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2009| January-June | Volume 1 | Issue 1
March 17, 2009
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The missing link in the history of urology: A call for more efforts to bridge the gap
Rabie E Abdel-Halim
January-June 2009, 1(1):2-8
With few exceptions, most of the current publications on history of urology still ignore the scientific and technological events of the more than a thousand years between the Greco-Roman times and the modern era. This has broken an important link in the globally continuous line of progress and evolution of world civilizations. Another aggravation of that missing-link problem in the history of urology, and history of medicine, in general, is the large number of articles based, only, on copying from secondary sources without checking the primary sources (the edited and published original manuscripts). Such articles easily propagate omissions, deficiencies, misunderstandings, distortions, and unfounded claims. On the other hand, in the Arabic and Islamic world, though many original authentic medical manuscripts written by famous scholars of the Islamic era were authoritatively edited and published during the twentieth century, the number of primary source studies based on them by historians or medical researchers remained few and were limited to individual efforts. Therefore, we focused on this missing-link era and performed several primary source studies of the published medical works of ten scholars who lived and practiced between the ninth and the thirteenth centuries and whose Latinized books were available in Europe as early as the twelfth century with their influence lasting until the eighteenth century. Our results confirm that those scholars of the Islamic era were not mere compilers or sheer transmitters of Greco-Roman medical literature. On the contrary, they critically reviewed the translated heritage of previous civilizations rejecting what is superfluous and accepting only what proves to be true. They added original contributions to the progress of urology and pioneered new fields of medical knowledge and practice such as medical ethics, medical education, medical certification, health education, preventive medicine, hospitals and hospital training, medical-practice quality control, clinical medicine, differential diagnosis, experimental medicine, experimental surgery, beginnings of specialization, pharmacology, use of anesthetics, and many other new discoveries in anatomy, physiology, pathology, therapeutics, surgical instruments, and surgical techniques.
Metastatic renal cell carcinoma: A guide to therapy based on current evidence
Toni K Choueiri
January-June 2009, 1(1):9-14
Metastatic renal cell carcinoma (RCC) was, until recently, considered a challenging disease to treat with few therapeutic options of limited benefit. The past few years have seen spectacular advances in the treatment of this disease based on understanding the molecular pathways behind tumor growth and angiogenesis. This progress has led to the development of targeted therapies such as the receptor tyrosine kinase inhibitors sunitinib and sorafenib, the anti-vascular endothelial growth factor antibody bevacizumab, and a class of rapamycin analogues that includes temsirolimus and everolimus that have each demonstrated clinical efficacy in patients with metastatic RCC. The goal of this manuscript is to review the current evidence based on large randomized trials and propose a rationale paradigm for the treatment of this disease.
Tunica vaginalis hydrocele of reposited testis
Manish K Tiwari, Anand A Sinha, Divyang N Dave
January-June 2009, 1(1):25-26
Tunica vaginalis hydrocele (TVH) is a relatively common entity. The procedure of testicular reposition in a subcutaneous pouch following severe scrotal avulsion injury is also a standard line of care. Though, the occurrence of TVH in such a reposited testis is extremely rare clinical presentation. We herein report a case of 55-year male patient who presented with swelling over medial aspect of left upper thigh which was diagnosed as TVH of reposited testis on detailed assessment. The patient was managed on the usual lines of management protocols of TVH with successful outcome.
Testicular sperm retrieval at the time of bilateral radical orchiectomy
Anmar M Nassir, John E Grantmyre, Rekha Gupta
January-June 2009, 1(1):22-24
A new indication for testicular tissue cryopreservation is discussed here. We evaluate the feasibility of testicular sperm extraction during bilateral orchiectomy for testicular cancer. A 26-year-old man with a history of right orchidopexy presented with primary infertility. Tests revealed left varicocele and oligospermia. He underwent varicocelectomy but was lost to follow-up. Nine months later, he presented with right-sided solid testicular swelling. Ultrasound examination confirmed the finding of possible neoplasm and revealed contralateral intratesticular lesion. Since the patient turned azoospermic, no semen sample could be cryopreserved. Permanent histopathological sections revealed bilateral classical seminomas. On processing the fresh healthy looking specimen, normal-looking viable sperm were obtained. Future attempts at
fertilization with intracytoplasmic sperm injection should be possible. This method has been described in metachronous testicular cancer, but to our knowledge, we are the first to use it in synchronous bilateral testicular tumors.
Sentinel node biopsy in carcinoma penis using methylene blue dye technique
Vinayak S Rohan, Rajen A Tankshali
January-June 2009, 1(1):18-21
Penile carcinoma is a common disease in India. This paper shows the results of sentinel node biopsy using methylene blue and discusses the incidence of false-negative rates.
Materials and Methods:
From September 2005 to March 2008, 22 newly diagnosed penile carcinoma patients (T1, T2, N0) were included in this prospective study. Intraoperative lymphatic mapping was done using methylene blue dye and the sentinel node was identified and removed. Lymphadenectomy was performed for positive inguinal lymph node metastasis.
There were 22 patients (mean age 52.7). The tumors were mostly located in the glans (73%). Eighty six percent was T1 lesions and 14% was T2. Ninety one percent of the patients underwent partial penectomy, and 9% underwent total penectomy. Sentinel node was identified in 20 patients (90.9%). In total, 49 sentinel nodes were identified (2.45 nodes per person). Only one patient had a positive pathological lymph node metastasis at the time of the surgery. Additionally, two patients became inguinal lymph node positive at the follow-up. This data yielded a sensitivity rate of 33% and a false-negative rate of 66%. There were no complications due to methylene blue.
Sentinel node biopsy using only methylene blue for penile carcinoma has a very low sensitivity and a high false-negative rate. However, methylene blue can be used as a substitute for lymphazurin.
Pseudotumor of the urinary bladder in a child: A case report and review of the literature
Punit Srivastava, AN Gangopadhyay, DK Gupta, VD Upadhyaya
January-June 2009, 1(1):30-31
Inflammatory pseudotumors (IPTs) are rare, nonepithelial tumors of the urinary bladder that are benign. They are very difficult to distinguish from sarcomas or carcinomas of the urinary bladder in children. Conservative surgical management by either transurethral resection or partial cystectomy is the treatment of choice. We report here a rare case of juvenile urinary bladder IPT that we managed by right partial cystectomy with right ureteric reimplantation because of involvement of the right ureteric orifice. On account of histological similarity of IPT to malignant urinary bladder tumors, it is mandatory to require definite diagnosis and long-term close follow up.
Double inferior vena cava in a patient with bilateral testicular tumor: A case report with review of literature
B Satheesan, D Suresh Kumar, N Kathiresan
January-June 2009, 1(1):27-29
Double inferior vena cava (IVC) is a rare developmental anomaly of IVC with a prevalence rate of 0.2-0.3%. Preoperative identification of major vascular anomalies is of paramount importance for a retroperitoneal surgeon. In addition, more anomalies are to be expected in those situations. Radiological studies in similar cases may be reported as retroperitoneal lymph nodes or masses if the radiologist is unaware. In this case report, a patient with bilateral testicular tumor with double IVC who underwent extensive retroperitoneal and pelvic lymph node dissection is described for rarity of the condition and technical difficulties associated with such a condition.
Multicentricity and its associated clinicopathological risk factors in renal cell carcinoma
B Cem Ozgur, Faruk Gonenc, Ahmet H Yazicioglu
January-June 2009, 1(1):15-17
: Although nephron-sparing tumor surgery (NSS) has become a routine procedure for renal tumors under certain precautions in many centers, due to the incidence of multifocality, it still remains controversial. This study examines some clinical and pathological risk factors associated with multifocal renal tumors and also factors contributing to the success or failure of NSS.
Materials and Methods:
From 2000-2005, 130 patients with renal cell carcinoma (RCC) who had undergone radical nephrectomy were included in this study at one academic center. The clinicopathologic features of these cases were reviewed and categorized to identify risk factors of multifocality including age, gender, size and side of the tumor, presence of vascular invasion, Fuhrman's grade, and clinical and pathological stages.
Data were expressed as mean. Statistical significance among groups was evaluated using Chi-square test and Fisher's exact test when appropriate. Student's
test was used for comparison of two means. Multiple logistic regression analysis was performed for risk factors of multicentricity.
P < .
05 was considered to indicate statistical significance. Analyses were carried out with SPSS (version 13) software.
: In all, 88 men and 42 women were included with a mean (range) age of 57 years. Vascular invasion, nuclear grade, and pathological and clinical stages of the primary tumors were the significant predictors of multicentricity in the statistical analyses.
: These data document that multifocality of RCCs is associated with presence of vascular invasion, high grade, and advanced staged tumors. Our results support the fact that NSS is an acceptable approach to RCC without these features, as oncological safety seems less evident in such cases and should be considered for absolute indications. Future trials should be performed with adequate funding and patient-focused outcomes.
Khalid Fouda Neel
January-June 2009, 1(1):1-1
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