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   2012| May-August  | Volume 4 | Issue 2  
    Online since May 3, 2012

 
 
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CASE REPORTS
Management of pelvic lymphoceles following robot-assisted laparoscopic radical prostatectomy
Omer A Raheem, Wassim M Bazzi, J Kellogg Parsons, Christopher J Kane
May-August 2012, 4(2):111-114
DOI:10.4103/0974-7796.95564  PMID:22629010
Pelvic lymphocele is a potential complication of radical prostatectomy. Although lymphoceles often regress spontaneously, many may progress, precipitate clinical symptoms, and ultimately require intervention. To date, the best treatment of pelvic lymphoceles has not yet been fully defined. However, laparoscopic marsupialization is a definitive and efficacious surgical alternative to percutaneous drainage. It is effective, results in minimal patient morbidity, and allows for rapid recovery. We report our experience with management of clinically symptomatic pelvic lymphoceles following robotic-assisted prostatectomy using laparoscopic marsupialization.
  12,944 566 2
ORIGINAL ARTICLES
The influence of urine cytology on our practice
Mahmoud Alameddine, Anmar Nassir
May-August 2012, 4(2):80-83
DOI:10.4103/0974-7796.95550  PMID:22629001
Objective: Bladder cancer is a common malignancy. It is ranked ninth among male population in Saudi Arabia. Urine cytology is used by some physicians routinely in the workup for diagnosis and follow-up of patients with urothelial cancer. Our objective is to determine whether urine cytology is still essential in the work up of suspected urothelial cancer patients and to measure its cost-effectiveness. Materials and Methods: We reviewed all urine cytology reports that were performed over a period of five years from 2006 to 2010 in the International Medical Center in Jeddah, Saudi Arabia. The medical records of patients with cytology reports of both positive for malignant cells and atypical cells suspicious of malignancy were retrospectively, studied for age, sex, nationality, cystoscopic findings, imaging results, and total cost. Results: A total of 563 urine cytology tests were done on 516 patients. Two patients were positive for malignant cell and 10 showed atypical cells suspicious of malignancy. All 12 patients underwent imaging and/or cystoscopy as part of their complete work up for hematuria. The two patients with positive cytology had a cystoscopic confirmation of bladder tumor. In the 10 patients with atypical cells, bladder tumor was identified in seven using cystoscopy and/or imaging. The mean age was 54.6±16 year (range 15-95). The total cost was 140,750 SR (37,533 USD) for a yield of 0.3% positive results and 2% atypical cytology. Conclusion: Routine urine cytology did not affect the diagnostic strategy for urothelial cancer. It should be only used in selected patients.
  8,059 674 2
CASE REPORTS
Priapism, pomegranate juice, and sildenafil: Is there a connection?
Subramanian Senthilkumaran, Namasivayam Balamurugan, Ponuswamy Suresh, Ponniah Thirumalaikolundusubramanian
May-August 2012, 4(2):108-110
DOI:10.4103/0974-7796.95560  PMID:22629009
We report the development of low flow priapism in three patients related to simultaneous consumption of sildenafil with pomegranate (Punica granatum) (POM) juice. There were no other concurrent diseases, intake of drugs, and chemicals or other risk factors in these patients. We want to create awareness among patients and practitioners for recognition and timely intervention. Probable mechanisms are highlighted.
  7,778 416 -
ORIGINAL ARTICLES
Ureterovaginal fistulas: The role of endoscopy and a percutaneous approach
Khalid M Al-Otaibi
May-August 2012, 4(2):102-105
DOI:10.4103/0974-7796.95556  PMID:22629006
Purpose: The aim of the study was to evaluate the minimal invasive approach and endourological techniques in managing the iatrogenic ureterovaginal fistula. The etiology and the diagnostic tools were also looked at. Patients and Methods: A retrospective study was conducted on 20 patients with ureterovaginal fistulas. The main causes for these were gynecological and obstetrical procedures. In all cases, the diagnosis was based on clinical presentation, intravenous pyelography, and cystoscopy. Various therapeutic methods were used. Eleven patients were treated by the endoscopic placement of a ureteral stent and 13 patients (including four with failed initial ureteral stent insertion) received ureteral reimplantation. Of these, two patients were treated by the Boari flap method, six by Psoas hitch, four by simple ureteric reimplant, and one by transureteroureterostomy. Results: Of the 11 patients treated by the endoscopic placement of a ureteral stent, 7 (64%) were successfully managed with this treatment alone. The remaining 4 (36%) also had open surgery. A total of 13 patients (including the 4 initially treated with endoscopic placement) underwent successful ureteric reimplantation. Routine cystoscopy revealed that 2 of the 20 patients (10%) had a concurrent vesicovaginal fistula. Conclusion: A ureterovaginal fistula is a rare but a relatively frequent complication of pelvic surgery. We recommend a minimal invasive approach including ureteric stent insertion as primary management and routine cystoscopy to rule out an association of a vesicovaginal fistula.
  4,012 429 1
Laparoscopic adrenalectomy: 10 years experience
Khalid M Al-Otaibi
May-August 2012, 4(2):94-97
DOI:10.4103/0974-7796.95553  PMID:22629004
Purpose: Laparoscopic adrenalectomy is considered the standard technique for the surgical removal of the adrenal gland. Shorter length of stay, decrease in postoperative pain and reduced complication are all the advantages of the laparoscopic approach. This report is about a 10-year single experience with laparoscopic adrenalectomy. Materials and Methods: A total of 34 lateral transperitonial laparoscopic adrenalectomies were performed. 24 right-sided lesions and 10 left-sided lesions were removed. The indications for surgery were aldosteronoma in 20 patients and nonfunctioning adenoma in 10 patients, and 1 child underwent bilateral adrenalectomy for bilateral adrenal hyperplasia. Results: All except one had successful laparoscopic adrenalectomy. Complication occurred in one patient who required open conversion because of bleeding. In addition, one patient suffered a pancreatic injury where the patient was managed conservatively. The average operative time was 2 hours and 30 minutes and the hospital stay was 2.5 days. Conclusion: Laparoscopic adrenalectomy is technically feasible and reproducible. Lateral transperitoneal approach offers advantages including better visibility and easy access to other organ systems. There is always a learning curve for the urological laproscopy.
  3,335 393 1
REVIEW ARTICLE
Introducing medical humanities in the medical curriculum in Saudi Arabia: A pedagogical experiment
Rabie E Abdel-Halim, Khaled M AlKattan
May-August 2012, 4(2):73-79
DOI:10.4103/0974-7796.95549  PMID:22629000
In a marked shift from the modern positivist materialist philosophy that influenced medical education for more than a century, Western medical educators are now beginning to realize the significance of the spiritual element of human nature. Consensus is currently building up in Europe and North America on the need to give more emphasis to the study of humanities disciplines such as history of medicine, ethics, religion, philosophy, medically related poetry, literature, arts and medical sociology in medical colleges with the aim of allowing graduates to reach to the heart of human learning about meaning of life and death and to become kinder, more reflective practitioners. The medicine taught and practiced during the Islamic civilization era was a vivid example of the unity of the two components of medical knowledge: natural sciences and humanities. It was also a brilliant illustration of medical ethics driven by a divine moral code. This historical fact formed the foundation for the three medical humanities courses presented in this article reporting a pedagogical experiment in preparation for starting a humanities program in Alfaisal University Medical College in Riyadh. In a series of lectures alternating with interactive sessions, active learning strategies were employed in teaching a course on history of medicine during the Islamic era and another on Islamic medical ethics. Furthermore, a third course on medically relevant Arabic poetry was designed and prepared in a similar way. The end-of-the-course feedback comments reflected effectiveness of the courses and highlighted the importance of employing student-centered learning techniques in order to motivate medical students to become critical thinkers, problem solvers, life-long learners and self-learners.
  3,080 541 2
CASE REPORTS
Primary isolated echinococcal cyst of the seminal vesicle: A rare case
Majid Mushtaque, Mohammad Farooq Mir, Parvez Nazir, Parwez Sajad Khan
May-August 2012, 4(2):122-125
DOI:10.4103/0974-7796.95571  PMID:22629014
Hydatid disease of the organs other than liver and lung is extremely rare. Although hydatid disease is endemic in India, we report a rare case of hydatid cyst in a young male primarily involving the seminal vesicle and aim to highlight the management of such cases. A 23 year old male farmer diagnosed with primary isolated echinococcal cyst of the seminal vesicle has been presented. Thorough investigations with radiological methods such as ultrasonography (abdominal and trans-rectal), and magnetic resonance imaging were carried out to aid in the diagnosis. Surgical excision of the lesion was carried out with careful removal of the cyst to prevent any bursting and spillage, leaving the seminal vesicle preserved. The cystic lesion was subjected to histopathological examination. Histopathology confirmed the diagnosis of hydatid disease. Postoperative period was uncomplicated and patient was discharged on seventh postoperative day. Patient was put on albendazole (10 mg/kg/day) for three cycles of 21 days each with a gap of one week between each cycle. There was no evidence of recurrence or development of cysts elsewhere in the body during the 2 year follow-up. Hydatid cyst of seminal vesicle is rare and should be kept in differential diagnosis of a cystic lesion in pelvis especially in regions where hydatid disease is endemic. Proper surgical and medical management to avoid any recurrences, and a regular follow-up, are of utmost importance to detect any late complications such as local recurrence of the disease and development of hydatidosis at the primary sites.
  3,188 286 -
Inflammatory myofibroblastic tumor of the urinary bladder diagnosed by anaplastic lymphoma kinase immunostaining
Ram Nawal Rao, Priydarshi Ranjan, Nidhi Singla, Rakesh Pandey
May-August 2012, 4(2):115-118
DOI:10.4103/0974-7796.95567  PMID:22629012
Inflammatory myofibroblastic tumor (IMFT) of the urinary bladder is an unusual spindle cell lesion that exhibits cytologic atypia, infiltrative growth, and mitotic activity mimicking malignant tumors, such as leiomyosarcoma, rhabdomyosarcoma, and sarcomatoid carcinoma. Recently, anaplastic lymphoma kinase (ALK) gene translocations or ALK protein expression in IMFT has been reported, especially in patients of children and young adults. This lesion has been described in numerous locations in addition to the urinary bladder. The detection of ALK protein and ALK gene rearrangements are useful in distinguishing IMFT from spindle cell malignancies in the urinary bladder.
  3,079 387 3
ORIGINAL ARTICLES
CA 19-9 as a serum marker in urothelial carcinoma
Mahander Pall, Javid Iqbal, Shrawan Kumar Singh, Satya Vati Rana
May-August 2012, 4(2):98-101
DOI:10.4103/0974-7796.95555  PMID:22629005
Introduction: CA 19-9 is a carbohydrate antigen related to Lewis A blood group antigen. It is well-known marker for pancreatic carcinoma and is being investigated for other malignancies including carcinoma bladder. We evaluated the role of serum CA 19-9 as a tumor marker and correlated its level with tumor stage and grade. Materials and Methods: Seventy-five patients with histologically proven urothelial carcinoma were included in this study as case and 25 healthy volunteers as control. Preoperative 5 ml blood sample was collected. Serum level of CA 19-9 was measured using solid-phase enzyme-linked immunosorbent assay kit. The value of CA19-9 was expressed in U/ml and 37 U/ml was taken as cut-off upper value of normal. Results: The range of CA19-9 in patients of urothelial carcinoma was 2 to 122 U/ml with a mean of 26.33±29.28, while in control, it was 8.48±5.01 U/ml (P<0.001). The sensitivity of CA19-9 was 29%. Serum CA19-9 was significantly elevated in invasive disease in comparison with superficial disease (47.17±34.43 vs 16.53±20.13) (P<0.001). Significantly high proportion of patients with invasive disease had value ≥37 U/ml (14/24 [58.3%] vs 8/51 [15.7%]) with P value <0.001. High proportion of high-grade tumor had raised value, 14/34 (41.25%); all patients with metastatic disease had value more than 37 U/ml. Conclusions: Serum CA19-9 is a marker of aggressiveness of urothelial carcinoma and is almost invariably raised in patients with metastatic disease. Thus, it may be used as a prognostic marker but not as a screening tool due to its low sensitivity.
  2,613 363 1
CASE REPORTS
Fat poor angiomyolipoma with lymphadenopathy: Diagnostic dilemma
Pankaj Kumar Garg, Bhupendra Kumar Jain, Anjay Kumar, Shuchi Bhatt, Vibhav Vibhav
May-August 2012, 4(2):126-129
DOI:10.4103/0974-7796.95573  PMID:22629015
A 24-year-old lady presented with left flank pain of 3 months duration. She had stigmata of tuberous sclerosis complex in the form of angiofibromas on face, ash-leaf macules on back and right upper limb and shagreen patches over back. Computed tomography scan of the abdomen showed 6.5 cm × 5.0 cm × 4.4 cm lobulated intensely enhancing exophytic mass lesion in mid pole of left kidney with significant para-aortic lymphadenopathy with no evidence of fat in the mass. She underwent radical left nephrectomy with a provisional diagnosis of renal cell carcinoma. Histopathological examination showed multicenteric angiomyolipoma involving kidney and para-aortic lymph nodes. This case report underscores the need for further research to differentiate fat-poor angiomyolipoma and lymphadenopathy from renal cell carcinoma.
  2,588 258 -
ORIGINAL ARTICLES
Effects of melatonin on partial unilateral ureteral obstruction induced oxidative injury in rat kidney
Dogan Atilgan, Bekir S Parlaktas, Nihat Uluocak, Fikret Erdemir, Fatih Firat, Unal Erkorkmaz, Oguzhan Saylan
May-August 2012, 4(2):89-93
DOI:10.4103/0974-7796.95552  PMID:22629003
Aim : This experimental study was designed to produce ischemia-reperfusion injury in rat kidney by performing partial unilateral ureteral obstruction (PUUO) and investigated the effects of melatonin on the levels of oxidative injury parameters. Materials and Methods: Twenty-four adult male rats were randomly divided into three groups as follows; control group (Group 1); only nephrectomy and blood (5 ml) drawn from vena cava inferior, PUUO group (Group 2); PUUO (10 days)+ipsilateral nephrectomy after recovery of PUUO+blood from vena cava inferior VCI, melatonin treated group (Group 3); PUUO (10 days)+melatonin (1/2 hr before release, 50 mg/kg, ip)+ipsilateral nephrectomy after recovery of PUUO+blood from VCI. The left ureter was embedded into the psoas muscle to create PUUO. After 10 days, PUUO was recovered and ipsilateral nephrectomies were performed for biochemical analysis of superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), glutathione peroxidase (GSH-Px), and protein carbonyl (PC) in the tissues and blood was drawn from inferior vena cava to study the same parameters in systemic circulation. The results were compared statistically. Results: The blood levels of MDA, NO, and PC were increased in the PUUO group in comparison to the sham-operated group (P<0.05). Melatonin treatment reduced MDA, NO, and PC levels in blood after PUUO recovery, but statistically significance consisted only for MDA and NO (P<0.05). The antioxidant enzyme activities (SOD, GSH-Px) were increased in the PUUO group (P<0.05). Melatonin treatment reduced SOD and GSH-Px activities in comparison with the sham-operated control group (P<0.05). Similarly, renal tissue levels of MDA, NO, and PC were increased in the PUUO group in comparison with the sham-operated group (P<0.05). Melatonin treatment ameliorated MDA, NO, and PC levels in renal tissue after PUUO recovery only MDA was statistically significant (P<0.05). Antioxidant enzyme activities (SOD, CAT, and GSH-Px) were increased in the PUUO group. Melatonin treatment caused reduction in SOD, CAT, and GSH-Px activities in comparison to the sham-operated control group (P<0.05). Conclusion : The results of this study showed that experimentally induced PUUO caused oxidative stress in rat kidney and melatonin treatment reduced oxidative stress and therefore may have a preventive effect on PUUO induced oxidative kidney damage in rats.
  2,439 326 4
CASE REPORTS
Fournier's gangrene developing secondary to infected hydrocele: A unique clinical scenario
Umran Sarwar, Nadeem Akhtar
May-August 2012, 4(2):131-134
DOI:10.4103/0974-7796.95577  PMID:22629017
We report the first case of Fournier's gangrene (FG) developing secondary to an infected hydrocele worldwide. We present a case report with a brief overview of the literature relating to FG and its aetiology, diagnosis and management. A 70 year-old male was referred by his General Practitioner with a 2 week history of worsening symptoms of scrotal discomfort and swelling. Following clinical examination, an initial diagnosis of an infected right-sided hydrocele was made and treatment, consisting of antibiotics, was initiated. Despite showing good clinical improvement, several days later, necrotic areas were observed over the right hemiscrotum with spreading cellulitis. A diagnosis of FG was made. The patient was started on triple-therapy antibiotics and taken to the operating room for urgent surgical debridement. Necrotic skin and subcutaneous tissue extending over the perineum and lower anterior abdomen was debrided down to healthy tissue. A further debridement took place 2 days later. The patient continued to improve and was eventually discharged under the care of Plastic Surgeons for reconstruction of the soft tissue defect. FG is a type of necrotising fasciitis predominantly affecting the male perineal, perianal, genital and anterior abdominal wall regions. It has a significant mortality rate, and the key to survival is early detection and treatment consisting of antibiotics and surgical debridement of the affected area. To the best of our knowledge, this is the first reported case of FG developing secondary to an existing hydrocele without any prior urological intervention. The case highlights the important clinical diagnostic and therapeutic interventions required to prevent complications associated with this, potentially fatal, condition.
  2,301 325 -
Intrascrotal solitary neurofibroma: A case report and review of the literature
Mohammad Mehdi Hosseini, Bita Geramizadeh, Saeed Shakeri, Mohammad Hossein Karimi
May-August 2012, 4(2):119-121
DOI:10.4103/0974-7796.95569  PMID:22629013
Solitary Neurofibroma of the scrotum is an extremely rare benign tumor, particularly when it is not associated with neurofibromatosis type I. To the best of our knowledge, less than 10 cases have been reported in the English literature. Herein, we report a 52-year-old man with the diagnosis of scrotal solitary neurofibroma.
  2,319 291 2
ORIGINAL ARTICLES
Results of low threshold to biopsy following high-intensity focused ultrasound for localized prostate cancer
Richard L Haddad, Tania A Hossack, Henry H Woo
May-August 2012, 4(2):84-88
DOI:10.4103/0974-7796.95551  PMID:22629002
Context: There are different treatment options for localized prostate cancer. The success of high-intensity focused ultrasound (HIFU) is based largely on biochemical prostate specific antigen (PSA) results. Aims: To evaluate the impact of using a low PSA threshold to perform prostate biopsies after HIFU in order to more accurately gauge treatment success. Settings and Design: Eleven patients underwent HIFU at Sydney Adventist Hospital in Sydney, 10 as primary and 1 as salvage therapy [post external beam radiation therapy (EBRT)]. The median age was 67 years (49-77 years). This was a prospective case series. Materials and Methods: Between 2006 and 2008, the Sonoblate device was used. Prostate biopsies were 12-core biopsies performed under local anesthesia, if PSA was ≥0.5 ng/mL or after two consecutive rises in PSA. The statistical analysis involved prospective data collection of results to calculate median and ranges. Results: The median PSA at diagnosis was 6.7 ng/mL (5.7-10.8 ng/mL). The median follow-up was 16 months (7-26 months). Nine men (82%) had post-HIFU biopsy. The median time to post-HIFU biopsy was 11.6 months (5-20 months), and all nine men had biopsy-proven residual disease. Conclusions: A low threshold to re-biopsy post-HIFU reveals a high local failure rate of 82%. Oncological efficacy is questioned, and using high threshold to biopsy may therefore be overestimating the effectiveness of HIFU as a primary treatment for localized prostate cancer.
  2,257 322 -
CASE REPORTS
Midureteric knotted stent removed by percutaneous access!
Parag Bhirud, Venkatesh Giridhar, Padmaraj Hegde
May-August 2012, 4(2):106-107
DOI:10.4103/0974-7796.95557  PMID:22629007
Indwelling ureteric stents are commonly used in the management of upper urinary tract obstruction. A rare complication is the knotting of an indwelling ureteric stent at its proximal coiled end. We present a case of a mid ureteric knotted stent that put the kidney at risk. Stent was extracted successfully by Percutaneous method, after failed minimally invasive methods.
  1,385 258 1
LETTER TO EDITOR
Urological concern and postcrisis Japanese nuclear accident
Viroj Wiwanitkit
May-August 2012, 4(2):135-136
DOI:10.4103/0974-7796.95578  PMID:22629018
  1,209 198 -
COMMENTARY
Commentary
Leonardo Oliveira Reis, Emerson Luís Zani
May-August 2012, 4(2):129-130
PMID:22629016
  1,182 191 -
Commentary
Ramen Kumar Baishya
May-August 2012, 4(2):107-107
PMID:22629008
  1,144 169 -
Commentary
Angelo Naselli
May-August 2012, 4(2):114-114
PMID:22629011
  1,101 182 -
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