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   2014| January-March  | Volume 6 | Issue 1  
    Online since February 13, 2014

 
 
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ORIGINAL ARTICLES
False fracture of the penis: Different pathology but similar clinical presentation and management
Adel Kurkar, Ahmad A Elderwy, Elderwy Orabi
January-March 2014, 6(1):23-26
DOI:10.4103/0974-7796.127015  PMID:24669117
Introduction: Penile fracture is the most common presentation of acute penis. Rupture of the superficial dorsal penile vein (s) may mimic penile fractures with similar clinical presentation but with intact corporeal bodies. Our aim of the study is to highlight superficial dorsal penile vein (s) injury as true emergency with better prognosis. Subjects and Methods: Sixty-eight patients with suspected penile fractures presented to our hospital between June 2007 and January 2013. Out of these, 11 patients showed intact tunica albuginea on exploration with injured dorsal penile vein (s) identified. Records of such 11 cases were reviewed regarding age, etiology, symptoms, physical signs, findings of surgical exploration and post-operative erectile function. Results: All 11 patients were injured during sexual intercourse and presented with penile swelling and ecchymosis and gradual detumescence. Mild penile pain was encountered in 5 cases and the "snap" sound was noted in 2 cases. Examination revealed no localized tenderness, or tunical defect. All the patients regained penile potency without deformity after surgical ligation of the severed vessels. One patient developed penile hypoesthesia. Conclusion: Although the classic "snap" sound and immediate detumescence are usually lacking in the symptomology of dorsal penile vein rupture, its clinical presentation can be indistinguishable from true penile fracture. Surgical exploration is still required to avoid missing tunical tear with possible future complications. The long-term outcome and prognosis are excellent.
  34,294 631 -
CASE REPORTS
New compression mechanism in penile-scrotal lymphedema and sexual rehabilitation
Jose Maria Pereira de Godoy, Fernando Nestor Facio, Eleni Cássia Matias de Carvalho, Maria de Fatima Guerreiro Godoy
January-March 2014, 6(1):88-90
DOI:10.4103/0974-7796.127025  PMID:24669133
The objective of this study is to describe a new compression mechanism in the treatment of lymphedema of the penis and scrotum and the ensuing sexual rehabilitation. The patient, a 58-year-old man, had edema of the penile and scrotal region as a result of surgery of the pancreas and spleen and chemotherapy. The patient complained of pain, discomfort, and difficulties to walk and urinate. A clinical diagnosis of lymphedema of the penis and scrotum was reached. Treatment involved the continuous use of a cotton-polyester compression garment for the region together with thorough hygiene skin care. The swelling reduced significantly within a week to almost a normal aspect which was accompanied by clinical improvements of the symptoms. The reduction in penile edema allowed sexual rehabilitation even though erectile dysfunction required the use of a specific medication (sildenafil). In conclusion, simple and low-cost options can improve lymphedema of the penis and scrotum and allow sexual rehabilitation.
  16,114 581 -
Surgical reimplantation of penile glans amputation in children during circumcision
Bouassida Khaireddine, Hidoussi Adnen, Ben B Khaled, Slama Adel
January-March 2014, 6(1):85-87
DOI:10.4103/0974-7796.127024  PMID:24669132
Circumcision is one of the oldest and most commonly performed surgical procedures. Unfortunately, various complications may occur during circumcision, ranging from trivial to tragic such as penile amputation which is a serious complication and a challenging injury to treat. We describe two cases of non-microsurgical successful reattachment of a distal penile glans which were amputated during circumcision. In the first case, a 5-year-old child underwent circumcision by an urologist under local anesthesia. In the second one, a 3-year-old child underwent circumcision by a general practitioner who used to make circumcision. In this article, the literature is reviewed; results and potential complications of this surgery are also discussed. Glans sensation was present, early morning erection was maintained, and there was an erectile response during penile manipulation in both cases. Although circumcision is not technically difficult, it should be taken seriously. The use of microsurgical reattachment is not always possible, especially in pediatric cases; it also requires special equipment and training.
  9,135 362 -
REVIEW ARTICLES
The role of Ibn Sina (Avicenna)'s medical poem in the transmission of medical knowledge to medieval Europe
Rabie El-Said Abdel-Halim
January-March 2014, 6(1):1-12
DOI:10.4103/0974-7796.127010  PMID:24669114
The Medical Poem ("Al-Urjuzah Fi Al-Tibb") of Ibn Sina (Avicenna, 980-1037), is the subject of this primary-source study evaluating its scientific value, poetics and pedagogical significance as well as assessing its role in the transmission of medical knowledge to Medieval Europe. In addition to one original manuscript and two modern editions, the English translation by Krueger was also studied. Ibn Sina's poem on medicine consisting of meticulously classified 1326 verses, can be considered as a poetic summary of his encyclopedic textbook: The Canon of Medicine; hence its popularity in the East then the West as a tool in the process of transmitting medical knowledge from master to student. Since first translated by Gerard of Cremona (1114-1187) in the middle of the 12 th century, the Latinized poem was frequently published in Medieval Europe either independently or combined with the Latinized Canon of Medicine or with the Articella; the famous collection of Greco-Roman and Latinized Arabian medical treatises in use in the universities of Salerno, Montpelier, Bologna and Paris up to the 17 th century. The study of the Krueger's English edition revealed few places where the full meanings of the original Arabic text were not conveyed. A list of those places is given together with the suggested corrections.
  8,263 745 -
CASE REPORTS
Uncommon causes of anterior urethral diverticula in children: Two cases and review of literature
Grahame H. H. Smith, Aniruddh V Deshpande, Robert W. K. Tang
January-March 2014, 6(1):75-79
DOI:10.4103/0974-7796.127018  PMID:24669129
Anterior urethral diverticula are rare in children. Anterior urethral valves and associated diverticulum is the commonly discussed pathological entity in children. There is a lack of awareness among clinicians regarding less common presentations of anterior urethral diverticula in children; which can have a diverse involvement of the urinary tract. This report describes two uncommon presentations of anterior urethral diverticula in children, their diagnoses and management. A systematic differential diagnosis and review of anterior urethral diverticula in children is also presented.
  8,000 363 -
ORIGINAL ARTICLES
Wrong site surgery! How can we stop it?
Vishwanath Hanchanale, Amrith Raj Rao, H Motiwala, O. M. A Karim
January-March 2014, 6(1):57-62
DOI:10.4103/0974-7796.127031  PMID:24669124
Introduction: "Primum non nocere" (first do no harm): Hippocrates (c. 460 BC-377 BC). Wrong site surgery is the fourth commonest sentinel event after patient suicide, operative and post-operative complications, and medication errors. Misinterpretation of the clinic letters or radiology reports is the commonest reason for the wrong site being marked before surgery. Materials and Methods: We analyzed 50 cases each of operations carried out on the kidney, ureter, and the testis. The side mentioned on clinic letters, the consent form, and radiology reports lists were also studied. The results were analyzed in detail to determine where the potential pitfalls were likely to arise. Results: A total of 803 clinic letters from 150 cases were reviewed. The side of disease was not documented in 8.71% and five patients had the wrong side mentioned in one of their clinic letters. In the radiology reports, the side was not mentioned in three cases and it was reported wrongly in two patients. No wrong side was ever consented for and no wrong side surgery was performed. Conclusion: The side of surgery was not always indicated in clinic letter, theatre list, or the consent form despite the procedure being carried on a bilateral organ. As misinterpretation is a major cause of wrong side surgery, it is prudent that the side is mentioned every time in every clinic letter, consent form, and on the theatre list. The WHO surgical safety checklist has already been very effective in minimizing the wrong site surgery in the National Health Service.
  4,953 713 -
REVIEW ARTICLES
Current practices in fertility preservation in male cancer patients
E Charles Osterberg, Ranjith Ramasamy, Puneet Masson, Robert E Brannigan
January-March 2014, 6(1):13-17
DOI:10.4103/0974-7796.127008  PMID:24669115
The incidence of a cancer diagnosis in children and young adolescents is increasing. With better treatments, the number of young cancer survivors living through reproductive age is increasing. Fertility preservation of these men and women has become essential and needs to be discussed prior to the start of cancer treatment. Here we review the current guidelines for male oncofertility patients and highlight some of the important gonadotoxic effects of chemotherapy, radiotherapy and surgery. Options for fertility preservation are also discussed along with resources that should be made available to all patients.
  3,217 639 -
CASE REPORTS
A case of polypoid and papillary cystitis mimicking an advanced bladder carcinoma with invasion of perivesical fat
Kumi Ozaki, Kiyohide Kitagawa, Toshifumi Gabata, Osamu Matsui
January-March 2014, 6(1):72-74
DOI:10.4103/0974-7796.127016  PMID:24669128
A rare case of polypoid and papillary cystitis without a history of catheterization is reported. A 69-year-old man was admitted to our hospital because of pain during urination and gross hematuria. The cystscopic and imaging findings including ultrasound, CT, and MR image showed an irregular wall thickening and stranding in the perivesical fat, which indicated an advanced bladder carcinoma, but histopathological findings obtained by transurethral resection revealed polypoid and papillary cystitis. Such benign lesions need to be discussed in the differential diagnosis of patients with bladder tumor to avoid excessive resection.
  3,248 273 -
ORIGINAL ARTICLES
Palliative chemotherapy in carcinoma penis: Does platinum and taxane combination holds a promise?
Vijay M Patil, Vanita Noronha, Amit Joshi, Vamshi Muddu, Bharat Bhosale, Ganesh Bakshi, Kumar Prabhash
January-March 2014, 6(1):18-22
DOI:10.4103/0974-7796.127011  PMID:24669116
Aim: To report safety and efficacy of chemotherapy incorporating the combination of paclitaxel and platinum in patients with advanced penile carcinoma. Materials and Methods: Retrospective analysis of patient with advanced penile carcinoma undergoing palliative chemotherapy with paclitaxel and platinum combination. The demographic profile, indication of treatment, chemotherapy details, toxicity and survival outcome were noted. Statistical analysis was done for estimation of progression free survival and overall survival. Factors affecting these outcomes were sought for. Results: Eighteen patients with a median age of 47.5 years (31-68 years) were offered palliative intent chemotherapy over a period of 2.5 years. ECOG performance was 1 in 12 patients (66.7%) and 2 in 6 patients (33.3%).The grade of tumor was poorly differentiated in 8 patients (44.4%), moderately differentiated in 5 (27.8%) and we1l differentiated in 5 patients (27.8%). Twelve patients had previous surgical treatment (66.7%), with 2 of them having received groin radiation in past. The indication for treatment was metastatic disease in 7 patients (38.9%) and locally advanced disease in 11 patients (61.1%). Out of 18 patients 13 received chemotherapy. Paclitaxel and carboplatin combination was given in 10 patients (76.9%) while paclitaxel and cisplatin was received by 3 patients (23.1%). The median numbers of cycles received were 3 (1-6 cycles). Response rate was 30.8%. The median estimated progression free survival (PFS) and overall survival (OS) for patients receiving atleast one cycle of chemotherapy (n = 13) were 96 days and 246 days respectively. Among tested variables the median OS in patients who had received 2 or more cycles was 351 days versus 55 days in those who received less than 2 cycles (P = 0.025). However, after applying Bonferroni correction, the difference was no longer significant. There was no toxicity related death or life threatening complication. Conclusion: Our institutional protocol of platinum-based doublet with paclitaxel is effective, well-tolerated and has the advantage being delivered on an outpatient basis alone. Overall, we believe that paclitaxel-platinum is an effective regimen that needs to be investigated further in larger studies.
  3,100 329 -
Antenatal diagnosis, prevalence and outcome of congenital anomalies of the kidney and urinary tract in Saudi Arabia
Nabeel S Bondagji
January-March 2014, 6(1):36-40
DOI:10.4103/0974-7796.127021  PMID:24669120
Objective: To study the prevalence, pattern of distribution, and the outcome of different types of kidney and urinary tract anomalies (CAKUT) diagnosed during the antenatal period. The second objective is to test the accuracy of antenatal diagnosis of CAKUT. Materials and Methods: In a cross-sectional hospital-based study, all cases diagnosed antenatally with urinary tract anomalies at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia, were studied. The prevalence, pattern of distribution, and immediate postnatal outcomes, in addition to the accuracy of antenatal diagnosis, of those cases are reported. Results: One hundred and forty-one cases of urinary tract anomalies were antenatally diagnosed; postnatal diagnosis was confirmed in 128 cases (90.1%). The prevalence of CAKUT in our population is 3.26 per 1000 births. The most common abnormalities detected were hydronephrosis, polycystic kidney disease, multicystic dysplastic kidney, and renal agenesis, in descending order of frequency. The perinatal mortality rate among fetuses with CAKUT is 310 per 1000, the majority of these cases (90%) occurred in cases with renal parenchyma involvement. Conclusions: The prevalence of different types of CAKUT is higher than that reported in developed countries. Urinary tract anomalies can be accurately diagnosed and classified in the antenatal period using ultrasonography imaging. Antenatal diagnosis is a helpful tool in planning immediate postnatal care and deciding the place for delivery. This might prevent or slow renal function deterioration and help in early identification of patients who need early surgical intervention.
  2,687 574 -
Clinical predictors of nocturia in the sleep apnea population
Omer A Raheem, Ryan K Orosco, Terence M Davidson, Charles Lakin
January-March 2014, 6(1):31-35
DOI:10.4103/0974-7796.127019  PMID:24669119
Objectives: This study aims to evaluate clinical predictors of nocturia in patients with obstructive sleep apnea (OSA). Materials and Methods: In retrospective manner, a total of 200 patients with OSA were randomly included. Group I contained 100 patients with OSA and no nocturia, and Group II included 100 patients with OSA and nocturia. Bivariate logistic analyses were used to identify variables most likely to contribute to nocturia. Multivariate logistic regression of age, waist circumference, STOP score (Snore, Tired, Obstruction and Pressure), and Apnea-Hypopnea Index (AHI) was performed to evaluate predictors of nocturia. Statistical significance was defined as P0 < 0.05. Results: Median nocturia episodes were 2.2 in Group II. Patients were younger in Group I, with a mean age of 45 vs 50 years (P = 0.008). Mean BMI of 30 was similar in both groups, but there were more overweight patients in Group II (28% vs 18%). AHI approached significance between groups-18 vs 23 in group I and II, respectively (P = 0.071). In multivariate analysis, age over 70 years and moderate AHI were statistically significant predictors of nocturia (coefficients 0.6 and -0.2 with P = 0.003 and 0.03, respectively). Conclusions: This study identifies age and AHI score as predictors of nocturia in patients with OSA. This may indicate the usefulness of incorporating nocturia in the screening of patients with OSA. Future studies are needed to further evaluate mechanism of action, clinical significance, and effect of treatment for nocturia in patients with OSA.
  2,396 377 -
An evaluation of the efficacy of different doses of ketamine for treatment of catheter-related bladder discomfort in patients underwent urologic surgery: A prospective, randomized, placebo-controlled, double-blind study
Mohammadreza Safavi, Azim Honarmand, Mohammadali Atari, Shirin Chehrodi, Mahsa Amoushahi
January-March 2014, 6(1):51-56
DOI:10.4103/0974-7796.127030  PMID:24669123
Background: Urinary catheterization might have catheter-related bladder discomfort (CRBD). We evaluated the efficacy of different doses of ketamine in comparison to placebo as a treatment of CRBD. Materials and Methods: One hundred twenty patients who were candidate for urological surgery requiring catheterization of the urinary bladder were randomly divided into four groups including 30 patients in each. Group I received normal saline, Group II received ketamine 150 μg/kg/iv, Group III received ketamine 200 μg/kg/iv, and Group IV received 250 μg/kg/iv in the equal volume of 2 mL. The patients were observed for each 15 min in the recovery room and in the 1 h, 2 h, 6 h, 12 h, and 24 h after discharging from it for severity of CRBD and pain, levels of sedation, and post-operative nausea and vomiting. Results: The severity of CRBD at the recovery room was significantly reduced in Group III and Group IV after 24 h compared with Group I and Group II ( P < 0.05). There was no significant difference between Group III and Group IV in this respect. The median sedation level was significantly lower in 15 min and 30 min after arrival to the recovery in Group III and Group IV compared with Group I and Group II ( P < 0.05). There was no significant difference between Group III and Group IV in this regard. Conclusions: Ketamine 200 μg/kg/iv had similar efficacy with ketamine 250 μg/kg/iv in reducing the severity of CRBD without occurring significant side effect.
  2,303 437 -
The protective effects of pomegranate extracts against renal ischemia-reperfusion injury in male rats
Ahmet A Sancaktutar, Mehmet N Bodakci, Namık K Hatipoglu, Haluk Soylemez, Kemal Basarılı, Gul Turkcu
January-March 2014, 6(1):46-50
DOI:10.4103/0974-7796.127029  PMID:24669122
Aim: To evaluate the possible protective effect of pomegranate extract (PE) on rats following renal ischemia-reperfusion (I/R) injury. Materials and Methods: Twenty-four Wistar rats were divided into three groups. Sham group underwent laparotomy then waited for 45 minutes without ischemia. I/R group were subjected to left renal ischemia for 45 minutes followed by 60 minutes of reperfusion. I/R + PE group were subjected to the same renal I/R as the I/R group were also given 225 mg/kg PE peroral 30 minutes prior to the ischemia. Malondialdehyde (MDA), total antioxidant capacity (TAC), total oxidant status (TOS), and oxidative stress index (OSI) were determined on the blood samples and kidney tissues. Histopathological analyses were conducted on the kidney tissues. Results: Serum TAC levels were significantly decreased in I/R group when compared with S group (P = 0.001). Serum MDA levels were increased in I/R group; however, it was not statistically significant. In rat kidney tissues, TOS levels and OSI index were significantly increased after I/R injury, while TAC levels were decreased. In I/R + PE group, PE reversed the negative effects of I/R injury. PE pretreatment was effective in decreasing tubular necrosis score. Conclusion: PE pretreatment ameliorated the oxidative damage and histopathological changes occurring following renal I/R injury.
  2,429 303 1
A single-center study examining the outcomes of percutaneous epididymal sperm aspiration in the treatment of obstructive azoospermia
Jason R Kovac, Kyle J Lehmann, Marc Anthony Fischer
January-March 2014, 6(1):41-45
DOI:10.4103/0974-7796.127026  PMID:24669121
Introduction: Obstructive azoospermia (OA) is characterized by normal spermatogenesis and the absence of sperm in the ejaculate. Variable success rates have been reported using in-vitro fertilization (IVF) combined with PESA in cases of men with OA. Aims: To determine fertilization and pregnancy outcomes from PESA-derived spermatozoa and to ascertain whether frozen spermatozoa yields similar outcomes compared to fresh specimens. Materials and Methods: The charts of 68 consecutive couples undergoing 68 cycles of sperm retrieval for OA over eight years (2002-2010) were retrospectively reviewed. Patients requiring testicular intervention were excluded ( n = 17). Results: Viable sperms were identified in 100% of men, and fresh spermatozoa were obtained in 40 patients (78.4%) simultaneously with female egg retrieval. The average fertilization rate was 77.7% with five embryos not surviving to transfer (12.5%). Pregnancies were confirmed in 48.6% (17/35). Twin gestations occurred in 11.8% (2/17) of cases. Frozen-thawed spermatozoa were used in 11 patients (21.6%). In this subgroup, the average fertilization rate was 73.6% with pregnancies confirmed in 54.5% (6/11). No multiple gestations were generated, and no complications occurred. The use of fresh spermatozoa for PESA provided no significant improvements in outcomes over frozen specimens. Summary: PESA is a very effective, simple, and safe method of obtaining spermatozoa for IVF. Outcomes obtained using fresh and frozen PESA-derived spermatozoa were similar and as such, either could be used during the IVF process.
  2,120 290 -
CASE REPORTS
Retrovesical hydatid cyst presenting with urinary retention and left kidney atrophy
Rami Nasr, George A Saad, Mohammed Shahait, Nazih Khater
January-March 2014, 6(1):68-70
DOI:10.4103/0974-7796.127013  PMID:24669126
Background: Hydatid disease of the urinary tract is uncommon, accounting for only 2-3% of cases. There are very few reported cases in the literature of pelvic hydatid cysts causing obstructive uropathy and renal failure. Materials and Methods: We report a case of pelvic hydatid cyst in a patient presenting with urinary retention and secondary complete atrophy of one kidney. Results: The patient was treated with surgical excision of this large retrovesical cyst, along with a simple left nephroureterectomy, with rapid improvement of symptoms. Conclusion: Hydatid disease should be taken into consideration in the differential diagnosis of a cystic mass in any anatomic localization, especially in patients from endemic areas.
  2,020 292 -
Botryoid-type of embryonal rhabdomyosarcoma of renal pelvis in a young woman
A Kaabneh, Ch. Lang, R Eichel, W Arafat, Sch. Alloussi
January-March 2014, 6(1):81-84
DOI:10.4103/0974-7796.127023  PMID:24669131
A 22-year-old woman presented with three weeks history of intermittent left loin pain, on radiological evaluation by U\S and MRI revealed left renal pelvic mass, ureterorenoscopy and biopsy taken, but couldn't reveal definitive diagnosis other than presence of a malignant process. Left nephroureterctomy was performed. Grossly there is a polypoid mass attached to the upper pole of the kidney by stalk. Light microscopic examination and immunohistochemical staining confirm a diagnosis of Botryoid-type of embryonal rhabdomyosarcoma. Treatment and follow up to 1 year is mentioned. Reviewing the literature the presented case is the second of this tumor in adult renal pelvis.
  1,989 293 -
ORIGINAL ARTICLES
Status of Her2 over expression in muscle invasive urothelial bladder carcinoma: Report of 21 cases
Nesrine Mejri, Rym Sellami, Charfi Lamia, Doghri Raoudha, Naziha B Hmida, Badreddine Sriha, Hmissa Sihem, Mrad Karima, Khaled B Romdhane
January-March 2014, 6(1):63-67
DOI:10.4103/0974-7796.127033  PMID:24669125
Background: Invasive urothelial bladder carcinomas have a poor prognosis even with cystectomy and chemotherapy. A high number of these patients have Her2 overexpression. The goal of this study is to assess the Her2 status in muscle invasive urothelial bladder carcinoma, to evaluation heterogeneity and discordance with metastases. Patients and Methods: We retrospectively analyzed 21 specimens of transurethral resection or cystectomy in patients with invasive urothelial bladder carcinoma. We selected one representative section from primary tumors and metastases for immunohistochemistry analysis. Staining was evaluated according to the same criteria of breast cancer. A chromogenic in situ hybridization (CISH) was performed in case of 2+ score or in heterogeneous samples. Results: Median age of our patients was 62 years. Intratumoral heterogeneity was observed in 2 cases (less than 1%). One case showed a Her2 3+ score (high grade, pT2 stage) and 3 cases showed a 2+ score (all low grades, stage T2, T4, M1, respectively). Two metastatic lymph nodes scored 1+ for the first (primary 1+) and 2+ for the second (primary 1+). Two cases showed CISH gene amplification. The first one scored 2+ and had area of 3+ score. The second one scored 1+ and had area with 2+ score. Four patients died from disease, one of them had Her2 3+ score. Conclusion: Her2 overexpression can be observed in muscle invasive urothelial bladder carcinoma in an important number of patients. Evaluation criteria must be standardized, especially with heterogeneous cases. Metastases tests can also readdress the expression of Her2, which gives the patient a supplementary therapeutic tool.
  1,857 372 -
CASE REPORTS
Percutaneous nephroscopic resection of pyelocaliceal transitional cell carcinoma in solitary kidney
Bo Yang, Weibing Sun
January-March 2014, 6(1):91-93
DOI:10.4103/0974-7796.127027  PMID:24669134
Percutaneous approaches to upper tract urothelial cancers have been performed in patients unsuitable for radical nephroureterectomy. We present two cases of transitional cell carcinoma involving the renal pelvis in either functional or anatomical solitary kidney, which were successfully treated by percutaneous nephroscopic resection using monopolar electrocautery.
  1,973 227 -
ORIGINAL ARTICLES
Predictors of viable germ cell tumor in postchemotherapeutic residual retroperitoneal masses
Khalid Al Othman, Naif Al Hathal, Alaa Mokhtar
January-March 2014, 6(1):27-30
DOI:10.4103/0974-7796.127017  PMID:24669118
Objective: The aim of this study was to identify predictors of viable germ cell tumor (GCT) in postchemotherapeutic residual retroperitoneal masses. Materials and Methods: The pertinent clinical and pathologic data of 16 male patients who underwent postchemotherapeutic retroperitoneal lymph node dissection (PC-RPLND) at King Faisal Specialist Hospital and Research Centre between 1994 and 2005 were reviewed retrospectively. It was found that all patients received cisplatin-based chemotherapy for advanced testicular GCT. Results: Out of the 16 male patients, 2 (13%), 8 (50%), and 6 (37%) had viable GCT, fibrosis, and teratoma, respectively. Ten (10) of the patients with prechemotherapeutic S1 tumor markers did not have viable GCT, and two of the six patients who had prechemotherapeutic S2 tumor markers have viable GCT. All tumor marker levels normalized after chemotherapy even in patients with viable GCT. Four patients had vascular invasion without viable GCT. Furthermore, four patients had more than 60% embryonal elements in the original pathology, but only 1 had viable GCT at PC-RPLND. Four of the five patients with immature teratoma had teratoma at PC-RPLND but no viable GCT; however, out of the four patients with mature teratoma, one had viable GCT and two had teratoma at PC-RPLND. Of the two patients with viable GCT, one had 100% embryonal cancer in the original pathology, prechemotherapeutic S2 tumor markers, history of orchiopexy, and no vascular invasion; the other patient had yolk sac tumor with 25% embryonal elements and 40% teratoma in the original pathology, and prechemotherapeutic S2 tumor markers. Conclusion: None of the clinical or pathological parameters showed a strong correlation with the presence of viable GCT in PC-RPLND. However, patients with ≥S2 may be at higher risk to have viable GCT. Further studies are needed to clarify this.
  1,819 301 -
CASE REPORTS
Isolated ureteric endometriosis presenting as a ureteric tumor
Raouf Seyam, Alaa Mokhtar, Waleed Al Taweel, Ahmed Al Sayyah, Asma Tulbah, Waleed Al Khudair
January-March 2014, 6(1):94-97
DOI:10.4103/0974-7796.127035  PMID:24669135
A 32 year old lady presented with recurrent left flank pain for 4 weeks and chronic lower back pain. CT without contrast showed no stones and mild left hydronephrosis. CT of the spine suggested an inflammatory process at L5-S1 vertebra. The diagnosis was supported by a bone scan. Incidentally, the scan showed nonfunctioning left kidney. Diuretic renography confirmed poor perfusion and no excretion. A retrograde study showed narrowing of the ureter at the pelvic brim. Ureteroscopy showed a papillary mass in the lumen of the ureter from which multiple cold cup biopsies were taken. The pathology however was not conclusive. A robotic nephroureterectomy was carried out. Definitive pathology showed intrinsic endometriosis of the ureter. We conclude that endometriosis should be considered in the differential diagnosis of unexplained ureteric obstruction and ureteric lumen filling defects in young women.
  1,816 275 -
LETTER TO EDITOR
Robot assisted laparoscopic retroperitoneal lymph node dissection in testicular tumor
Cesar E Ercole, Maria Carmen Mir, Riccardo Autorino, Jihad H Kaouk
January-March 2014, 6(1):99-99
DOI:10.4103/0974-7796.127037  PMID:24669137
  1,640 229 -
COMMENTARY
Two rare pathologies of male urethra in children
Serdar Moralioglu
January-March 2014, 6(1):79-80
PMID:24669130
  1,323 188 -
Interposition flaps in vesicovaginal fistula repairs can optimize cure rate
Ayman Mahdy
January-March 2014, 6(1):98-98
  1,124 175 -
Retrovesical hydatid cyst presenting with urinary retention and left kidney atrophy
Sivasubramanian Srinivasan
January-March 2014, 6(1):70-71
  1,121 169 -
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