor antigen quantitative test (BTA TRAK) and urine cytology in the diagnosis of bladder carcinoma in a schistosoma endemic area. Materials and Methods: This is a 12-month cross-sectional study of 88 patients, 52 of them with features of bladder carcinoma as study group, and 36 of them with hematuria from other urologic conditions, and benign urologic conditions and healthy volunteers as control group (CG). The mean ages of patients in the study and CGs were 47.17 ± 17.00 and 44.19 ± 18.89 years, respectively (P = 0.412). Bladder tumor antigen was assayed using enzyme-linked immunosorbent assay. Data were analyzed using SPSS version 20.0 for Windows. Results: The sensitivity of urine cytology and BTA TRAK in the study was 29.1% and 98.8%, respectively. The specificity of urine cytology and BTA TRAK was 95.5% and 13.6%, respectively (P = 0.05). The positive predictive values of urine cytology and BTA TRAK in the study were 96.2% and 81.7%, respectively. The negative predictive values were 25.0% and 75.0% for urine cytology and BTA TRAK, respectively. Conclusion: BTA TRAK is more sensitive but poorly specific as compared to that of the urine cytology for bladder cell carcinoma detection in a schistosoma endemic area.
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Investigation of the reasons for withdrawal from long-term treatment with mirabegron of treatment-naïve Japanese female patients with overactive bladder in the real-world clinical setting p. 149
Yoshinori Tanaka, Yasushi Tanuma, Naoya Masumori, Hirofumi Ohnishi
DOI:10.4103/UA.UA_70_18  PMID:31040599
Purpose: The persistence of treatment with mirabegron and the reasons for withdrawal from the treatment among treatment-naïve Japanese female patients with overactive bladder (OAB) were prospectively investigated for 3 years in the real-world clinical setting. Materials and Methods: A total of 62 treatment-native Japanese female patients clinically diagnosed with OAB were treated with mirabegron and prospectively followed for 3 years. The persistence rate was estimated using the Kaplan-Meier method. If mirabegron had to be terminated or a patient did not come to the hospital to receive a prescription, the reasons for withdrawal from treatment were determined. Results: The 6-month, 1-year, 2-year, and 3-year persistence rates were 51.6%, 38.7%, 32.3%, and 25.8%, respectively. The most frequent reasons for withdrawal from treatment with mirabegron were symptom resolution (38.7%), deterioration of comorbidity unrelated to OAB (12.9%), lack of efficacy (8.1%), and adverse events (4.8%). Conclusions: The persistence rate of treatment with mirabegron among treatment-naïve Japanese female patients with OAB is low for 3 years in the real-world clinical setting. Many patients discontinue the treatment for various reasons, the most frequent of which is symptom resolution. These findings provide important considerations for clinicians whose patients are continuing medication for OAB.
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Evaluation of response in patients of metastatic castration resistant prostate cancer undergoing systemic radiotherapy with lutetium177-prostate-specific membrane antigen: A comparison between response evaluation criteria in solid tumors, positron-emission tomography response criteria in solid tumors, European organization for research and treatment of cancer, and MDA criteria assessed by gallium 68-prostate-specific membrane antigen positron-emission tomography-computed tomography p. 155
Manoj Gupta, Partha Sarathi Choudhury, Sudhir Rawal, Harish Chandra Goel, Shriram Avinash Rao
DOI:10.4103/UA.UA_111_18  PMID:31040600
Introduction: We evaluated various morphological and molecular response criteria in metastatic castration-resistant prostate cancer (PCa) patient undergoing peptide receptor radioligand therapy (PRLT) with Lutetium177-prostate-specific membrane antigen (PSMA) by using Gallium 68-PSMA positron-emission tomography-computed tomography (Ga68-PSMA PET-CT). Methods: A total of 46 pre- and 8–12 weeks' post-PRLT Ga68-PSMA PET-CT studies were reanalyzed (23 comparisons). Prostate-specific antigen drop of ≥50% and ≥25% increase was considered as partial response (PR) and progressive disease (PD), respectively, for biochemical response (BR) while change in-between was considered as stable disease (SD). Response evaluation criteria in solid tumors 1.1 (RECIST 1.1) and MD Anderson (MDA) criteria for morphological response while PET response criteria in solid tumors 1.0 (PERCIST 1.0) and European organization for research and treatment of cancer (EORTC) criteria for molecular response were used. Kappa coefficient was derived to see the level of agreement. Results: The proportion of PD, PR, and SD by BR and RECIST criteria was 9 (39.13%), 3 (13.04%), and 11 (47.83%) and 5 (21.74%), 2 (8.70%), and 16 (69.57%), respectively. The proportion of PD, PR, and SD was same by PERCIST and EORTC criteria and which were 8 (34.78%), 5 (21.74%), and 10 (43.48%). The proportion of PD, PR, and SD by MDA criteria was 1 (4.35%), 1 (4.35%), and 21 (91.30%), respectively. Poor agreement between BR and both morphological criteria while a statistically significant agreement with both molecular criteria seen. Conclusion: We concluded that molecular criteria performed better than morphological criteria in response assessment by Ga68-PSMA PET-CT in metastatic castration resistant PCa patients undergoing PRLT.
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Effects of fluid absorption following percutaneous nephrolithotomy: Changes in blood cell indices and electrolytes p. 163
Dipti Saxena, Divyangna Sapra, Atul Dixit, Saurabh Chipde, Santosh Agarwal
DOI:10.4103/UA.UA_117_18  PMID:31040601
Background and Aims: Effects of fluid absorption on hematological profile in the immediate postoperative period in patients undergoing percutaneous nephrolithotomy (PCNL) have not been given due importance. Considering the limited number of studies available, we conducted this study to evaluate the changes in hemodynamics, complete blood count (CBC), and electrolytes in patients undergoing PCNL using normal saline for irrigation in the prone position. Furthermore, we evaluated the common factors known to affect the absorption. Materials and Methods: Forty American Society of Anesthesiologist Class I or II patients aged 18–65 years were recruited who underwent PCNL under general anesthesia. Heart rate, blood pressure (BP), CBC, and serum electrolytes were recorded preoperatively and just before extubation and compared using the Student's t-test. Correlation of these changes with height and total volume of irrigating fluid, total time of irrigation, duration of operation, and total intravenous fluids administered intraoperatively were performed using the Pearson's correlation coefficient. Results: There was a statistically significant fall in mean hemoglobin (12.5 g/dL to 11.5 g/dL), packed cell volume (38.6%–35.6%), platelet count (2.9 × 105 cells/μL to 2.5 × 105 cells/μL), and sodium ion concentration (Na+) (138.9 meq/L to 137.7 meq/L) in the immediate postoperative period as compared to that of the preoperative values. Rest of the blood indices and electrolytes did not show any significant change. There was a significant rise in postoperative heart rate and BP. Postoperative systolic BP showed a significant positive correlation with the total volume of irrigating fluid. No significant correlation was observed with height and total time of irrigation. Conclusion: This study reveals that there is a significant fall in hemoglobin and Na+ during PCNL in the immediate postoperative period. Only, total volume of irrigating fluid and total duration of surgery had a significant correlation with blood cell indices.
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Practice patterns in ordering a voiding cystourethrogram for pediatric patients among different specialties in a Middle Eastern Tertiary care center p. 168
Mohammad Hout, Bilal Aoun, Lamya Ann Atweh, Ali Merhe, Yaser El-Hout
DOI:10.4103/UA.UA_124_18  PMID:31040602
Introduction: Voiding cystourethrogram (VCUG) is a very popular test performed to evaluate genitourinary tract anomalies. Nevertheless, this test can be overused and can lead to unnecessary patient discomfort, radiation exposure, and cost. We sought to study the practice patterns in ordering a VCUG in a Middle Eastern tertiary care center. Methods: Over a period of 3 years, a retrospective analysis of all VCUG images done for pediatric patients in a single center was made. Further clinical details were extracted from the electronic health records. The specialty of an ordering physician and the reported indication for the procedure were noted. Indications for VCUG were recorded based on the AAP 2011 guidelines, NICE guidelines 2007, and ACR 2011 guidelines. Based on these criteria, patients were analyzed. Results: A total of 92 VCUGs were evaluated. Of all VCUGs done, pediatricians ordered the most VCUGs (50/92), followed by pediatric infectious disease (16/92), pediatric nephrology (9/92), pediatric urology (7/92), adult urology (5/92), pediatric surgery (3/92), obstetrician-gynecologist (1/92), and emergency medicine (1/92). Properly indicated VCUGs were 50% by general pediatrics, 55% by pediatric infectious disease, 45% by pediatric nephrology, 40% by adult urology, 33% by pediatric surgery, and 100% by pediatric urology. Conclusion: VCUG is utilized differently by different specialties. In some centers, adult specialties may order a pediatric VCUG. General pediatricians order VCUG the most with a tendency for misuse in up to 50%. Pediatric urology is not the most ordering specialty of VCUG; however, it utilizes it most appropriately. The noted practice patterns may be improved with awareness of the indications and limitations of the study and with proper referral.
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Single-step dilatation in percutaneous nephrolithotomy, its safety and efficacy: A prospective, single-center study p. 171
TD Girisha, Preetham Dev, R Vijaykumar, Sachin Dharwadkar, KM Madappa
DOI:10.4103/UA.UA_43_18  PMID:31040603
Background: Percutaneous nephrolithotomy (PCNL) is gold standard technique for the treatment of renal calculi larger than 2 cm or complex renal calculi. Establishment of nephrostomy tract is the important step during PCNL. Hence, this study was conducted to evaluate the effectiveness of single-step dilatation in patients with renal calculi undergoing PCNL. Methods: This is a prospective, single-center study conducted between August 2014 and December 2017. Patient who underwent PCNL using single-step dilatation between the study period were included in the study. Demographic details, stone characteristics, operative time dilatation time, radiation exposure time, rate of complication and blood transfusion were recorded. Data was analyzed and reported using summary statistics. Results: A total of 332 patients were enrolled in this study. The mean (SD) age was 42.46 (15.53) years and 181 (54.52%) patients were male. Overall, stone clearance rate was 92%. The mean (SD) operative time was 62.74 (29.61) minutes, tract dilatation time was 2.18 (1.05) minutes, and the radiation exposure time was 12.68 (6.45) seconds. Blood transfusion was required in 12(3.6%) patients. No major complications were reported during post-operative period. Conclusion: Single-step dilatation technique is safe, economical and feasible technique with added advantage of lesser time of dilatation, lesser radiation exposure and lesser chance of blood transfusion.
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Safety and efficacy of transurethral vaporization of the prostate using plasma kinetic energy: Long-term outcome p. 175
Mahmoud Talat, Abdrabuh Mostafa Abdrabuh, Mohammed Elhelali, Ibrahim Elsotohi, Sayed Eleweedy
DOI:10.4103/UA.UA_76_18  PMID:31040604
Objective: The objective of this study was to assess the long-term efficacy and safety of plasma kinetic vaporization (PKVP) of the prostate for symptomatic benign prostatic hyperplasia. Patients and Methods: Twenty-one patients had been enrolled in this study at Al-Azhar University Hospitals to evaluate their long-term follow-up after PKVP. The outcome was evaluated using the International Prostate Symptom Score (IPSS), quality of life (QOL), peak urinary flow rate (Qmax), postvoiding residual (PVR) of urine, prostate volume, prostate-specific antigen (PSA) level, and long-term complications of the surgery. Results: Preoperatively, IPSS was 22.14 ± 2.22, QOL score was 4.90 ± 0.54, Qmaxwas 8.97 ± 2.49 ml/s, PVR was 138.5 ± 56.5 ml, prostate volume was 64.32 ± 11.16 ml, and PSA level was 4.18 ± 1.95 ng/ml. Two years' post-PKVP, IPSS decreased to 8.57 ± 5.55, QOL score decreased to 1.90 ± 1.22, Qmaxincreased to 17.17 ± 7.91 ml/s, PVR decreased to 38.81 ± 59.54 ml, prostate volume decreased to 22.45 ± 7.22 ml, and PSA level decreased to 1.59 ± 0.74 ng/ml. One patient (4.8%) developed bulbar urethral stricture, 1 (4.8%) developed bladder neck contracture, and 1 (4.8%) developed meatal stenosis. Erectile dysfunction was reported by two out of 12 patients who were sexually potent before surgery, and retrograde ejaculation was reported by 10 patients (83%). Conclusion: The present study has demonstrated satisfactory good efficacy and safety of PKVP on the long term.
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Predictors for severe hemorrhage requiring angioembolization post percutaneous nephrolithotomy: A single-center experience over 3 years p. 180
Amandeep Manjeet Arora, Prakash W Pawar, Ashwin S Tamhankar, Ajit S Sawant, Shankar T Mundhe, Sunil R Patil
DOI:10.4103/UA.UA_75_18  PMID:31040605
Context and Aim: About 1% of the patients undergoing percutaneous nephrolithotomy (PCNL) have bleeding severe enough to require angioembolization. We identified factors which could predict severe bleeding post-PCNL and reviewed patients who underwent angioembolization for the same. Settings and Design: This is a single-institutional, retrospective study over a period of 3 years. Subjects and Methods: We retrospectively studied 583 patients undergoing PCNL at our institute from 2013 to 2016. We analyzed nine patients (three from our institute and six referred patients) who underwent angioembolization for severe bleeding post-PCNL. We analyzed the preoperative characteristics, intraoperative findings, and postoperative course of these patients and compared this with those patients who did not have a severe post-PCNL bleeding. Statistical Analysis Used: Fischer's exact test and Chi-square test were used in univariate analysis. Logistic regression analysis was used in multivariate analysis with a value of P < 0.05 considered statistically significant. Results: Three of the 583 patients (0.51%) who underwent PCNL at our institute required embolization to control bleeding. Preoperative characteristics that were significant risk factors for severe bleeding were a history of ipsilateral renal surgery (P = 0.0025) and increased stone complexity (P = 0.006), while significant intraoperative factors were injury to the pelvicalyceal system (P = 0.0005) and multiple access tracts (P = 0.022). Angiography revealed arteriovenous fistula in two patients and a pseudoaneurysm in seven patients. All patients underwent successful superselective angioembolization with preserved renal perfusion in six patients on control angiography postembolization. Conclusions: History of ipsilateral renal surgery, increased stone complexity, multiple access tracts, and injury to the pelvicalyceal system are risk factors predicting severe renal hemorrhage post-PCNL. Early angiography followed by angioembolization should be performed in patients with severe post-PCNL bleeding who fail to respond to conservative measures.
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RENAL nephrometry score: Predicting perioperative outcomes following open partial nephrectomy p. 187
Supriya Basu, Imran Ahmad Khan, Ranjit K Das, Ranjan K Dey, Dawood Khan, Vishnu Agarwal
DOI:10.4103/UA.UA_93_18  PMID:31040606
Background: Partial nephrectomy has emerged as a standard treatment for small renal masses offering oncologic control equivalent to radical nephrectomy, with preservation of renal function and evidence for equivalent survival. In this study, we evaluated RENAL nephrometry score (RNS) in predicting perioperative outcomes in patients with partial nephrectomy. Materials and Methods: This was a prospective observational study conducted from February 2016 to August 2017 which included patients who underwent partial nephrectomy. The patients were divided into three groups depending on the complexity scores (low, moderate, and high). Tumors were assigned RNS and tumor-node-metastasis staging of the clinically malignant tumors was done. Blood loss, warm ischemia time (WIT), and surgical complications were assessed. Results: A total of 20 patients underwent open partial nephrectomy during the study. There were 4 (20%) low, 11 (55%) moderate, and 5 (25%) high-complexity lesions. Blood loss was significantly different in three groups. All the cases in high-complexity group were performed with clamping the renal vessels with a mean WIT of 29 min. The overall complication rates were significantly different between the groups (P = 0.007); however, majority of the complications were low grade (Grades I and II) and were managed conservatively. Conclusion: In the present study, RNS was correlated with predicting surgical access route, need for clamping during partial nephrectomy, blood loss, decrease in glomerular filtration rate of operated kidneys, postoperative complications, and tumor grade.
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The autologous rectus fascia sheath sacrocolpopexy and sacrohysteropexy, a mesh free alternative in patients with recurrent uterine and vault prolapse: A contemporary series and literature review p. 193
Jai Seth, Bogdan Toia, Hazel Ecclestone, Mahreen Pakzad, Rizwan Hamid, Tamsin Greenwell, Jeremy Ockrim
DOI:10.4103/UA.UA_85_18  PMID:31040607
Introduction: About 40% of women suffer pelvic organ prolapse (POP) in a lifetime. The current standard intervention for vault prolapse is a mesh sacrocolpopexy or sacrohysteropexy. However, patients and surgeons are increasingly hesitant to use mesh given recent the UK and Food and Drug Administration warnings and litigation. A possible alternative is to use autologous tissue to support the vault, as a mesh-free solution. We report the outcomes from an initial series of autologous rectus fascia sheath (RFS) sacrocolpopexy and sacrohysteropexy in patients with complex pelvic floor dysfunction. Patients and Methods: All patients had previous, multiple urological/gynecological surgery and declined standard mesh repairs. All had preoperative videourodynamics and defecating magnetic resonance imaging evaluation. The autologous POP repair was performed using 10–18 cm of rectus sheath with a similar technique to that employing mesh to support the anterior-posterior vaginal walls or encircle the cervix and secured to the sacral promontory. Results: Seven patients with a mean age of 52 (33–64) years underwent autologous RFS POP repair between 2014 and 2017. Mean follow-up is 16 (range 2–33) months. All patients have durable result at last follow-up. No significant complications are reported. Conclusions: This is the first report of patients with complex pelvic floor dysfunction and apical POP being managed with autologous RFS sacrocolpopexy/sacrohysteropexy, and only the second report of a free graft being utilized with success. Autologous RFS sacrocolpopexy/sacrohysteropexy avoids the 10%–15% risks of mesh-related complications. Further studies of long-term durability are needed.
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Evaluation of outcome of transurethral needle ablation for treating symptomatic benign prostatic hyperplasia: A 10-year experience p. 198
Hossam Haroun, Hassan Eltatawy, MG Soliman, Ahmed Tawfik, MM Ragab, Ahmed Ramadan, Magdy Sabaa
DOI:10.4103/UA.UA_99_18  PMID:31040608
Aim: The aim of this study is to report our 10-year experience with transurethral needle ablation (TUNA) to evaluate its outcome on long-term basis. Patients and Methods: A total of 351 patients' records who underwent TUNA procedure for the management of benign prostatic hyperplasia were reviewed. The International Prostate Symptom Score (IPSS) and peak urinary flow rate were evaluated before the procedure, at 3 and 6 months postoperatively, and then yearly for 10 years. For patients complaining of de novo erectile dysfunction, the International Index of Erectile Function-5 was evaluated. Postoperative complications, number of patients who required additional therapeutic modality/other TUNA sessions, or those dropped out during follow-up were all recorded. Results: Three hundred and fifty-one patients who underwent TUNA with fulfillment of our selection criteria were included in the study. The yearly records of included patients showed that patients' baseline IPSS was significantly improved all over the follow-up years. Similarly, the maximum flow rate of the patients was significantly improved during the next 8 years. About 96.4% of patients who underwent TUNA did not require additional therapeutic modality/other TUNA sessions during the 1st-year follow-up. However, by 10 years, 26.4% of patients were offered another TUNA session and shifted to either medical therapy or other minimally invasive therapies. Mild hematuria was the most common complication (85.7%). Urinary retention, urethral stricture, and de novo erectile dysfunction were developed in 15.1%, 1.7%, and 6.8% of patients, respectively. There were no cases of retrograde ejaculation. Conclusion: TUNA can be considered as a relatively effective technique with a good safety profile. The current study demonstrated both significant subjective and objective improvements over 10 and 8 years of follow-up, respectively. It can be considered as a preferable option for patients who prefer surgical option with preservation of their sexual function and fertility.
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Outcome of orthotopic sigmoid versus ileal neobladder reconstruction p. 204
Hisham Abdulazim El-Helaly, Mohamed Kamal Saifelnasr, Khaled Mohyeelden Mohamed, Alsayed Saad Abdelaziz, Hamada Ahmed Youssof
DOI:10.4103/UA.UA_137_18  PMID:31040609
Introduction: Radical cystectomy with orthotopic urinary diversion is considered the gold standard for treatment of muscular invasive bladder cancer or high-risk nonmuscular invasive bladder cancer. The choice of orthotopic neobladder reconstruction depends on the clinical outcomes of it and should be planned with the patients, especially the risk of incontinence. Methods: this study included 52 Egyptian patients underwent radical cystectomy and orthotopic neobladder reconstruction with sigmoid (25 patients) and ileal (27 patients) segments. Postoperative clinical outcomes between the sigmoid and ileal neobladder groups were compared. Results: In the present study, 12 intraoperative complications (6 in each group) and 19 postoperative complications (17 in sigmoid and 15 in ileal group) occurred; however, there was no significant difference in the incidence of intraoperative and postoperative complications between both groups. There were no significant differences in the continence status and spontaneous voiding between both groups. There were no significant differences in maximal flow rate and voided volume between both groups. Night voiding frequency in the ileal neobladder patients was significantly smaller than sigmoid neobladder patients. Free flowery showed a significant difference of voiding time and volume in favor of sigmoid neobladder group. Maximum urethral pressure and urethral closing pressure were significantly higher in ileal neobladder group. Conclusions: Both types of neobladder reconstruction resulted in comparatively satisfactory outcomes; however, the voiding function in sigmoid neobladder group appeared to be more favorable than that in ileal neobladder group.
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Splenorenal fusion mimicking renal cancer: One case report and literature review p. 211
Ahmed S Zugail, Youness Ahallal, Eva-Maria Comperat, Bertrand Guillonneau
DOI:10.4103/UA.UA_47_18  PMID:31040610
Splenorenal fusion is an extremely rare benign entity. This abnormality is presented in a case of a 29-year-old-male patient. We discuss the distinction between this condition and renal splenosis and their embryology. The course of this condition and modalities of investigation including radiological imaging, management, and pitfalls are reviewed.
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Extra-large renal calculi removal using single puncture percutaneous nephrolithotomy p. 214
Parag M Gavande, Harsha P Gavande
DOI:10.4103/UA.UA_150_18  PMID:31040611
With the ever-increasing use of ultrasonography and X rays, renal calculi are being detected while still small thus large renal calculi are becoming less common. Percutaneous nephrolithotomy (PCNL) is a gold standard for the treatment of renal calculi >2 cm in size and being widely used worldwide. Here, we present a case of an extra-large kidney stone (10 cm × 7.5 cm and 2.7 cm × 2.3 cm) in a 45-year-old male patient which was removed through a single puncture PCNL.
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Plication without degloving – Safe and effective approach for correcting lateral and dorsal penile curvature: Case series p. 217
Hüseyin Cihan Demirel, Cumhur Yeşildal, Musab Ilgi, Ahmet Tevfik Albayrak, Emre Aykanlı, Sinan Levent Kireççi
DOI:10.4103/UA.UA_181_17  PMID:31040612
Penile curvature deformities are often manageable with surgical reconstruction methods. We aimed to show the safety and efficacy of ventral and dorsal plication techniques without degloving in our two patients who have penile curvature. Two young adults, aged 20 and 23 years, presented to our clinic with lateral and dorsal penile curvatures. This problem has been sustaining since their teenage. Following the required preparations, two surgical techniques were used, namely Nesbit and Lue's “16-dot” technique. Patients completed a satisfaction survey at a mean of 6 months later the surgery. Although both patients reported a subjective decrease in penile length, their satisfaction rate was high. Penile plication without degloving is a safe and effective technique for correcting dorsal and lateral penile curvatures.
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Nine-year survival after iterative metastasectomies for renal cell carcinoma p. 219
Tiago Ribeiro de Oliveira, Adama Ouattara, Wouter Everaerts, Gert De Meerleer, Steven Joniau
DOI:10.4103/UA.UA_53_18  PMID:31040613
We report the case of a 24-year-old male, diagnosed with an incidental T3a papillary renal cell carcinoma (RCC), treated with left laparoscopic radical nephrectomy. After 7 months, nodal recurrence was identified and retroperitoneal lymph node dissection (RPLND) was performed. Four months later, due to local recurrence, the patient underwent salvage RPLND, partial psoas resection and left adrenalectomy, and remained without recurrence during the following 15 months, after which treatment with sunitinib was started due to multiple metastases in pelvic lymph nodes, lungs, and bone. After 4 years of stable disease, progression at the quadratus lumborum and psoas muscles led to subsequent metastasectomy. No evidence of progression was identified for 2 years, after which, despite multimodal treatment (axitinib and radiotherapy to bone lesions), widespread disease progression led to patient death. This uncommon case of prolonged survival with metastatic RCC highlights the possible role of iterative metastasectomies in the management of advanced stage disease, as well as its potential to extend the survival substantially, even when progressive on tyrosine kinase inhibitors.
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Malignant refractory priapism: An urologist's nightmare p. 222
Vinod Kumar Prabhuswamy, Pramod Krishnappa, Krishnaprasad Tyagaraj
DOI:10.4103/UA.UA_140_18  PMID:31040614
Malignant priapism is described as persistent, nonsexual erections caused by invasion or metastasis from a primary neoplasm. We present two cases of malignant priapism with different etiologies and the respective management strategies. A 75-year-old patient had undergone radical cystectomy for a high-grade bladder tumor 5 months ago and came with priapism. The patient persisted to have partial penile tumescence with low-grade pain even after intervention. Another 66-year-old patient came to emergency with persistent painful priapism who had been diagnosed to have Multiple Myeloma. He required a corporotomy and open drainage as a last resort which finally relieved him of pain but with loss of erection. The treatment needs to be individualized based on the clinical course of the patient.
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Sebaceous carcinoma of the penis: As aggressive as it is rare p. 226
Ranil Johann Boaz, Chandan Phukan, S Mandeep, Antony Devasia
DOI:10.4103/UA.UA_139_18  PMID:31040615
Malignant neoplasm of the penis is a rare cancer in industrialized countries but is not uncommon in India. Nearly 95% of penile cancer is squamous cell carcinoma. Malignant neoplasms of the sebaceous glands, which are mostly confined to the head and neck region, are even rarer. We present a 74-year-old male with sebaceous cell carcinoma of the penis. He underwent excision of the primary lesion with bilateral inguinal lymph node dissection followed by adjuvant chemotherapy.
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Percutaneous nephrolithotomy of a staghorn calculus in a patient with renal angiomyolipoma p. 229
Akbar Jalal, Abdolsalam Ahmadi, Mohamed Mubarak, Ameer Al Arrayedh, Sharif Al Arrayedh
DOI:10.4103/UA.UA_148_18  PMID:31040616
Renal angiomyolipoma (AML) is the most common benign renal tumor and is prevalent in around 0.2%–0.6% of the population. Its main associated risk is bleeding. It is uncommon that AML presents simultaneously with a staghorn calculus requiring percutaneous nephrolithotomy (PCNL) for stone resolution with only two previously reported cases. In this case, we present a 41-year-old female patient who presented with a 2-year complaint of left flank pain and hematuria. Following investigation, the patient had a large staghorn calculus in the left kidney and an incidental finding of a large AML in the ipsilateral kidney. A single puncture was made under ultrasound guidance, to avoid any form of injury to the AML, and complete stone clearance was achieved through a single tract only. Although the concurrence of AML with a renal calculus requiring PCNL presents a clinical challenge, using ultrasound guidance for stone clearance is a safe and successful means of management with minimal exposure to radiation.
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An urgent call for further study on endovascular management for renal trauma p. 232
Wesam T Abuznadah
DOI:10.4103/UA.UA_132_18  PMID:31040617
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