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GUIDELINES |
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Saudi oncology society and Saudi urology association combined clinical management guidelines for urothelial urinary bladder cancer  |
p. 273 |
Mubarak Al-mansour, Ahmad Saadeddin, Sultan Alkhateeb, Ashraf Abusamra, Danny Rabah, Mohammed Alotaibi, Esam Murshid, Abdullah Alsharm, Imran Ahmad, Khalid Alghamdi, Shouki Bazarbashi DOI:10.4103/0974-7796.140941 PMID:25371600In this report, updated guidelines for the evaluation, medical, and surgical management of transitional cell carcinoma of the urinary bladder are resented. They are categorized according the stage of the disease using the TNM staging system 7 th edition. The recommendations are presented with supporting level of evidence. |
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Saudi oncology society and Saudi urology association combined clinical management guidelines for prostate cancer  |
p. 278 |
Sultan Alkhateeb, Ashraf Abusamra, Danny Rabah, Mohammed Alotaibi, Rana Mahmood, Mubarak Almansour, Esam Murshid, Abdullah Alsharm, Ashwaq Alolayan, Imran Ahmad, Hussain Alkushi, Abdullah Alghamdi, Shouki Bazarbashi DOI:10.4103/0974-7796.140959 PMID:25371601In this report, updated guidelines for the evaluation, medical, and surgical management of prostate cancer are presented. They are categorized according the stage of the disease using the tumor node metastasis staging system 7 th edition. The recommendations are presented with supporting evidence level. |
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Saudi oncology society and Saudi urology association combined clinical management guidelines for renal cell carcinoma |
p. 286 |
Shouki Bazarbashi, Sultan Alkhateeb, Ashraf Abusamra, Danny Rabah, Mohammed Alotaibi, Mubarak Almansour, Esam Murshid, Abdullah Alsharm, Ashwaq Alolayan, Imran Ahmad, Khalid Alghamdi, Abdullah Alghamdi In this report, updated guidelines for the evaluation, medical and surgical management of renal cell carcinoma are presented. They are categorized according the stage of the disease using the tumor node metastasis staging system 7 th edition. The recommendations are presented with supporting evidence level. |
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Saudi oncology society and Saudi urology association combined clinical management guidelines for testicular germ cell tumors |
p. 290 |
Mohammed Alotaibi, Shouki Bazarbashi, Sultan Alkhateeb, Ashraf Abusamra, Danny Rabah, Mubarak Almansour, Esam Murshid, Abdullah Alsharm, Imran Ahmad, Khalid Alghamdi, Ahmad Saadeddin, Abdullah Alghamdi DOI:10.4103/0974-7796.140978 PMID:25371603In this report, updated guidelines for the evaluation, medical, and surgical management of germ cell tumor of testes are resented. They are categorized according the stage of the disease using the tumor-node-metastasis staging system 7 th edition. The recommendations are presented with supporting level of evidence. |
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ORIGINAL ARTICLES |
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Plasma rennin activity: Early indicator of renal injury in bilateral pelviureteric junction obstruction in children |
p. 295 |
Amit Singh, Minu Bajpai DOI:10.4103/0974-7796.140981 PMID:25371604Objective: The objective of the present study is to analyze the early indicators of renal injury in children with bilateral pelviuretric junction obstruction.
Materials and Methods: We investigated 23 children, 46 kidney units who were diagnosed with bilateral pelvi-ureteric junction obstruction (PUJO) and underwent unilateral or bilateral pyeloplasty between January 2001 and December 2011. Ipsilateral kidney biopsy was performed during pyeloplasty. Kidney biopsy results were divided into three categories. Pre-operative investigation included ultrasonography with the Society of Fetal Urology (SFU) grading , plasma rennin activity (PRA) and differential renal function (DRF).
Results: Out of 23 children there were 17 (73.9%) boys while 6 (26.1%) girls. Median age at operation was 35.4 months (range: 9-60 months). Unilateral pyeloplasty was performed in 14 (60.8%), simultaneous bilateral pyeloplasty in 2 (8.6%) and sequential bilateral pyeloplasty in 7 (30.4%).
Conclusion: In bilateral PUJO where DRF and SFU grading of hydronephrosis did not correctly reflect renal injury, PRA showed a significant relationship with renal histopathologic grade and could be an early indicator of renal injury in bilateral PUJO. |
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Cystatin C for early detection of acute kidney injury after laparoscopic partial nephrectomy |
p. 298 |
Anwar Alesawi, Geneviève Nadeau, Alain Bergeron, Thierry Dujardin, Louis Lacombe, Yves Caumartin DOI:10.4103/0974-7796.140988 PMID:25371605Introduction and Objectives : Mortality due to AKI has not changed significantly over the past 50 years. This is due in part to failure to detect early AKI and to initiate appropriate therapeutic measures. There is therefore a need to identify biomarkers that would improve the early detection of AKI. The objective of this study was to assess whether cystatin C levels obtained at specific timepoints during laparoscopic partial nephrectomy (PN) could be early predictors of AKI.
Materials and Methods: Twenty-five patients underwent laparoscopic PN for organ-confined tumors. All procedures were performed by two surgeons in a single institution. Plasma samples were collected preoperatively, and post-unclamping at 5, 20, 120 min and on the day following surgery. Plasma cystatin C was measured by enzyme-linked immunosorbent assay. Correlation between levels of cystatin C and other parameters of interest were assessed in order to define cystatin C ability to predict AKI and loss of renal function following laparoscopic PN.
Results: The mean baseline eGFR was 93 ml/min/1.73 m 2 . Warm ischemia time varied between 16 and 44 min. Post-operative day 1 (POD1) cystatin C levels compared to baseline were increased in 13 (52%) of the patients. There was a high correlation between the difference of POD 1 and baseline value, and eGFR in the immediate postoperative period (r = −0.681; P = 0.0002) and at 12-month follow-up (r = −0.460, P = 0.048). However, the variation in cystatin C levels at earlier timepoints were not associated to AKI nor renal function.
Conclusions: High increase in POD 1 cystatin C levels from baseline may help identify patients with AKI and those at higher risk of chronic kidney disease, following laparoscopic PN. |
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Predictive factors for residual tumor and tumor upstaging on relook transurethral resection of bladder tumor in non-muscle invasive bladder cancer |
p. 305 |
Tejpal S Gill, Ranjit K Das, Supriya Basu, Ranjan K Dey, Subrata Mitra DOI:10.4103/0974-7796.140990 PMID:25371606Context: Relook transurethral resection of bladder tumor (TURBT) improves the diagnostic and therapeutic efficacy of primary TURBT. However, it is still not established as to which category of patients would benefit most from this repeat invasive procedure.
Aims: This prospective interventional study was designed to identify the category of patients with non-muscle invasive bladder cancer who may benefit from a routine relook procedure.
Setting and Design: A total of 52 consecutive patients with biopsy proven non muscle invasive bladder cancer on primary TURBT underwent a relook TURBT between March 2011 and September 2012.
Materials and Methods: The incidence of residual tumor and tumor upstaging on relook procedure was correlated with various histopathological (stage, grade, CIS, presence of muscle) and cystoscopic (type and focality of tumor, any apparent field change) parameters on primary TURBT.
Results: Out of the total 52 patients, 23 (44.2%) had a residual tumor on relook TURBT. 12 (23.1%) were upstaged (of these 9 i.e. 17.3% to muscle invasion). While most of the parameters studied showed a positive correlation with incidence of residual tumor and upstaging to muscle invasion, statistical significance (for both) was reached only for tumor stage (P = 0.028 and 0.010), tumor grade (P = 0.010 and 0.002) and tumor type (solid vs. papillary; P = 0.007 and 0.001). Carcinoma in situ showed a significant correlation with incidence of residual tumor (P = 0.016) while the absence of muscle in the primary TURBT specimen was significantly associated with upstaging to muscle invasive disease (P = 0.018).
Statistical Analysis: The data was analyzed using SPSS software v. 16.0.
Conclusions: Relook TURBT may be especially recommended for high grade and T1 tumors and tumors with a solid/sessile appearance on primary TURBT especially when deep muscle was absent in the primary TURBT specimen. |
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The comparison of ultrasound and non-contrast helical computerized tomography for children nephrolithiasis detection |
p. 309 |
Majid Malaki DOI:10.4103/0974-7796.140991 PMID:25371607Aims: Nephrolithiasis is less common in children than adults, but its diagnosis and management in children may be more perplexing. In this article, we compare two imaging ultrasound (US) and non-contrast helical computerized tomography (CT) for diagnosis of nephrolithiasis.
Subjects and Methods: A total of 20 children who diagnosed as nephrolithiasis by US were imaged simultaneously by non-contrast helical CT. Their history like as family history in first and second degree relatives and urine analysis for hematuria and urine randomly calcium to creatinine ratio was obtained. All data analyzed by χ2 and Mann-Whitney U-test in SPSS 16 and P < 0.05 was considered to be significant.
Results: Out of 20 cases, only 5 cases diagnosed as nephrlithiasis by US were confirmed by CT method 2 out of 20 cases had another extrarenal origin for their complaint who diagnosed wrongly as nephrolithiasis by US. Stone size based of US that was confirmed by CT method was larger 4.6 ± 1.5 (minimum 3 max 6 mm) than non-confirmed ones 2.3 ± 0.7 mm (P 0.002). Hematuria occurred more in correct diagnosed compared with misdiagnosed (P 0.005). Positive family history and urine calcium ratio was not differed between two groups.
Conclusions: Non contrast helical CT is essential to confirm of nephrolithiasis and other extrarenal origin of complaints, which diagnosed wrongly as nephrolithiasis in children. Stone size and presence of hematuria are two major factors for right diagnosis of nephrolithiasis as US method but Urine calcium excretion ratio or positive family history cannot be predictive as this study. |
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The effects of combined free radical scavenger and sildenafil therapy on age-associated erectile dysfunction: An animal model |
p. 314 |
Jason R Kovac, Ling DeYoung, Kyle J Lehmann, Eric Chung, Gerald B Brock DOI:10.4103/0974-7796.140993 PMID:25371608Introduction: Aging results in erectile dysfunction that is partially attributed to decreased nitric oxide (NO) and increased free radical generation. Vitamin E enhances endothelial cell function and acts as a free radical scavenger; however, its benefits on erectile function in the elderly are unknown.
Aims: The aim of the following study is to determine if Vitamin E alone, or in combination with the phosphodiesterase 5 inhibitor sildenafil, may improve erectile function and the NO signaling in a cohort of aged (13-15 month old) rats.
Materials and Methods: Male Sprague-Dawley rats (n = 28) were divided based upon age into young (4-5 months old, n = 7) and aged (13-15 months old, n = 21) cohorts. Aged rats were treated with Vitamin E, sildenafil or a combination of both. Penile cavernosal and dorsal nerve tissues were evaluated for neuronal nitric oxide synthase (nNOS) and caveolin-1 expression. Erectile function was assessed through intra-cavernous pressure (ICP) recordings.
Results: nNOS and cavoelin-1 were significantly decreased in aged rats compared with young controls. In aged rats, both Vitamin E and sildenafil partially recovered nNOS expression but when combined, a synergistic elevation in nNOS was observed. The significant decreases in ICP recorded in aged rats were improved with sildenafil; however, Vitamin E did not yield any additional improvements in ICP.
Conclusions: Diminished levels of nNOS and caveolin-1 are found in aged rats. When combined with sildenafil, Vitamin E synergistically increased nNOS expression. Since biochemical gains were not realized physiologically, other contributing factors likely exist. |
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Relationship between development of urethral stricture after transurethral resection of prostate and glycemic control |
p. 321 |
Sükrü Kumsar, Hasan Salih Saglam, Osman Köse, Salih Budak, Oztug Adsan DOI:10.4103/0974-7796.140995 PMID:25371609Objectives: The purpose of this study is to investigate the association of glycemic control prior to TUR-P and postoperative urethral stricture development.
Materials and Methods: Of the 168 patients with a diagnosis of urethral stricture, who underwent internal urethrotomy in our hospital were retrospectively analyzed for this study.
98 patients who underwent monopolar TUR-P in our hospital previously and were developed urethral stricture were divided into two groups as diabetic and nondiabetic. Based on their HbA1c concentrations, diabetics were allocated to two groups with good (HbA1c ≤ 6.5%) or poor (HbA1c > 6,5%) glycemic control. Time to internal urethrotomy and the other operative parameters were compared among groups.
Results: Time to internal urethrotomy after TUR-P was significantly shorter in diabetic patients with poor glycemic control than Group 1 and Group 2 (P = 0,02, P = 0,012) but no significant difference was found between Group 1 and Group 2 (P = 0,368). There was no significant difference in the mean diagnosed and resected prostate wight among groups There was no significant difference in the mean resection time and the mean time to urethral catheter removal among groups.
Conclusions: Especially in poor glycemic control patients, urethral stricture development was seen in the early period after TUR-P. For this reason, in the elective TUR-P scheduled poor glycemic controlled patients the operation should be done after glycemic control. |
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Evaluation of healing at urethral anastomotic site by pericatheter retrograde urethrogram in patients with urethral stricture |
p. 325 |
Shailesh Solanki, Shabbir Hussain, Deepti B Sharma, Fanindra S Solanki, Dhananjay Sharma DOI:10.4103/0974-7796.140996 PMID:25371610Introduction: Stricture urethra has been always a surgical challenge. Different opinions regarding time require healing at anastomotic site after urethroplasty, so various strategies are there regarding time for post-operative catheter removal. In this study, healing was assessed by pericatheter retrograde urethrogram (PUG) before the catheter removal.
Materials and Methods: Prospective study was conducted from January 2006 to December 2009. Twenty eight cases of short-segment urethral stricture (<2 cm) who underwent urethroplasty were included and divided into two groups depending upon etiology; post-traumatic group (road traffic accident/straddle type injury) and iatrogenic stricture group (due to prolong catheterization/after cystoscopy/Faulty Foleys balloon placement). Post-operative PUG was done on 14 th post-operative day in all patients for healing assessment. Extravasation of dye on PUG was taken as anastomotic leak. If the patient had not showed extravasation, the catheter was removed. Otherwise it was kept further for next one week and again PUG was done for healing assessment.
Results: Extravasation of dye was noted in 4 patients (33%) of iatrogenic group and 14 patients (87.5%) of the post-traumatic group on 14 th post-operative day PUG. (P ≤ 0.05). The decision to remove catheter was depended upon PUG finding and it was safe, no complication was developed in any patient.
Conclusion: Iatrogenic strictures have better healing than post-traumatic stricture in the post-operative period. PUG is a safe and simple procedure and can guide about safe removal of catheter in the post-operative period. |
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Evaluation of holmium laser versus cold knife in optical internal urethrotomy for the management of short segment urethral stricture |
p. 328 |
Sudhir Kumar Jain, Ram Chandra Murthy Kaza, Bipin Kumar Singh DOI:10.4103/0974-7796.140997 PMID:25371611Objectives: Sachse cold knife is conventionally used for optical internal urethrotomy intended to manage urethral strictures and Ho: YAG laser is an alternative to it. The aim of this study was to evaluate the role of urethral stricture treatment outcomes, efficacy, and complications using cold knife and Ho: YAG (Holmium laser) for optical internal urethrotomy
Materials and Methods: In this prospective study included, 90 male patients age >18 years, with diagnosis of urethral stricture admitted for internal optical urethrotomy during April 2010 to March 2012. The patients were randomized into two groups containing 45 patients each using computer generated random number. In group A (Holmium group), internal urethrotomy was done with Holmium laser and in group B (Cold knife group) Sachse cold knife was used. Patients were followed up for 6 months after surgery in Out Patient Department on 15, 30 and 180 post-operative days. At each follow up visit physical examination, and uroflowmetry was performed along with noting complaints, if any.
Results: The peak flow rates (PFR) were compared between the two groups on each follow up. At 180 days (6 month interval) the difference between mean of PFR for Holmium and Cold knife group was statistically highly significant (P < 0.001). Complications were seen in 12.22% of cases.
Conclusion: Both modalities are effective in providing immediate relief to patients with single and short segment (<2 cm long) urethral strictures but more sustained response was attained with Cold knife urethrotomy. |
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Day care monopolar transurethral resection of prostate: Is it feasible? |
p. 334 |
Altaf Khan DOI:10.4103/0974-7796.140998 PMID:25371612Introduction: Benign prostatic hyperplasia is a common disease accounting for 30% of our OPD cases and about 25% of our surgery cases. Various treatment options are now available for more efficient care and early return to work. We wanted to determine the safety and feasibility of day care monopolar transurethral resection of prostate (m-TURP), by admitting the patients on the day of surgery and discharging the patient without catheter on the same day. We also compared the morbidity associated with conventional TURP where in the catheter is removed after 24-48 h of surgery and day care TURP where in the catheter is removed on the day of surgery.
Materials and Methods: A total of 120 patients who fulfilled the criteria were included in the study which was conducted between November 2008 and December 2010. A total of 60 patients were assigned for day care and 60 for conventional monopolar TURP. There was no significant difference in age, prostatic volume or IPSS score. Day care patients were admitted on day of surgery and discharged the same day after the removal of catheter.
Results: Both the groups were comparable in outcome. Stricture rate was less with day care TURP. Mean catheterization time was similar to laser TURP.
Conclusion: Monopolar TURP is still the gold standard of care for BPH. If cases are selected properly and surgery performed diligently it remains the option of choice for small and medium sized glands and patients can be back to routine work early. |
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Analysis of case series of milky urine: A single center and departmental clinical experience with emphasis on management perspectives: A prospective observational study |
p. 340 |
Sham Sunder, Rajesh Jayaraman, Himanshu Sekhar Mahapatra, Satyanand Sathi, K Venkataramanan, K Prabhu, Anurag Gupta, Suman Sethi DOI:10.4103/0974-7796.141002 PMID:25371613Background: Milky urine can be due to chyluria or lipiduria due to nephrotic syndrome. Filarial chyluria usually responds to medical management while non-filarial cases may require surgical intervention.
Aim: To perform a prospective observational study in patients presenting with milky urine in our centre over a period of one year from July 2011 to June 2012, a complete biochemical work up and imaging to find out the site of leakage of lymph if it is a case of chyluria, its response to medical management and the requirement of surgical intervention.
Materials and Methods: Routine blood and urine investigations, 24 hour urine protein excretion, USG abdomen, serum lipid profile and rapid filarial antigen test were done in all. MRI abdomen was done in affordable patients. Renal biopsy was done in some chyluria patients for academic purpose and in milky urine with negative urine ether test. Sclerotherapy was done with 50% dextrose and 0.2% povidone iodine. Patients were followed up with 24 hour urine protein and triglyceride estimation.
Results : 18 cases of milky urine were encountered. 8 were filarial chyluria, 9 non- filarial and 1 MCD. Mean urine TG level and median 24 hour urinary protein excretion were 37.2 ± 24.6 mg% and 4.96 g respectively. The mean age for filariasis (22.9 ± 4.5 years) was significantly different from that of non-filarial etiology (31.5 ± 4.8 years) (P = 0.005). The mean 24 hour urinary protein for normal MRI cases (4.64 ± 0.70 g) was significantly different from those with dilated lymphatics (8.15 ± 2.55 g) (P = 0.02). All the non- filarial and 4 filarial cases required sclerotherapy. One patient required a second sitting.
Conclusion : Milky urine is most commonly due to chyluria and occasionally due to nephrotic syndrome. Nephrotic syndrome is managed in its own way while chyluria not amenable to pharmacological intervention is managed with sclerotherapy. |
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Efficacy of extracorporeal shockwave lithotripsy using Dornier SII in different levels of ureteral stones |
p. 346 |
Mohamed M Elkholy, Hassan Ismail, Mohamed A Abdelkhalek, Mohamad M Badr, Mohamed M Elfeky DOI:10.4103/0974-7796.141003 PMID:25371614Objective: The objective of this study was to evaluate the efficacy and safety of the Dornier lithotripter S II system in the treatment of ureteral calculi.
Patients and Methods: A total of 97 cases which consists of 54 males and 43 females with ureteral stones were treated by extracorporeal shock wave lithotripsy (ESWL). Mean age was 42.6 years. Inclusion criteria were solitary radiopaque ureteral stones of radiological stone size of ≤1 cm. The stones were not impacted, with normal kidney functions. Procedure time, number of shocks, energy used, number of sessions and complications were reported. The outcome of ESWL was also recorded.
Results: Stones were in the abdominal (upper ureter) in 50% of patients, in pelvic (middle ureter) in 47% of patients. All patients had unilateral stones and the mean stone size in maximum length was) 10 mm). Good dye excretion passing the stone was noted in all patients. Mild hydronephrosis was found in 85% of cases. A total of 49 cases were treated by a single session, while in 35% of cases two sessions were enough and 16% received three sessions. The average number of shocks per session was 3125. The average number of shocks per patient was 5962.5 shocks and average energy was 204.3 Joules. The overall stone-free rate 3 months after lithotripsy was 94%. After a single session of lithotripsy, 49 patients (49%) became stone-free. Stone free rates after ESWL for upper, middle ureteral stones were 94%, 95.7% respectively. Additional procedures were needed in only 6 cases (6%) to render patients stone-free after lithotripsy. No serious complications occurred.
Conclusion: The Dornier lithotripter S II is very effective in the treatment of ureteral calculi with no major complications. |
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CASE REPORTS |
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Modified medial nephropexy for treatment of the anterior nutcracker syndrome |
p. 352 |
Wissem Hmida, Faouzi Mallat, Mouna Ben Othmen, Faouzi Limayem, Faouzi Mosbah DOI:10.4103/0974-7796.141004 PMID:25371615We report the case of a 15-year-old male, presenting with recurrent gross hematuria complicated by acute anemia. Cystoscopy showed little bleeding from the left ureteral orifice. Diagnosis of left renal vein compression at the aortomesenteric space was established through color Doppler ultrasonography and computed tomographic angiography. Therapeutic attitude was interventionist in our case, performing successful management with modified medial nephropexy, with a retroperitoneal approch. To the best of our knowledge, we report the second case of left medial nephropexy for treatment of the anterior nutcracker syndrome. The first case of modified medial nephropexy was done by lowering the left renal vein from its initial position in the aortomesenteric angle through a restrict retroperitoneal approach. |
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Leiomyoma of the epididymis treated with partial epididymectomy |
p. 356 |
Basri Cakiroglu, Faruk Ozcan, Lora Ates, Suleyman Hilmi Aksoy DOI:10.4103/0974-7796.141005 PMID:25371616Tumors of the epididymis are very rare, they are both primary and secondary and whether the benign or malignant. Adenomatoid tumors and leiomyoma are the most frequently diagnosed benign tumors of the epididymis. Leiomyomas are benign, often bulky tumors that are derived embryologically from mesenchymal cells. Herein, we present a case of epididymal leiomyoma and review its differential diagnosis and treatment. |
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Urinary bladder metastasis from lung adenocarcinoma: A rare cause of hematuria |
p. 359 |
Kan Wai Man Raymond, Ting Shun Hin, Kan Chi Fai, Chan Wai Hee Steve DOI:10.4103/0974-7796.141006 PMID:25371617We presented an unusual case of hematuria caused by a solitary bladder metastasis from lung adenocarcinoma. A confident diagnosis of secondary adenocarcinoma of the bladder was made by clinical suspicion based on patient's past history, careful examination of tumor morphology, and a directed panel (cytokeratin [CK] 7/CK20/thyroid transcription factor 1) of immunohistochemistry. We sought, through sharing our experience in the investigative and diagnostic process, to contribute to the better understanding of this unusual cause of hematuria. |
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Seminal vesicle schwannoma presenting with left hydroureteronephrosis |
p. 363 |
Gopalakrishnan Arun, Shrijeet Chakraborti, Santosh Rai, Gurupur Guni Laxman Prabhu DOI:10.4103/0974-7796.141007 PMID:25371618We report a very rare case of seminal vesicle schwannoma in a 50-year-old male, with left hydroureteronephrosis. Only five cases of seminal vesicle schwannomas have been reported in medical literature until date. |
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Priapism associated with pregabalin |
p. 366 |
Ali A Alsulihem, Danny M Rabah DOI:10.4103/0974-7796.141012 PMID:25371619Priapism is a well-known cause of erectile dysfunction. There are a wide variety of causes, including hemoglobinopathy, neurological diseases, and drugs. We present a case report of an Asian man who presented with priapism that was continuous for 3 days after taking three doses of pregabalin for chronic back pain. Cavernous aspiration, phenylephrine injection, and a winter shunt all failed to achieve detumescence. The patient then presented to our institution on the 5 th day of his initial presentation, and an El-Ghorab shunt was performed, after which detumescence and pain relief were achieved. We suggest that pregabalin might induce tumescence through acting on the α2δ1 subunit of voltage-gated calcium channels in the penile smooth muscle or by presynaptic inhibition of noradrenaline release. Further studies are warranted regarding the action of pregabalin and its effect on penile physiology. |
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COMMENTARY |
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Pregabalin and priapism |
p. 368 |
Ranjith Ramasamy DOI:10.4103/0974-7796.141014 PMID:25371620 |
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CASE REPORTS |
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Conservatively managed spontaneous intraperitoneal bladder perforation in a patient with chronic bladder outflow obstruction |
p. 370 |
Abeyna L. C. Jones, James N Armitage, Christof Kastner DOI:10.4103/0974-7796.141017 PMID:25371621We present the unusual case of a spontaneous intraperitoneal bladder rupture as a first presentation of chronic bladder outflow obstruction secondary to benign prostatic hyperplasia. A contributing factor to diagnostic delay was unfamiliarity with the classical presentation of abdominal pain, abdominal distension and urinary ascites leading to autodialysis represented by an unusually high serum creatinine. A cystogram was performed after a non-contrast computed tomography (CT) scan originally performed to determine the cause of abdominal pain, failed to confirm the diagnosis. The patient's initial acute presentation was successfully managed conservatively with prolonged urinary catheterization. |
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Extensive xanthogranulomatous cystitis mimicking bladder cancer |
p. 373 |
Amir M Ali, Girish G Nelvigi, Venkatesh Garageshwara Keshavaiah, Chandrashekar S Ratkal DOI:10.4103/0974-7796.141018 PMID:25371622Xanthogranulomatous cystitis (XC) is a rare benign disease of unknown etiology. A 39-year-old female presented with 2 month history of urgency, dysuria, lower abdominal mass. On physical examination a hard hypogastric mass was present fixed to the rectus muscle. Computerized tomography (CT) abdomen showed heterogeneous enhancing mass arising from the anterior bladder wall with infiltration of the overlying parietal wall. Cystoscopy revealed extensive growth involving the entire wall of the bladder. A biopsy showed cystitis with focal areas suggestive of urothelial neoplasia of unknown malignant potential. Suspecting bladder cancer, we proceeded with radical cystectomy with ileal conduit. Histopathology revealed cystitis cystica with XC of the entire bladder. This is, to our knowledge, the first time that a case has been found to be so extensive with infiltration of the parietal wall and second time that radical cystectomy has been performed for XC. |
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Challenges in the diagnosis of xanthogranulomatous cystitis |
p. 375 |
Nikolaos Grivas DOI:10.4103/0974-7796.141019 PMID:25371623 |
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CASE REPORTS |
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Enucleation/partial nephrectomy for large mixed epithelial stromal tumor and herniating into the pelvicalyceal system |
p. 377 |
Mohamed H Kamel, Rodney Davis, Roni M Cox, Adam Cole, Ehab Eltahawy DOI:10.4103/0974-7796.141008 PMID:25371624Objectives: Mixed Epithelial and Stromal Tumor of the kidney is an adult renal neoplasm. It is mostly benign in nature. Typically it is composed of a mixture of epithelial and mesenchymal components. We hereby report on the feasibility of performing partial nephrectomy/enucleation for Huge Mixed Epithelial Stromal Tumor of the kidney without sacrificing the involved renal unit even in the tumors herniating into the collecting system.
Methods: Two female patients on long term hormonal therapy developed large enhancing multiloculated and septated renal masses. Kidney mass size was 18.5 cms in one patient and 11.5 in the second. In one patient, the mass was herniating into the collecting system. Both patients had enucleation/partial nephrectomy.
Results: Enucleation and partial nephrectomy were successfully performed in both patients. In the patient with the mass herniating into the collecting system, the horns of the mass herniating into the collecting system were easily enucleated with repair of the collecting system and salvage of the involved renal unit. Post op pathology revealed MEST in both patients. There were no intraoperative or postoperative complications.
Conclusions: Enucleation and partial nephrectomy for huge MEST is feasible. Mixed Epithelial Stromal Tumor herniating into the pelvicalyceal system may not warrant nephroureterectomy as previously reported. |
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A bone fide atypical fibroxanthoma of penis |
p. 381 |
Roberto Cuomo, Maria Addesso, Roberto Altieri, Antonio D'Antonio DOI:10.4103/0974-7796.141009 PMID:25371625Malignant mesenchymal tumors of the penis are very rare and they have vascular origin. We present a case of a 71-year-old man with a painless nodule of 2.0 cm in diameter located in the penile foreskin. There was no history of urinary or sexually transmitted disease. An excisional biopsy revealed a markedly pleomorphic sarcoma resembling atypical fibroxanthoma (AFX) associated with a squamous cell carcinoma in situ. The patient refused a wide re-excision and was free of disease after 36 months. Because the different therapeutic management and prognosis, differential diagnosis should be made with sarcomatoid squamous cell carcinoma and melanoma: A diagnosis of AFX or malignant fibrous histiocytoma may be considered only after the complete exclusion of these two entities. |
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Prostatic melanosis |
p. 384 |
Hasan Gucer, Pelin Bagci DOI:10.4103/0974-7796.141010 PMID:25371626Prostatic melanosis is a very rare, benign lesion characterized by the presence of melanin in the epithelium of the prostate gland and stromal dendritic cells, requiring no additional treatment. It constitutes the melanocytic lesions of the prostate together with blue nevus and malignant melanoma. We present a case with prostatic melanosis because it is rarely seen and its distinction from malignant melanoma is clinicopathologically very important. |
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Plasma cell granuloma of the urinary bladder: A pseudotumor - A clinical dilemma |
p. 387 |
Vinod Priyadarshi, Jitendra Pratap Singh, Debashish Chakrabarty, Dilip Kumar Pal DOI:10.4103/0974-7796.141011 PMID:25371627Plasma cell granuloma is a rare benign proliferative lesion that often mimics a malignant mass clinically and radiologically and its presentation in the urinary bladder is exceptional. Presuming malignant mass, such lesions often receive radical treatment. We are presenting here one such tumor, which resembled as an urachal tumor and underwent partial cystectomy. |
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Inflammatory pseudotumor of urinary bladder: Beware lest we forget |
p. 390 |
Pankaj Kumar Garg DOI:10.4103/0974-7796.141013 PMID:25371628 |
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CASE REPORTS |
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Urethrocutaneous fistula following fracture penis |
p. 392 |
Raj Kumar Sinha Mahapatra, Rajendra Prasad Ray, Swetank Mishra, Dilip Kumar Pal DOI:10.4103/0974-7796.141015 PMID:25371629Penile fracture is an emergency in urology. Early surgical management is recommended, to prevent long term complications. Although urethrocavernosal fistula is one of the described complications following fracture penis repair in literature, no case of urethrocuteneous fistula has been reported till now. Here we report the first case of urethrocutaneous fistula following repair of fracture penis. |
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COMMENTARY |
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Urethrocutaneous fistula following penile fracture |
p. 394 |
Jason M Scovell, Ranjith Ramasamy DOI:10.4103/0974-7796.141016 PMID:25371630 |
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OBITUARY |
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Dr. Abdullah Baker Fallatah 1943-2014 |
p. 395 |
Mohammed Abomelha DOI:10.4103/0974-7796.135536 |
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