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   2011| May-August  | Volume 3 | Issue 2  
    Online since June 17, 2011

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Removal of foreskin remnants in circumcised adults for treatment of premature ejaculation
Mohammad Reza Namavar, Boroomand Robati
May-August 2011, 3(2):87-92
DOI:10.4103/0974-7796.82175  PMID:21747599
Background and Aim : Premature ejaculation (PE) is the most prevalent sexual dysfunction in every country. There are many types of treatment, but the main limitation of medical treatment for premature ejaculation is recurrence after withdrawal of medicine. The prepuce is a specific erogenous zone that contains a rich and complex network of nerves. Circumcision radically desensitizes the penis, but incomplete circumcision may cause premature ejaculation. We evaluate the effect of removal of foreskin remnants in adults on PE. Materials and Methods : The sensitive area of penile skin and the remaining parts of foreskin in adult men were recognized in 47 selective patients. Under local anesthesia, the remnant parts of foreskin were incised and removed. They were asked to fill the investigating questionnaire about the changes of intravaginal latency ejaculatory time (IVELT), patients and their sexual partners' satisfaction with sexual life, control over ejaculation, and penile sensitivity, before and after treatment. Results : There were no signs of inflammation and no serious adverse reactions in all cases after operation. IVELT significantly increased from 64.25 before surgery to 731.49 sec after surgery (P<0.001). The percentage of postoperative satisfaction in both the patient and his partner significantly increased (P<0.001). After surgery, 95.7% of men had better control over their ejaculation. This surgery significantly decreased sensitivity of penis (P<0.001), but it did not change glans penis insensitivity. Conclusions : These results indicate that removal of foreskin remnants in adults is an effective modality in selective patients of PE.
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Primitive neuroectodermal tumor/Ewing's sarcoma in adult uro-oncology: A case series from a developing country
Rehan Mohsin, Altaf Hashmi, Muhammed Mubarak, Gohar Sultan, Asad Shehzad, Abdul Qayum, Syed Ali Anwer Naqvi, Syed Adeeb ul Hassan Rizvi
May-August 2011, 3(2):103-107
DOI:10.4103/0974-7796.82180  PMID:21747604
Peripheral primitive neuroectodermal tumor/Ewing's sarcoma (PNET/EWS) is primarily a tumor of soft tissues and bones. Primary localization of PNET/EWS in genitourinary organs is rare. No data on this localization of PNET/EWS are available in literature from Pakistan. We searched our adult uro-oncology records from 1994 till date and identified all cases of adult genitourinary and adrenal PNET/EWS diagnosed on histology and immunohistochemistry. Their case records were reviewed to obtain data on demographics, presentation, pathologic features, management and outcome. Six cases were found; all were young and had aggressive disease at presentation. Four had renal PNET/EWS. One case each of prostate and adrenal PNET/EWS was seen. Surgery and chemotherapy formed the mainstay of management. Three patients (50%) died during treatment, two were lost to follow-up and one case with renal PNET/EWS showed good initial response to chemotherapy but was later on lost to follow-up. In conclusion, PNET/EWS should be considered in the differential diagnosis of genitourinary malignant tumors in young patients. These tumors are aggressive with poor outcome.
  5,382 557 7
Prospective randomized clinical trial comparing phytotherapy with potassium citrate in management of minimal burden (≤8 mm) nephrolithiasis
Iqbal Singh, Ishu Bishnoi, Vivek Agarwal, Shuchi Bhatt
May-August 2011, 3(2):75-81
DOI:10.4103/0974-7796.82172  PMID:21747596
Aim : To compare efficacy and tolerability of phytotherapy (PT) vs. potassium citrate (KC) in patients with minimal nephrolithiasis. To compare and assess changes in value of certain serum (Ca 2 +, PO4 3- , uric acid [UA]) and urinary (24-hr Ca 2+ , PO4 3- , UA, citrate, oxalate, and urine pH) parameters in patients being treated with PT or KC. Materials and Methods : After clearance by the local institutional ethics committee, 60 patients of nephrolithiasis who had consented for the study, were enrolled (as per entry criteria) and randomized into citrate therapy (group-I) or PT (group-II). PT was administered as a nutritional supplement, using a lupeol-based extract (Tablet Calcury™, two tablets twice a day). They were monitored for the changes in the serum and urinary biochemical, radiological, and clinical parameters (efficacy and tolerability) as per protocol. Results : Group-I patients demonstrated favorable changes in certain biochemical parameters (decreased serum calcium, urinary UA/oxalate, increased urinary citrate and pH) along with significant symptomatic improvement (decrease in visual analogue pain score with increased stone clearance/reduction in stone size). Four (13.3%) patients of group-I had mild upper gastrointestinal discomfort which was controlled with antacids. Group-II patients had favorable changes in biochemical parameters (decreased serum UA and increased urinary citrate) along with significant symptomatic improvement (reduction/clearance in the stone size), but without any noticeable side effects. Conclusions : Medical therapies with both KC and PT (with lupeol extract using Calcury™) were effective in reducing the stone size and symptoms of nephrolithiasis. It appeared that KC was biochemically efficacious in producing some favorable biochemical changes with some side effects, whereas PT was probably clinically efficacious in hastening stone expulsion (<8 mm) without any observed adverse events. Although both the medical therapies were not effective in all aspects, we believe that PT using lupeol-based extract (Calcury™) may be used as an alternative form of medical therapy in select patients with minimal nephrolithiasis. Long-term randomized placebo-controlled trials are needed to better define the precise role of lupeol-based PT vs. citrate therapy in minimal nephrolithiasis.
  4,780 746 10
Experimental medicine 1000 years ago
Rabie E Abdel-Halim
May-August 2011, 3(2):55-61
DOI:10.4103/0974-7796.82168  PMID:21747591
Little is known about the state of experimentation in the field of medicine during the Medieval Islamic era. With few exceptions, most of the contemporary sources on history of medicine propagate the idea that the roots of experimental medicine in its modern form, including clinical trials and drug-potency studies, first started during the European Renaissance in the 16 th to the 18 th centuries. This study is part of an ongoing multidisciplinary primary-source investigation of the original Arabic works of 11 Islamic medical scholars who lived and practiced between the 9 th and the 13 th centuries. The study critically evaluated and documented their contributions to the development of the scientific method and experimental medicine during that medieval Islamic era in several areas including critical appraisal of previous knowledge, clinical observations and case reports, clinical therapeutic trials, drug potency trials, experimentation on animals, dissection and dissection experiments as well as postmortem examinations. In each of the above-mentioned areas, significant contributions were made during the Medieval Islamic era from as early as the ninth century AD.
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Gender and urinary pH affect melamine-associated kidney stone formation risk
Xiuli Lu, Jing Wang, Xiangyu Cao, Mingxin Li, Chunling Xiao, Takahiro Yasui, Bing Gao
May-August 2011, 3(2):71-74
DOI:10.4103/0974-7796.82171  PMID:21747595
Objectives : Melamine was known as a new risk for kidney stone due to recent incidences of milk powder contamination in China. Here, we performed a retrospective study to investigate whether age, gender, and urinary pH affect melamine-associated kidney stone risk. Materials and Methods : A retrospective review was performed of 217 children aged less than 3 years old. All children had a history of being fed with Sanlu milk powder contaminated by melamine, and underwent a clinical screening on kidney stone in Shenyang from November 2008 to February 2009. A comparison with the Chi-square was conducted between 83 cases and 125 normal subjects. The difference between children's gender, age, and urinary pH was evaluated. Results : A total of 208 subjects, 136 boys and 72 girls, were included in the study. Significant association was observed between melamine-associated kidney stone risk and gender [odds ratio (OR), 2.03; 95% confidence interval (CI), 1.11-3.74; P=0.02] and urinary pH (OR, 1.78; 95% CI, 1.01-3.11; P=0.04), respectively. Male children were at about twofold increased melamine-associated kidney stone risk compared with female children. Acidic urine showed about 1.78-fold increased melamine-associated kidney stone risk compared with normal urine. Conclusions : Our investigation results showed an association of gender and urinary pH with melamine-associated kidney stone formation risk.
  4,357 539 7
Prospective randomized trial of 100u vs 200u botox in the treatment of idiopathic overactive bladder
Waleed AlTaweel, Alaa Mokhtar, Danny M Rabah
May-August 2011, 3(2):66-70
DOI:10.4103/0974-7796.82170  PMID:21747594
Aim : To evaluate the clinical outcomes of two different doses of BTX-A in patients with refractory idiopathic overactive bladder. Patients and Methods : Thirty nine patients with refractory idiopathic overactive bladder from 1/1/2008 till 30/3/2009 were evaluated in a tertiary care hospital. Patients were evaluated using urodynamic studies, voiding diary, UDI-6 and IIQ-7 questionnaires prior to being prospectively randomized (alternate randomization) to the BTX-A applications and three months after treatment. Voiding diary and residual volume were followed two weeks later. All patients received intradetrusorial injections of BTX-A (Botox, Allergan, Irvine, CA) of 100u or 200u under cystoscopic control on an outpatient basis. The primary endpoint was assessed for the improvement of urodynamic parameters and adverse events at three months after the initial treatment. Secondary end points included urinary frequency, urgency and UUI episodes as assessed by voiding diary and QoL. Results : Eleven patients were enrolled to each arm of the study. There were no significant differences in demographic characteristics between the two groups. Urodynamic assessment at the end of the third month showed significant improvement in urodynamic variables in both groups. There was no statistically significant difference in urodynamic parameters and in the voiding diary between the two groups. QOL was significantly improved in both groups with no statistically significant difference between the different doses. Only three patients developed acute urinary retention. Conclusion : BTX-A at 100u and 200u appears to improve symptoms, urodynamic parameters and QoL with no statistical significance between the two groups.
  3,767 619 4
Photoselective vaporization of the prostate in men taking clopidogrel
Daniel M.G Spernat, Tania A Hossack, Henry H Woo
May-August 2011, 3(2):93-95
DOI:10.4103/0974-7796.82176  PMID:21747600
Aim : To evaluate the peri-operative morbidity of men taking clopidogrel who underwent photoselective vaporisation of the prostate (PVP). Patients and Methods : A prospective database was collected. Between March 2005 and July 2010, 480 men underwent PVP. Of these, 18 men underwent PVP treatment while on clopidogrel. The surgery was carried out with either an 80W KTP laser or a 120W lithium triborate laser. Results : In the peri-operative period there were no complications related to PVP. There were no urinary tract infections, nor did any patient require bladder re-catheterisation. No cardiovascular events were reported within 3 months of the procedure. At 3 months post operatively, the International Prostate Symptom Score±standard deviation had improved from was 17.5±10.6 to 9.2±6.1 P<0.05. While the Quality of Life±standard deviation improved from 4.7±1.2 to 2.2±1.5 P<0.01. The maximum flow rate (Qmax), and post void residual volume (PVR) improved from 6.2±3.0 mL/s to 19.7±9.1 mL/s (P<0.01), and 140±102 mL to 59±77 mL (P<0.05), respectively. Conclusions : PVP is a safe and efficacious in the treatment of high risk patients with bladder outlet obstruction. Further, the ability to continue therapeutic anticoagulation and anti-platelet agents, is a significant advantage over Holmium enucleation of the prostate and conventional transurethral resection of the prostate. Larger studies with greater numbers of patients are required prior to PVP becoming the gold standard for high-risk patients with bladder outlet obstruction.
  3,638 614 6
Outcomes of laparoscopic donor nephrectomy in the presence of multiple renal arteries
Anil Kapoor, Shahid Lambe, Ashley L Kling, Kevin R Piercey, Paul J Whelan
May-August 2011, 3(2):62-65
DOI:10.4103/0974-7796.82169  PMID:21747593
Purpose : Data of laparoscopic donor nephrectomy (LDN) with multiple renal arteries for donor and recipient outcomes were reviewed, with the aim of clarifying whether the laparoscopic approach is safe in the presence of multiple renal arteries. Materials and Methods : All donor nephrectomies performed at our institution from 2004 to 2008 were reviewed retrospectively. Results were compared between LDN kidneys with multiple arteries and those with a single renal artery. Results : Out of 171 donor nephrectomies, 21 (12%) were performed for kidneys with multiple renal arteries. All of the 150 (88%) donor nephrectomies in the single vessel group were performed laparoscopically. In the multiple artery group, 9 (43%) underwent an open procedure while 12 (57%) underwent a laparoscopic procedure. The warm ischemia time was longer in the multiple artery group than the single artery group, but the difference was not statistically significant (4.25±0.87 min vs. 4.12±0.95 min, respectively). Regarding transplant recipients, the vascular anastomosis time was similar in both groups (30±4.6 min vs. 29.5±3.7 min). The operative blood loss in the transplant recipients was significantly more in the multiple artery group compared to the single artery group (339±292 ml and 130.7±44.8 ml, respectively; P=0.03). The recipient renal function was similar for both the groups at postoperative day 7, 1 month, and at 1 year. Conclusion : The data support the fact that the laparoscopic approach to donor nephrectomy in the presence of multiple renal arteries can be performed safely with adequate laparoscopic experience.
  3,735 481 7
Secondary signet-ring cell adenocarcinoma of urinary bladder from a gastric primary
Pramod K Sharma, Mukesh K Vijay, Ranjit K Das, Uttara Chatterjee
May-August 2011, 3(2):97-99
DOI:10.4103/0974-7796.82177  PMID:21747602
Primary bladder tumor is a frequent urological malignancy, whereas the incidence of secondary bladder tumor from a distant organ is quite rare. Secondary bladder neoplasms represent 1% of all malignant bladder tumors, of which distant metastases from stomach account for about 4% of cases. We present the case of a 30-year-old male who underwent partial gastrectomy for Signet-ring cell carcinoma of the stomach and presented 2 years later with hematuria. On computerized tomography scan, a bladder tumor was found which was resected cystoscopically. The histopathological examination revealed secondary Signet-ring cell adenocarcinoma of the urinary bladder.
  3,696 436 1
Primary renal synovial sarcoma
Vandana U Grampurohit, Aneel Myageri, Ravikala V Rao
May-August 2011, 3(2):110-113
DOI:10.4103/0974-7796.82182  PMID:21747606
Primary synovial sarcoma (SS) of kidney is very rare and difficult to diagnose. Here, we present a case of a 21-year-old female clinically diagnosed as renal cell carcinoma. Right nephrectomy specimen showed a cystic tumor in the upper pole of kidney with areas of hemorrhage and solid growth. Histologically, it showed poorly differentiated cells with hemangiopericytoma-like vascular pattern. Morphologic and immunohistochemical features were compatible with the diagnosis of poorly differentiated SS of kidney. Primary renal SS is a recently described entity. To the best of our knowledge, approximately 34 cases have been reported till date and this is the eighth documented case of poorly differentiated variant. Most of the time, poorly differentiated SS of kidney exhibits hemangiopericytoma like histology. Reverse transcriptase-polymerase chain reaction analysis to demonstrate SYT-SSX fusion gene transcript helps to confirm the diagnosis.
  3,285 510 3
A blind-ending ureter with infection due to vesicoureteric reflux with associated renal agenesis: A rare cause of pain abdomen
Vinita Rathi
May-August 2011, 3(2):100-102
DOI:10.4103/0974-7796.82179  PMID:21747603
We report a 12-year-old male child with an unusual cause of abdominal pain, i.e. a blind-ending ureter with vesicoureteral reflux. The pain improved with antibiotic therapy, implying infection as the cause of pain. This entity is difficult to diagnose clinically, thereby affecting management. Usually, a blind-ending ureter is not filled on intravenous urography (IVU) and the diagnosis is confirmed by retrograde pyelography, which is an invasive procedure. We illustrate the contribution of IVU and computerized tomographic cystography, which has not been reported earlier, in the evaluation of such cases.
  2,810 347 1
Iatrogenic neonatal bladder perforation
Lilia Trigui, Mohamed Jallouli, Nedia Hmida, Zeineb Mnif, Riadh Mhiri, Abdellatif Gargouri
May-August 2011, 3(2):108-109
DOI:10.4103/0974-7796.82181  PMID:21747605
Neonatal bladder rupture is rare as a complication of bladder obstruction due to abnormal anatomy or iatrogenic causes. The present study describes the case of a 3-day-old infant with ascites due to bladder perforation secondary probably to manual decompression of the bladder. The infant underwent successful surgical repair of the perforation.
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Knowledge about urology in the general population of Jeddah, Saudi Arabia
Ghassan A Barayan, Anmar M Nassir
May-August 2011, 3(2):82-86
DOI:10.4103/0974-7796.82174  PMID:21747598
Introduction : The knowledge of the general population about the medical specialties is not well studied in our community. Our aim is to explore the amount of knowledge known about urology by the general population. Materials and Methods : A questionnaire was completed by 154 respondents in Jeddah, Saudi Arabia. After measuring the amount of knowledge in our population, we looked forward to compare it with English as well as French speaking population in North America (NA). We translated to Arabic the same questionnaire used in their study. Two extra questions were added to further serve our aim. Results : Of the 154 respondents, 66% (102) said that they know little or nothing about urology, and 43% (66) did not know that urology involves surgery. When asked to mention three diseases within the field of urology, only 37% (57) were able to do so. Fourteen percent (21) were unable to mention even one disease. When asked about naming modalities of treatment in urology, 67% (104) were able to mention one or more. The rest were unable to mention even one modality. Most of the wrong answers were related to mixing urology with anatomically related fields rather than pronunciation similarity. Most of the results were better when compared to the studies done in NA. Conclusion : Although significant proportion of our population know little about the field of urology, the overall result is better when compared to North American population. The clarity of Arabic terminology related to the field may explain the difference.
  2,441 379 -
Urogenital fistulae: A prospective study of 50 cases at a tertiary care hospital, important issues missed
Onkar Singh, Shilpi Singh Gupta, Ankur Hastir
May-August 2011, 3(2):114-114
DOI:10.4103/0974-7796.82183  PMID:21747607
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Editorial Commentary
Hisham A Mosli
May-August 2011, 3(2):96-96
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May-August 2011, 3(2):61-61
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Editorial Comment
Khaled Madbouly
May-August 2011, 3(2):81-81
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