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   2013| January-March  | Volume 5 | Issue 1  
    Online since February 5, 2013

 
 
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REVIEW ARTICLE
Flexible ureterorenoscopy: Tips and tricks
Bhaskar Kumar Somani, Omar Aboumarzouk, Aneesh Srivastava, Olivier Traxer
January-March 2013, 5(1):1-6
DOI:10.4103/0974-7796.106869  PMID:23662000
With advancement in technology, improvement in endoscope and ancillary equipment, more complex procedures can be performed using flexible ureterorenoscopy. In this review article we provide a summary of flexible ureterorenoscopic procedures with "tips and tricks'' for success for each type of procedure. It looks at the disposables used with flexible ureterorenoscopic procedures, set up and patient positioning for gaining access, insertion and handling of scope and the use of urethral access sheath. We also provide techniques for various flexible ureterorenoscopic procedures including management of renal stones, calyceal diverticula and upper tract urothelial tumours.
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ORIGINAL ARTICLES
Adult multilocular cystic nephroma: Report of six cases with clinical, radio-pathologic correlation and review of literature
Christopher Wilkinson, Victor Palit, Mallikarjun Bardapure, Jennifer Thomas, Anthony J Browning, Kanwar Gill, Chandra Shekhar Biyani
January-March 2013, 5(1):13-17
DOI:10.4103/0974-7796.106958  PMID:23662002
Background: Cystic renal neoplasms of the kidney can be benign or malignant. Multicystic nephroma (MCN) represents a rare benign cystic lesion of the kidney, which usually presents as a unilateral multicystic renal mass without solid elements. According to the World Health Organization (WHO) classification of the renal neoplasms, it is grouped along with mixed epithelial-stromal tumor of the kidney. Materials and Methods: We report a retrospective review of six cases of MCN of kidney. Patient demographics, imaging findings, operative details and final histology were recorded. Results: All patients had suspicious/malignant features on radiological examination, leading to a radical nephrectomy. However, microscopically these lesions were lined by cuboidal epithelium, and in a few places hobnail epithelium. No cells with clear cytoplasm, blastemal or immature elements were seen. In one case, foci of inflammatory cells and histiocytes were present. Conclusions: MCN is a benign cystic lesion and clinical presentations are nonspecific with symptoms such as abdominal pain, hematuria and urinary tract infection. These nonspecific clinical presentations and confusing radiological features create difficult preoperative differentiation from malignant cystic renal neoplasms.
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Assessment of Clavien-Dindo classification in patients >75 years undergoing nephrectomy/nephroureterectomy
Atif Khan, Victor Palit, Andy Myatt, Jon J Cartledge, Anthony J Browning, Adrian D Joyce, Chandra Shekhar Biyani
January-March 2013, 5(1):18-22
DOI:10.4103/0974-7796.106959  PMID:23662003
Introduction: There is a paucity of a standardized post-operative complications grading system in urology especially in the elderly population. Studies show satisfactory survival and oncological outcomes albeit with a slight increase in post-operative morbidity compared to younger patients. The Clavien-Dindo classification for post-operative complications is established as a valid system worldwide and applicable in many fields of surgery. Purpose: Retrospective assessment of post-operative complications in patients >75 years who underwent open/laparoscopic nephrectomy/nephroureterectomy for renal diseases and grading the post-operative complications according to the Clavien-Dindo classification. Materials and Methods: Retrospective review of case notes was performed in patients >75 years who underwent a laparoscopic/open nephrectomy/nephroureterectomy between 2000 and 2008. Post-operative complications were graded according to the Clavien-Dindo classification. Results: A total of 54 patients >75 years underwent nephrectomy/nephroureterectomy. 29 patients had laparoscopy and 25 had open surgery. Fifty one patients had a malignancy and 3 had benign diseases. Grade I, II, IIIa, IIIb and IVa were 25.6%, 41.1%, 7.7%, 7.7% and 17.9% respectively. No significant difference was noted in the 2 groups Conclusions: We believe that in elderly patients, laparoscopic surgery can be offered safely without significantly increasing the surgical risks. The Clavien-Dindo classification is easy to use and effectively applied to categorize post-operative complications associated with nephrectomy/nephroureterectomy in elderly population. However, this system needs slight modification to incorporate intra-operative complications and large studies are needed to validate and standardize this classification for all urological procedures.
  4,580 489 -
Reliability of Arabic ICIQ-UI short form in Saudi Arabia
Ghadeer Al-Shaikh, Ahmad Al-Badr, Amira Al Maarik, Nikki Cotterill, Hazem M Al-Mandeel
January-March 2013, 5(1):34-38
DOI:10.4103/0974-7796.106964  PMID:23662008
Context: The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) provides a brief measure of symptoms and impact of urinary incontinence on quality of life. It is suitable for use in clinical practice and research. An Arabic version of the ICIQ-UI SF was translated and validated in Egypt and Syria. Aims: The objective was to assess the reliability of the Arabic version of the ICIQ-UI SF in women from Saudi Arabia. Settings and Design: A study at the Urogynecology Clinic was conducted from November 2010 until August 2011. Materials and Methods: Thirty-seven consecutive Saudi women attending urogynecologic clinic were recruited. Questionnaires were distributed for self-completion and then redistributed to the same set of respondents two to four weeks later as part of a test-retest analysis for assessing questionnaire's stability. Statistical Analysis Used: Agreement between two measurements was determined by weighted Kappa. Internal consistency was assessed using Cronbach's alpha coefficient. Results: Participants had a mean (SD) age of 39 (9.9), median parity of 4, and mean BMI (SD) of 30.9 kg/m 2 (4.6). There were no differences in the frequency and amount of urine leaks or the impact of UI on quality of life observed between the two visits. Assessment of internal consistency was excellent with the Cronbach's alpha coefficient of 0.97 (95% CI: 0.88-0.98). Participants agreed that the questionnaire was clear, appropriate, and easy to understand. Conclusions: The Arabic ICIQ-UI SF is a stable and clear questionnaire that can be used for UI assessment in clinical practice and research among Saudi women.
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Do we really know the prevalence of multi-drug resistant Escherichia coli in the territorial and nosocomial population?
Stefano Picozzi, Cristian Ricci, Maddalena Gaeta, Alberto Macchi, Emmanuel Dinang, Gaia Paola, Milvana Tejada, Elena Costa, Giorgio Bozzini, Stefano Casellato, Luca Carmignani
January-March 2013, 5(1):25-29
DOI:10.4103/0974-7796.106962  PMID:23662006
Introduction: The purpose of this work was to evaluate the prevalence of the Quinolones resistant Escherichia coli and/or ESBL producers in the population of our catchment area and hospital component. Materials and Methods: From January 2008 to December 2010, all data concerning urine cultures in patients with suspected urinary tract infection and/or asymptomatic bacteriuria referring at our center located in the south of Milan were prospectively evaluated. Results: In 2008, 2136 outpatient and 1232 hospital urine cultures were analyzed. The presence of quinolone-resistant strains was 21% at a local level and 53% in hospitals. ESBL-producing strains were isolated in 3.5% of cases at a local level and 20.5% in hospitals. In 2009, 2396 outpatient and 1320 hospital urine cultures were analyzed. The presence of quinolone-resistant strains was 21% at a local level and 46% in hospitals. ESBL-producing strains were isolated in 5.4% of cases at a local level and 20% in hospitals. In 2010, 2601 outpatient and 1717 hospital urine cultures were analyzed. The presence of quinolone-resistant strains was 34% at a local level and 26% in hospitals. ESBL-producing strains were isolated in 6.7% of cases at a local level and 20.6% in hospitals. The multidrug resistance was significantly (P < 0.01) higher in ESBL-positive strains. Conclusion: Due to rising antibiotic resistance among uropathogens, it is important to have knowledge of the organisms causing urinary tract infections and their antibiotic sensitivity patterns. In areas with high prevalence of E. Coli resistance, performing urine culture before every surgical procedure became mandatory, in order to prevent fatal sepsis.
  3,466 536 1
Comparable effect with minimal morbidity of low-dose Tokyo 172 strain compared with regular dose Connaught strain as an intravesical bacillus Calmette-Guérin prophylaxis in nonmuscle invasive bladder cancer: Results of a randomized prospective comparison
Teruo Inamoto, Takanobu Ubai, Takeshi Nishida, Yutaka Fujisue, Yoji Katsuoka, Haruhito Azuma
January-March 2013, 5(1):7-12
DOI:10.4103/0974-7796.106873  PMID:23662001
Aim: The aim was to compare patients' morbidity and response of bacillus Calmette-Guérin (BCG) prophylaxis after the intravesical instillation of low-dose Tokyo 172 strain and regular dose Connaught strain in patients with nonmuscle invasive bladder cancer (NMIBC). Patients and Methods: This was a randomized, active-controlled, open-label, monocenter study. Thirty-eight, NMIBC patients were treated sequentially, in a random order, with low-dose Tokyo 172 strain and regular dose Connaught strain, receiving each therapy for 6 weeks. A total of 18 and 20 patients were randomly assigned to a Tokyo 172 strain arm and a Connaught strain arm, respectively. Complication, morbidity, and recurrence-free survival (RFS) after each treatment were compared. Results: There was no significant difference in the 1-year RFS rate in patients treated with Tokyo 172 strain and Connaught strain (72.2% vs. 83.5%, respectively; P = 0.698). There were no significant differences in adverse events between the arms. Severe adverse events (>Grade 3) were seen in 15% of the Connaught strain group while no severe adverse events were observed as a result of Tokyo 172 strain. Conclusion: Our results indicated that low-dose Tokyo 172 strain decreased adverse events although it was not significant, and the RFS difference was not statistically significant between the two arms. Further investigation is warranted.
  2,678 538 1
CASE REPORTS
Radio-frequency ablation helps preserve nephrons in salvage of failed microwave ablation for a renal cancer in a solitary kidney
Scott M Castle, Nelson Salas, Raymond J Leveillee
January-March 2013, 5(1):42-44
DOI:10.4103/0974-7796.106966  PMID:23662010
Recurrent tumors after renal ablative therapy present a challenge for clinicians. New ablative modalities, including microwave ablation (MWA), have very limited experience in methods of retreating ablation failures. Additionally, in MWA, no long-term outcomes have been reported. In patients having local tumor recurrence, options for surveillance or surgical salvage must be assessed. We present a case to help assess radio-frequency ablation (RFA) for salvage of failed MWA. We report a 63-year-old male with a 4.33-cm renal mass in a solitary kidney undergoing laparoscopic MWA with simultaneous peripheral fiber-optic thermometry (Lumasense, Santa Clara, CA, USA) as primary treatment. Follow-up contrast-enhanced computed tomography (CT) scan was performed at 1 and 4.3 months post-op with failure occurring at 4.3 months as evidenced by persistent enhancement. Subsequently, a laparoscopic RFA (LRFA) with simultaneous peripheral fiber-optic thermometry was performed as salvage therapy. Clinical and radiological follow-up with a contrast-enhanced CT scan at 1 and 11 months post-RFA showed no evidence of disease or enhancement. Creatinine values pre-MWA, post-MWA, and post-RFA were 1.01, 1.14, and 1.17 mg/ml, respectively. This represents a 15% decrease in estimated glomerular filtration rate (eGFR) (79 to 67 ml/min) post-MWA and no change in eGFR post-RFA. Local kidney tumor recurrence often requires additional therapy and a careful decisionmaking process. It is desirable not only to preserve kidney function in patients with a solitary kidney or chronic renal insufficiency, but also to achieve cancer control. We show the feasibility of RFA for salvage treatment of local recurrence of a T1b tumor in a solitary kidney post-MWA.
  2,793 343 1
Eosinophilic cystitis mimicking tuberculosis: An analysis of five cases with review of literature
Santosh Kumar, Varun Sharma, Raguram Ganesamoni, Shrawan Singh
January-March 2013, 5(1):50-52
DOI:10.4103/0974-7796.106969  PMID:23662013
Eosinophilic cystitis (EC) is a rare disease. It is a transmural inflammation of the bladder, predominantly with eosinophils. High index of suspicion is needed for timely intervention. EC should be kept as a differential diagnosis in patients presenting with lower urinary tract symptoms due to small capacity bladder with a negative workup for urinary tuberculosis and in patients having hematuria and negative cytology, or incidentally found bladder lesions with known risk factors. Initial treatment is conservative with removal of risk factor, anti-histaminics and steroids. Augmentation cystoplasty should be considered in patients with a small capacity bladder. These patients need a strict and long term follow-up.
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Spermatic cord metastasis as early manifestation of small bowel adenocarcinoma
Nasim Valizadeh, Ali Eishi Oskuie, Ali Tehranchi
January-March 2013, 5(1):53-55
DOI:10.4103/0974-7796.106971  PMID:23662014
Malignant tumors of the spermatic cord are rare. There are a few case reports on spermatic cord metastasis from colonic, gastric, pancreas, and prostatic cancer. Here, we report a 36-year-old man with brucellosis presenting with spermatic cord metastasis as early manifestation of small bowel adenocarcinoma.
  2,555 271 -
ORIGINAL ARTICLES
Hemosepermia after transrectal ultrasound-guided prostatic biopsy: A prospective study
M Abdelkhalek, M Abdelshafy, H Elhelaly, M Kamal
January-March 2013, 5(1):30-33
DOI:10.4103/0974-7796.106963  PMID:23662007
Objectives: Trans-rectal ultrasound (TRUS) is a safe, cost-effective, radiation-free imaging modality for evaluation of prostate. But unfortunately, hemospermia is known to be associated with TRUS-guided prostate biopsy. The aim of this study is to measure the incidence and risk factors of hemospermia in patients undergoing TRUS. Patients and Methods: A prospective observational study involving patients undergoing TRUS for suspected prostate cancer has been conducted at Al-Hussein and Sayed Galal Hospitals. Forty patients were included in the study. Results: Most men (90% = 36 patient) undergoing TRUS-guided prostatic biopsy, who were able to ejaculate, experienced hemospermia, which was associated with some degree of anxiety. The mean duration of hemospermia was 4 (±1.4) weeks. The number of ejaculations before the complete resolution of hemospermia was 6 (±5.6). None of the clinical and pathological factors was a significant predictor of the duration of hemospermia. Conclusion: Patients should be adequately counseled before TRUS-guided prostatic biopsy to avoid anxiety and alterations in sexual activity.
  2,395 431 1
CASE REPORTS
Chylous ascites after laparoscopic hand-assisted donor nephrectomy: Is it specific for the left-side?
S Ter Meulen, KA van Donselaar-van der Pant, FJ Bemelman, MM Idu
January-March 2013, 5(1):45-46
DOI:10.4103/0974-7796.106967  PMID:23662011
We describe a case-report of a chylous ascites after laparoscopic donor nephrectomy, summarize the current literature, and hypothesize on the etiology of this complication.
  2,410 273 -
Robot-assisted laparoscopic radical prostatectomy after heart transplantation
Iqbal Singh, Bhavin N Patel, Vinay Thohan, Ashok K Hemal
January-March 2013, 5(1):56-58
DOI:10.4103/0974-7796.106972  PMID:23662015
Prostate cancer (CaP) is the leading visceral malignancy in males. Patients who undergo cardiac transplantation are immune compromised, thus presenting a therapeutic challenge. Immunosuppresion could accelerate tumor growth, while medical intervention may be associated with increased treatment mortality or morbidity. Due to paucity of such cases, there are no randomized trials that address the treatment algorithm for cardiac transplant patients with CaP, with only a few scattered reports in the literature. Treatment options range from hormonal manipulation to radiation therapy to radical prostatectomy. To our knowledge, we report the first successful robot-assisted laparoscopic radical prostatectomy in a heart transplant patient with CaP.
  2,298 295 -
The type of lymphocyte infiltration near urothelial carcinoma is diagnostic for chronic lymphocytic leukemia
Barbaros Baseskiogulu, Funda Canaz, Coskun Kaya, Turgut Dönmez
January-March 2013, 5(1):47-49
DOI:10.4103/0974-7796.106968  PMID:23662012
T-lymphocytic infiltration near the tumor site is an expected immune response in bladder cancers. However, reports of patients with bladder cancer exhibiting small lymphocytic infiltration of the bladder tissue are very rare in the literature. Here, the patient was presented to our group with hematuria, but subsequently diagnosed as exhibiting invasive bladder cancer and chronic lymphocytic leukemia with suspicious lymphocytic infiltration in a transurethral resection specimen. This case emphasizes the importance of lymphocytic infiltration's nature near urothelial carcinoma.
  1,997 243 -
Primary testicular plasmocytoma: A five year follow-up
Milton Ghirelli Filho
January-March 2013, 5(1):39-41
DOI:10.4103/0974-7796.106965  PMID:23662009
The testicular plasmocytoma represents only 5% of the non-germinative cell testicular tumors, and accounts for only 2% of all plasma cell neoplasms. Approximately, 50 cases of testicular plasmocytoma have been reported in medical literature; however, only 9 of these are isolated tumors without previous history or progression to multiple myeloma. A 47-year-old patient, presenting progressive and painless growth of the right testicle in the last four years, underwent surgical treatment in another hospital two years ago, to correct a hydrocele in the same testicle with no improvement at all. Sonography showed a tumor with the following measurements for the right testicle: 84 × 59 × 80 mm. The tumor marker values were all normal. An abdominal computed tomography found no evidence of retroperitoneal lymph nodes invasion. The patient underwent a right radical orchiectomy. Pathologic analysis revealed a malignant neoplasia described as a plasmocytoma (solitary myeloma) that produces immunoglobulin's kappa light chain. After five years of follow-up, there were no signs of metastasis or local recurrence in the exams. Case report and review of literature have been presented here.
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COMMENTARY
Commentary
Safwat E Abouhashem
January-March 2013, 5(1):23-24
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ERRATUM
Erratum

January-March 2013, 5(1):24-24
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