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   2015| April-June  | Volume 7 | Issue 2  
    Online since March 11, 2015

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A randomized, double-blind, placebo-controlled, crossover trial of "on-demand" tramadol for treatment of premature ejaculation
Adel Kurkar, Ahmad A Elderwy, Sherief Abulsorour, Sara M Awad, Ahmed S Safwat, Ahmed Altaher
April-June 2015, 7(2):205-210
DOI:10.4103/0974-7796.150481  PMID:25835132
Objectives: The objective of this study is to assess the dose-related effects of tramadol on a group of patients with premature ejaculation (PE). Subjects and Methods: During the period of months between June 2010 and July 2012, 180 PE patients presented to outpatient clinic of our hospital. Patients were randomized in a 1:1:1 fashion to receive different sequences of the three medications: placebo, 50 mg of tramadol and 100 mg of tramadol. Every patient received 10 doses of each medication for 2 months. Intra-vaginal ejaculatory latency time (IELT) was recorded in seconds initially and for each arm. Successful treatment of PE is defined if IELT exceeded 120 s. Side-effects of medications were reported. Results: Of patients enrolled, 125 (69.4%) continued the study. Patients' age range was 20-55 years with PE complaint of 1 to 10 years duration. Mean IELT was 72 at presentation, 82 for placebo, 150 for tramadol 50 mg, and 272 for tramadol 100 mg (P < 0.001 for all comparisons). PE was successfully treated in only 2.4% of patients with placebo, in contrast to 53.6% and 85.6% with 50 and 100 mg tramadol, respectively (P < 0.001 for all comparisons). On multivariate logistic regression analysis, baseline IELT was the only predictor of successful treatment of PE with both tramadol 50 mg (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.03-1.07, P < 0.001) and tramadol 100 mg (OR: 1.07, 95% CI: 1.04-1.11, P < 0.001). Postmicturition dribble annoyed 12.8% of those who received 50 mg tramadol and 33.6% of those who received 100 mg tramadol (P < 0.001). Weak scanty ejaculation was the main complaint in 7.2% versus 21.6% of those using 50 and 100 mg tramadol, respectively (P = 0.002). Two patients discontinued tramadol 100 mg due to side-effects. Conclusion: Tramadol hydrochloride exhibits a significant dose-related efficacy and side-effects over placebo for treatment of PE.
  12,370 676 -
Scroto-perineal hidradenitis suppurativa complicated by giant scrotal elephantiasis
Badr Alharbi, Ahmed Shlash, Khaled Bedaiwi, Qais Al Hooti, Abdulrahman Almohaisen, Saud Shlash, Mohammad Said
April-June 2015, 7(2):265-267
DOI:10.4103/0974-7796.152945  PMID:25837812
Scrotal elephantiasis has been a recognized complication of inguinal node irradiation, filarial infection, tumor involvement and surgical lymphatic destruction, but has rarely been reported in association with hidradenitis suppurativa (HS). HS, also known as acne inversa, is a chronic and often debilitating disease primarily affecting the axillae, inframammary regions and perineum. The location of the lesions may lead to social embarrassment and failure to seek medical treatment. Scroto-preineal HS complicated by scrotal elephantiasis is a distressing disease. Excisional surgery with reconstruction is the recommended treatment with a high likelihood of good outcome. We present a 38-year-old male patient with long-standing scroto-perineal HS complicated by giant scrotal elephantiasis.
  9,748 327 -
Mini percutaneous nephrolithotomy in the treatment of renal and upper ureteral stones: Lessons learned from a review of the literature
Nikolaos Ferakis, Marios Stavropoulos
April-June 2015, 7(2):141-148
DOI:10.4103/0974-7796.152927  PMID:25837662
The aim of this review is to present the most recent data regarding the indications of mini percutaneous nephrolithotomy (PCNL), the results and the complications of the method. Medline was searched from 1997 to January 2014, restricted to English language. The Medline search used a strategy including medical subject headings and free-text protocols. PCNL is a well-established treatment option for patients with large and complex renal calculi. In order to decrease morbidity associated with larger instruments like blood loss, postoperative pain and potential renal damage, a modification of the technique of standard PCNL has been developed. This is performed with a miniature endoscope via a small percutaneous tract (11-20 F) and was named as minimally invasive or mini-PCNL. This method was initially described as an alternative percutaneous approach to large renal stones in a pediatric patient population. Furthermore, it has become a treatment option for adults as well, and it is used as a treatment for calculi of various sizes and locations. However, the terminology has not been standardized yet, and the procedure lacks a clear definition. Nevertheless, mini-PCNL can achieve comparable stone-free rates to the conventional method, even for large stones. It is a safe procedure, and no major complications are reported. Although less invasiveness has not been clearly demonstrated so far, mini-PCNL is usually related to less blood loss and shorter hospital stay than the standard method.
  6,492 1,010 -
Role of steroidal anti-inflammatory agent prior to intracorporeal lithotripsy under local anesthesia for ureterovesical junction calculus: A prospective randomized controlled study
Bijit Lodh, Kaku Akoijam Singh, Rajendra Singh Sinam
April-June 2015, 7(2):188-192
DOI:10.4103/0974-7796.150477  PMID:25835035
Objective: The objective of the following study is to assess the effect of steroidal anti-inflammatory agent on the outcome of ureterorenoscopic lithotripsy (URSL) for ureterovesical junction (UVJ) calculus. Settings and Design: This was a prospective randomized controlled study conducted at the Department of Urology, Regional Institute of Medical Sciences, Imphal. Subjects and Methods: One hundred and twenty-six patients requiring ureteroscopic lithotripsy for UVJ calculus were randomly assigned into two groups. The study group received tablet deflazacort 30 mg once a day for 10 days prior to the procedure, whereas the control group did not receive such treatment. Parameters with respect to the outcome of the procedure were recorded for all patients in both groups. Statistical Analysis Used: Fisher's exact and independent t-test was used to compare the outcome between the groups where P < 0.05 was considered to be statistically significant. Results: There was significant statistical difference (P - 0.016) on the endoscopic appearance of the region of ureteric orifice in patients receiving steroidal anti-inflammatory agent compared with control. Severe procedure related pain and mean operative time was less in the study group compared to control (P - 0.020 and 0.031, respectively). Re-treatment rates in the study group were lower than the control group (4.76% vs. 17.46%) and found to be statistically significant (P - 0.044). It is found that computed tomography (CT) appearance (r - 0.399) and stone size (r - 0.410) strongly correlate with the endoscopic findings of the region of UVJ (P - 0.001). Conclusions: Inflamed and or obliterated ureteric orifice is the major constraints for stone clearance at ureterovesical junction. The present study showed the administration of tablet deflazacort (a steroidal anti-inflammatory agent) significantly improves the outcome of URSL under local anesthesia. We strongly recommend its use prior to URSL for UVJ calculus, especially for stone size ≥10.24 mm and on CT evidence of prominent soft tissue swelling at the UVJ.
  7,229 227 -
Fibroepithelial vaginal polyp in a newborn
Abdulhakim A Alotay, Osama Sarhan, Mustafa Alghanbar, Ziyad Nakshabandi
April-June 2015, 7(2):277-278
DOI:10.4103/0974-7796.152952  PMID:25835034
A fibroepithelial polyp of the vagina (FEPV) is a mucosal polypoid lesion with a connective tissue core covered by a benign squamous epithelium. A vaginal polyp must be considered in the evaluation of interlabial masses in prepubertal girls. This article describes a newborn girl with an interlabial mass that the histological analysis revealed to be an FEPV. Surgical excision of the mass was performed, and the patient has not experienced recurrence after 1-year of follow-up. A review of the literature revealed that our case was the third reported case of a fibroepithelial polyp in a neonate.
  6,673 261 -
Comparison of dynamic contrast-enhanced and diffusion weighted magnetic resonance image in staging and grading of carcinoma bladder with histopathological correlation
Neetika Gupta, Binit Sureka, Mittal Mahesh Kumar, Amita Malik, Thukral Brij Bhushan, NK Mohanty
April-June 2015, 7(2):199-204
DOI:10.4103/0974-7796.150480  PMID:25835087
Background: Bladder cancer is the second most common neoplasm of the urinary tract worldwide. Dynamic contrast-enhanced and diffusion-weighted MRI has been introduced in clinical MRI protocols of bladder cancer because of its accuracy in staging and grading. Aim: To evaluate and compare accuracy of Dynamic contrast enhanced (DCE) and Diffusion weighted (DW) MRI for preoperative T staging of urinary bladder cancer and find correlation between apparent diffusion coefficient (ADC) and maximum enhancement with histological grade. Materials and Methods: Sixty patients with bladder cancer were included in study. All patients underwent Magnetic Resonance Imaging (MRI) on a 1.5-T scanner with a phased-array pelvic coil. MR images were evaluated and assigned a stage which was compared with the histolopathological staging. ADC value and maximum enhancement curve were used based on previous studies. Subsequently histological grade was compared with MR characteristics. Results: The extent of agreement between the radiologic staging and histopathological staging was relatively greater with the DW-MRI (κ=0.669) than DCE-MRI (κ=0.619). The sensitivity, specificity, and accuracy are maximum and similar for stage T4 tumors in both DCEMRI (100.0, 96.2 and 96.7) and DW-MRI (100.0, 96.2 and 96.7) while minimum for stage T2 tumors - DCEMRI (83.3, 72.2, and 76.7) and DWI-MRI (91.7, 72.2, and 80). Conclusion: MRI is an effective tool for determining T stage and histological grade of urinary bladder cancers. Stage T2a and T2b can be differentiated only by DCE-MRI. Results were more accurate when both ADC and DCE-MRI were used together and hence a combined approach is suggested.
  5,232 495 -
The Qur'ān and the development of rational thinking
Thoraya E Abdel-Maguid, Rabie E Abdel-Halim
April-June 2015, 7(2):135-140
DOI:10.4103/0974-7796.152926  PMID:25837451
In this study, the means utilized by the Qur'ān in actualizing the possibilities of all intellect to face the problem of blind imitation of ancestors were elaborated. Rationality as meant by the Qur'ān and embodied in its unique style is presented. Furthermore, the Qur'ānic documentation of the role of practical demonstration on the individual's mind as well as the societies' collective mind is pointed out. In addition, the study shows how the Qur'ān guides people to the proper use of reason within a scientific framework of mind.
  5,119 508 -
Knowledge and attitude of the population toward cancer prostate Riyadh, Saudi Arabia
Mostafa A Arafa, Karim H Farhat, Danny M Rabah
April-June 2015, 7(2):154-158
DOI:10.4103/0974-7796.150516  PMID:25837827
Aims: The aim of the following study is to assess the knowledge and attitude of men, in our region, regarding cancer prostate and its screening practices. Subjects and Methods: The field work was conducted in Riyadh City, during the period February through July 2011. It was a population - based cross-sectional study comprising 400 men over 40 years. In addition to socio-demographic data, history of the present and past medical illness, history of prostatic diseases and examination, family history of cancer prostate; participants were inquired about their knowledge and attitude toward prostate cancer (PC) and screening behavior using through two different Likert scales. Results: Only 10% of the respondents had practiced a regular PC examination checkup. Their knowledge about PC was poor and their attitude toward examination and screening was fair, where the mean of total correct knowledge score was 10.25 ± 2.5 (51.25%), while the mean of total attitude score was 18.3 ± 4.08 (65.3%). The respondents identified the physicians as the main sources of this information (62.4%), though they were not the main motives for a regular checkup. Knowledge represented the only significant predictor for participants' attitude. Conclusion: Beliefs and attitudes have a great impact, at every stage of the cancer continuum, this attitudes depends mainly on level of knowledge and quantity of information provided to patients and their families. Such attitudes should rely on a solid background of proper information and motivation from physicians to enhance and empower attitudes toward PC screening behavior.
  5,041 402 -
Angiosarcoma of penis: Case report of an aggressive penile cancer
Vinod Priyadarshi, Hemant Kumar Goel, Debashish Chakrabarty, Dilip Kumar Pal
April-June 2015, 7(2):251-253
DOI:10.4103/0974-7796.150497  PMID:25837261
Angiosarcoma is a very rare mesenchymal tumor of penis. Though extremely unusual, it should be considered in the differential diagnosis in patients presenting with a penile growth or a localized subcutaneous penile lesions as they are very aggressive and there is a high chance of recurrence. One such case is reported here, which was aggressively treated with total penectomy and the patient did not show any recurrence in 2 years of follow-up.
  5,131 267 -
Laparoscopic management of recurrent ureteropelvic junction obstruction following pyeloplasty
George P Abraham, Avinash T Siddaiah, Krishnamohan Ramaswami, Datson George, Krishanu Das
April-June 2015, 7(2):183-187
DOI:10.4103/0974-7796.150489  PMID:25834982
Objective: The aim was to analyze the operative, postoperative and functional outcome of laparoscopic management of previously failed pyeloplasty and to compare operative and postoperative outcome with laparoscopic pyeloplasty for primary ureteropelvic junction obstruction (UPJO). Materials and Methods: All patients who underwent laparoscopic management for previously failed dismembered pyeloplasty were analyzed in this study. Detailed clinical and imaging evaluation was performed. Transperitoneal approach was followed to repair the recurrent UPJO. Operative, postoperative, and follow-up functional details were recorded. Operative and postoperative outcomes of laparoscopic redo pyeloplasty were compared with that of laparoscopic primary pyeloplasty. Results: A total of 16 patients were managed with laparoscopic approach for previously failed pyeloplasty. Primary surgical approach for dismembered pyeloplasty was open in 11, laparoscopy in four patients and robotic assisted in one patient. Fifteen were treated with redo pyeloplasty and one with ureterocalicostomy. Mean operative time was 191.25 ± 24.99 min, mean duration of hospital stay was 3.2 ± 0.45 days and mean follow-up duration was 29.9 ± 18.5 months with success rate of 93.3%. Operative time was significantly prolonged with redo pyeloplasty group compared with primary pyeloplasty group (191.25 ± 24.99 vs. 145 ± 22.89, P = 0.0001). Conclusion: Laparoscopic redo pyeloplasty is a viable option with a satisfactory outcome and less morbidity.
  4,989 404 -
Laparoscopic retroperitoneoscopic nephrectomy and partial nephrectomy in children
Hamdan H Al-Hazmi, Hamzeh M Farraj
April-June 2015, 7(2):149-153
DOI:10.4103/0974-7796.150493  PMID:25837722
Objectives: The aim was to evaluate our experience in the retroperitoneal laparoscopic approach in total and partial nephrectomies in children. Materials and Methods: We retrospectively reviewed the medical records of 41 patients who underwent retroperitoneal laparoscopic total or partial nephrectomies performed in our center from 2004 to 2012. We looked at the demographic data, age at surgery, indication, operative time, surgical complications, conversion to open surgery and operative complications. Results: Thirty-five total and six partial nephrectomies (upper pole) were performed. The mean age was 84 months (7-175). Vesicoureteric reflux, pelviureteric junction obstruction, and multicystic dysplastic kidney disease were the main underlying pathologies. The mean operative time was 158 min (60-280). There were no intraoperative complications (surgical and anesthetic), and no significant blood loss was observed. Conversion to open surgery was necessary in two cases caused by failure to progress due to difficult anatomy during the partial nephrectomies. No major postoperative complications were noted. The mean hospital stay was 2.5 days (1-5). A drain was used in 12 cases and was removed after a mean of 2 days. Conclusions: Laparoscopic retroperitoneoscopic renal surgery can be carried out safely and effectively in children. Still, this procedure is more challenging and requires an excellent image of the retroperitoneal space, especially when partial nephrectomies are concerned.
  4,917 325 -
Hidden penile fracture: An unusual presentation and review of literature
Sagar Sabharwal, Arun Jacob Philip George, J Chandra Singh
April-June 2015, 7(2):248-250
DOI:10.4103/0974-7796.150495  PMID:25836974
Penile fractures, a not so uncommon urological emergency, mostly present with a characteristic history and physical examination. Here, we present an atypical case where even in the absence of physical findings, a characteristic history led us to penile exploration and timely repair, highlighting the importance of careful history-taking in these cases.
  4,492 351 -
Minimally invasive surgical approach to treat posterior urethral diverticulum
Ossamah Alsowayan, Fayez Almodhen, Ahmed Alshammari
April-June 2015, 7(2):273-276
DOI:10.4103/0974-7796.152950  PMID:25834967
Urethral diverticulum is a localized saccular or fusiform out-pouching of the urethra. It may occur at any point along the urethra in both male and females. Male urethral diverticulum is rare, and could be either congenital or acquired, anterior or posterior. The mainstay treatment of posterior urethral diverticulum (PUD) is the open surgical approach. Here we discuss our minimally invasive surgical approach (MIS) in managing posterior urethral diverticulum.
  4,569 250 -
Posterior urethral valve with unilateral vesicoureteral reflux and patent urachus: A rare combination of urinary tract anomaliess
Mutiu O Atobatele, Olalekan I Oyinloye, Abdulrasheed A Nasir, John O Bamidele
April-June 2015, 7(2):240-243
DOI:10.4103/0974-7796.150496  PMID:25836363
Posterior urethral valve (PUV) is a common cause of lower urinary tract obstruction in male infants with an incidence of 1:5000-8000. PUV continues to be a significant cause of morbidity and ongoing renal damage in infants and children. It can coexist with vesicoureteral reflux (VUR) in about 50% of cases and also with patent urachus in about one-third of cases. It is a case of a 22-day-old full-term male child who presented with poor urinary stream and progressive abdominal distension of 5-day duration as well as leakage of clear fluid from umbilicus of 1-day duration. Abdominopelvic ultrasonography showed bilateral hydronephrosis. Micturating cystourethrogram also showed features of bladder outlet obstruction and PUV. In addition, a grade V left VUR and a fistulous tract between the dome of the urinary bladder and the umbilicus, which was consistent with a patent urachus was demonstrated. In conclusion, this case demonstrates a rare combination of congenital urinary tract anomalies involving PUV, left VUR and patent urachus.
  4,482 276 -
Assessment of lower urinary tract symptoms in Saudi men using the International Prostate Symptoms Score
Mostafa A Arafa, Karim Farhat, Saad Aqdas, Mohamed Al-Atawi, Danny M Rabah
April-June 2015, 7(2):221-225
DOI:10.4103/0974-7796.150492  PMID:25835352
Background: Benign prostatic hyperplasia-related lower urinary tract symptoms (LUTS) are common among older men, the incidence and prevalence are increasing rapidly, and they are associated with diminished health-related quality-of-life (QOL). Objective: The aim was to describe the prevalence of LUTS in Saudi population and its relation to some other parameters. Subjects and Methods: Saudi men over the age of 40 were invited to participate in the study; in Riyadh city from August 2012 through March 2013. All participants were assessed for the serum level of prostate-specific antigen (PSA) and digital rectal examination. Participants were given a linguistically validated Arabic version of the International Prostate Symptom Score (IPSS). Demographic and other medical comorbidities were assessed. Results: Based on the IPSS, a subdivision of men into three symptoms classes has been proposed, resulting in groups with mild (1265, 58.3%), moderate (505, 27.3%), and severe symptoms (81, 4.4%) and the prevalence of moderate to severe was 31.7%. There was a weak, but significant correlation between the total IPSS and age, total prostate volume, and PSA. Severity of symptoms is increasing with increased age. Multiple regression analysis reported that prostate volume and all individual items of IPSS except straining were significant predictors of QOL and patient satisfaction, where frequency and incomplete emptying had the heaviest impact on patient's QOL. Conclusion: LUTS were common among men in Saudi population over 40, the prevalence increases with age and most of them were unpleased because of their urinary symptoms, poor QOL was mainly determined by individual symptoms; mainly frequency and incomplete emptying.
  4,389 353 -
Mixed nutcracker syndrome with left renal vein duplication: A severe and exceptional presentation in an 18-year-old boy
Faouzi Mallat, Wissem Hmida, Mouna Ben Othmen, Faouzi Mosbah
April-June 2015, 7(2):244-247
DOI:10.4103/0974-7796.150494  PMID:25836700
The nutcracker syndrome (NCS) is rare and often misdiagnosed because it embraces an extended non-pathognomonic spectrum of symptoms that imply a difficult diagnosis. Ultimately it may be associated with substantial morbidity and even life-threatening events. Mixed NCS with renal vein duplication is an exceptional variety, have previously been reported to the best of our knowledge. We report a rare case of an 18-year-old boy who presented with a long history of abdominal, pelvic and left flank pain, fatigue and higher bilateral varicocele. Computed tomographic angiography, Doppler ultrasonography and venography were performed revealed left renal vein duplication with dilated retroaortic and preaortic branchs, entrapped respectively between the aorta and the vertebral column and in the aortico-mesenteric space, with extensive and complex varices of the deep pelvic venous plexus; promoting the mixed renal NCS. Auto transplantation of the left kidney was suggested, but refused by the patient; and only the varicocele was managed. The patient is still suffering from his severe initial symptoms. Diagnosis is difficult and should be considered in patients with inexplicable flank or abdominal pain. Our purpose is to raise clinician's awareness for this condition so that they will be more likely to diagnose it. This will facilitate prompt diagnosis and treatment.
  4,473 267 -
Transfer of skills on LapSim virtual reality laparoscopic simulator into the operating room in urology
Amjad Alwaal, Talal M Al-Qaoud, Richard L Haddad, Tarek M Alzahrani, Josee Delisle, Maurice Anidjar
April-June 2015, 7(2):172-176
DOI:10.4103/0974-7796.150475  PMID:25838162
Objective: Assessing the predictive validity of the LapSim simulator within a urology residency program. Materials and Methods: Twelve urology residents at McGill University were enrolled in the study between June 2008 and December 2011. The residents had weekly training on the LapSim that consisted of 3 tasks (cutting, clip-applying, and lifting and grasping). They underwent monthly assessment of their LapSim performance using total time, tissue damage and path length among other parameters as surrogates for their economy of movement and respect for tissue. The last residents' LapSim performance was compared with their first performance of radical nephrectomy on anesthetized porcine models in their 4 th year of training. Two independent urologic surgeons rated the resident performance on the porcine models, and kappa test with standardized weight function was used to assess for inter-observer bias. Nonparametric spearman correlation test was used to compare each rater's cumulative score with the cumulative score obtained on the porcine models in order to test the predictive validity of the LapSim simulator. Results: The kappa results demonstrated acceptable agreement between the two observers among all domains of the rating scale of performance except for confidence of movement and efficiency. In addition, poor predictive validity of the LapSim simulator was demonstrated. Conclusions: Predictive validity was not demonstrated for the LapSim simulator in the context of a urology residency training program.
  4,164 341 -
Attitude and perception of urology by medical students at the end of their medical school: An appraisal from Saudi Arabia
Saleh Binsaleh, Abdulrahman Al-Jasser, Raed Almannie, Khaled Madbouly
April-June 2015, 7(2):211-220
DOI:10.4103/0974-7796.150511  PMID:25835262
Objectives: To evaluate the attitude and perception of the graduates of King Saud University (KSU) College of Medicine regarding the quality of their urology rotation, urology exposure during this rotation, confidence about managing common conditions, and career prospects. Materials and Methods: In 2013, a questionnaire regarding the students' perceptions of urology rotation was developed and E-mailed to all final (5 th ) year medical students and interns of KSU College of Medicine, Riyadh, Saudi Arabia. Individual responses were recorded, tabulated and compared using descriptive statistics. Results: The overall response rate was 67.7%. Respondents included 101 (49.8%) males and 102 (50.2%) females. All the respondents but 18 (8.9%) were enrolled in a urology rotation during undergraduate years. Only 27 (13.3%) were willing to choose urology specialty as a future career. Significant gender differences were found regarding choice of urology as a future career (P = 0.002) and the need for more urology exposure during surgical rotation (P = 0.002). Conclusions: Knowledge of medical school graduates is insufficient in many urologic subjects, and there is a need for more urology exposure. Social reasons and lack of knowledge about urology hinder the choice of urology specialty as a future career. Clearance of learning objectives, immediate and prompt feedback on performance and adequate emphasis of common problems and ambulatory care are some aspects that should be taken into account by curriculum planners as they consider improvements to urology rotation program.
  4,194 283 -
Clinical features and outcomes of nontransitional cell carcinomas of the urinary bladder: Analysis of 125 cases
Burak Arslan, Ibrahim Halil Bozkurt, Tarik Yonguc, Enver Vardar, Tansu Degirmenci, Zafer Kozacioglu, Bulent Gunlusoy, Suleyman Minareci
April-June 2015, 7(2):177-182
DOI:10.4103/0974-7796.150533  PMID:25838209
Objectives: The aim was to evaluate pathologic diagnosis, treatment and prognosis of 125 patients with nontransitional cell carcinoma of the urinary bladder. Materials and Methods: A total of 3590 patients with bladder tumors operated in our clinic between September 1998 and May 2013 were retrospectively evaluated. A total of 125 patients (107 men and 18 women) with nontransitional cell bladder cancer, confirmed by histopathology, were included in this study. The patients' characteristics, including age, gender, smoking history, tumor size, and localization, histological types, pathological tumor stages, treatment modalities, and survival rates were all recorded. Results: Of these tumors, 47 (37.6%) were adenocarcinoma (AC), 42 (33.6%) were squamous cell carcinoma (SCC), 23 (18.4%) were undifferentiated carcinoma (UC), 13 (10.4%) were other types of bladder carcinoma. Sixty-three (50.4%) patients had undergone radical cystectomy and pelvic lymphadenectomy ± adjuvant treatment (chemotherapy [CT]/radiotherapy) and 52 (41.6%) patients received radiotherapy ± CT. The median survival time of patients with AC and SCC were significantly higher than patients with UC (AC vs UC, P = 0.001; SCC vs UC, P = 0.000; AC vs. SCC, P = 0.219). Median survival time was significantly higher in radical cystectomy ± adjuvant treatment group (P < 0.05) in all histological types. Conclusion: Prognosis of urinary bladder tumors was directly related to histological type and stage of the tumor. CT or radiotherapy has limited response rates. Early radical cystectomy should be performed to improve prognosis.
  4,042 355 -
Primary bladder lymphoma, diffuse large B-cell type: Case report and literature review of 26 cases
W Greg Simpson, Armando Lopez, Paurush Babbar, Lynnetta Faith Payne
April-June 2015, 7(2):268-272
DOI:10.4103/0974-7796.152947  PMID:25837971
Primary lymphoma of the urinary bladder is exceedingly rare, representing 0.2% of all extranodal non-Hodgkin's lymphoma. Although Matsuno et al. and others state the most common type is mucosa-associated lymphoid tissue (MALT) lymphoma, 20% of all the primary lymphomas of the urinary bladder are considered to be high grade neoplasms; the majority being diffuse large B-cell lymphoma (DLBCL). This is a case report of a 48-year-old man that presented with hematuria, frequency, nocturia, and flank pain that was found to have high grade DLBCL. Twenty-six other cases of both low and high grade primary bladder lymphomas were selected in order to provide a thorough comparison of different treatment modalities. Of the cases reviewed, bladder lymphoma was more common in females (2:1). The average age at diagnosis was 63.9 years old (low grade: 68.7 years old, high grade: 58.8 years old). The most common low-grade neoplasm was MALT lymphoma (85.7%). For the low-grade malignancies, the most successful treatments were simple therapies (2 transurethral resection of a bladder tumour [TURBT], 1 antibiotics), solitary chemotherapy, and combination TURBT/chemo; all 3 of which achieved 100% clinical remission (CR) in the cases reviewed. The most common high grade neoplasm was DLBCL (76.9%). The most successful therapies used to treat high grade lesions were solitary chemotherapy (cyclophosphamide, duanorubacin, vincristine, prednisolone [CHOP] or ritoximab, CHOP [R-CHOP]) and combination therapies (2 radiation/CHOP, 2 surgery/CHOP). In the agreement with the current literature, this review has shown that simple therapies (TURBT) are equally as effective as aggressive treatments (chemotherapy, radiation) and should therefore be used as first line treatment in low grade tumors. For high grade malignancies, chemotherapy (R-CHOP or CHOP) alone or combination therapy (CHOP/surgery or CHOP/radiation) is recommended.
  3,969 394 -
Off-clamp robotic partial nephrectomy: Technique and outcome
Abdulraouf Y Lamoshi, Mohamad W Salkini
April-June 2015, 7(2):226-230
DOI:10.4103/0974-7796.150529  PMID:25835489
Introduction: Robotic partial nephrectomy (RPN) is a technically challenging procedure. Advanced skills are needed to accomplish tumor resection, hemostasis, and renorrhaphy within short ischemia time in RPN. Off-clamp RPN with zero ischemia may decrease the risk of ischemic reperfusion injury to the kidney. However, the off-clamp technique has been associated with an increased risk of blood loss. The purpose of this study was to evaluate the outcome of our modified off-clamp technique utilized in certain RPN cases. Patients and Methods: A total of 81 patients underwent RPN between September 2009 and July 2013 for renal masses. We studied a subgroup of patients who underwent off-clamp RPN with zero ischemia time. The off-clamp technique was utilized for exophytic, nonhilar tumors that have a base of 2 cm or less. We developed a novel technique to avoid ischemia reperfusion renal injury while minimizing blood loss in certain cases of RPN. Results: Of the 81 cases of RPN, we reviewed and adopted the off-clamp technique in 34 patients (41.98%). Utilizing off-clamp RPN resulted in an average blood loss of 96.29 ml and 1.56 days (range: 1-3 days) of hospital stay and minimal change in serum creatinine. Conclusions: Off-clamp RPN is safe and feasible approach to excise certain kidney tumors. It carries the benefits of RPN and prevents ischemia reperfusion renal injury.
  4,054 301 -
Pomegranate extract attenuates unilateral ureteral obstruction-induced renal damage by reducing oxidative stress
Alper Otunctemur, Emin Ozbek, Suleyman Sami Cakir, Emre Can Polat, Murat Dursun, Mustafa Cekmen, Adnan Somay, Nurver Ozbay
April-June 2015, 7(2):166-171
DOI:10.4103/0974-7796.150488  PMID:25838069
Aims: Ureteral obstruction may cause permanent kidney damage at late period. We know that the pomegranate extract (PE) play a strong role on removal of free oxygen radicals and prevention of oxidative stress. In the current study study, we evaluated the effect of PE on kidney damage after unilateral ureteral obstruction (UUO). Settings and Design: A total of 32 rats were divided into four groups. Group 1 was a control, Group 2 was a sham, Group 3 was rats with UUO and Group 4 was rats with UUO that were given PE (oral 100 μL/day). After 14 days, rats were killed and their kidneys were taken and blood analysis was performed. Subjects and Methods: Tubular necrosis, mononuclear cell infiltration, and interstitial fibrosis scoring were determined histopathologically in a part of kidneys; nitric oxide (NO), malondialdehyde (MDA), and reduced glutathione (GSH) levels were determined in the other part of kidneys. Statistical Analysis Used: Statistical analyses were performed by the Chi-square test and one-way analysis of variance. Results: There was no difference significantly for urea-creatinine levels between groups. Pathologically, there was serious tubular necrosis, mononuclear cell infiltration and fibrosis in Group 3, and there was significantly decreasing for tubular necrosis, mononuclear cell infiltration and fibrosis in Group 4 (P < 0.005). Furthermore, there was significantly increasing for NO and MDA levels; decreasing for GSH levels in Group 3 compared the other groups (P < 0.005). Conclusions: We think that the PE prevents kidney damage by decreasing oxidative stress in kidney.
  3,992 306 -
Primitive neuroectodermal tumor of the kidney in a young male: Case report and review of literature
Nivedita Patnaik, Kiran Mishra, Pradeep Saini, Nitin Agarwal
April-June 2015, 7(2):236-239
DOI:10.4103/0974-7796.150537  PMID:25836041
Primitive neuroectodermal tumor of the kidney is a rare tumor. A total of approximately 79 primary renal cases have been reported to date. Primitive neuroectodermal tumors occur preferentially in the soft-tissues of the paravertebral region and chest wall, less frequently in extremities, with a slight male predominance. We report a case of primitive neuroectodermal tumor of the kidney in a 17-year-old male with a pre-operative diagnosis of renal cell carcinoma-stage 4. The patient underwent radical nephrectomy and histopathological examination revealed a highly aggressive tumor of monotonous sheets of round cells with focal areas of rosette formations and high mitotic rate with Ki67 index of 25-30%. Tumor cells were positive for CD 99 confirming the diagnosis of primitive neuroectodermal tumor. Primitive neuroectodermal tumor of the kidney needs to be kept in mind as a differential diagnosis in young adults presenting with a large kidney mass.
  4,016 270 -
A comparative study of open, laparoscopic and robotic partial nephrectomy in obese patients
Clairese M Webb, Mohamed Kamel, Ehab Eltahawy, Mohammed F Faramawi, Annashia L Shera, Rodney Davis, Nabil Bissada, Supriya Jadhav
April-June 2015, 7(2):231-234
DOI:10.4103/0974-7796.152023  PMID:25835601
Objectives: Partial nephrectomy is a standard intervention for the treatment of small renal tumors. Our study compares the outcomes of three different partial nephrectomy methods (open, laparoscopic and robotic assisted) in obese (≥30 Kg/m 2 ) patients with renal tumors. Materials and Methods: Between 2005-2011, 66 obese patients had partial nephrectomy. Patients were divided into three groups according to intervention received: Open (n = 21), laparoscopic (n = 31) and robotic (n = 14). The outcome variables of blood loss, length of hospital stay, and complications were assessed. Results: Mean blood loss in the laparoscopic group (100 mls) was significantly less than open group (300 mls) and no difference between laparoscopic and robotic groups (150 mls). We observed a shorter median hospital stay in the laparoscopic group (two days) than open group (four days) and no difference between laparoscopic and robotic groups (three days). Three patients in the laparoscopic group had complications: Two grade II and one with grade III (based on Clavien-Dindo classification). Tumor location, pathology, grade, stage, patient gender, age, preoperative creatinine and postoperative creatinine were not different among the groups (P > 0.05). The mean tumor size in the laparoscopic group (2.70 cms) was significantly smaller than that of the open group (4.22 cm) (P; < 0.05), but not statistically different from that of the robotic group (2.99 cm). Conclusions: Our study demonstrates that in obese patients, both laparoscopic and robotic partial nephrectomy are associated with less blood loss than open partial nephrectomy. Second, the length of the hospital stay was not related to the type of utilized intervention.
  3,889 330 -
Upgrading prostate cancer following proton beam therapy
Jennifer K Logan, Soroush Rais-Bahrami, Maria J Merino, Peter A Pinto
April-June 2015, 7(2):262-264
DOI:10.4103/0974-7796.152944  PMID:25837674
Pre- and post-radiation therapy (RT) effects on prostate histology have not been rigorously studied, but there appears to be a correlation between escalating radiation dosage and increasing post-RT histologic changes. Despite this dose-response relationship, radiation-induced changes may be heterogenous among different patients and even within a single tumor. When assessing residual tumor it is important to understand biopsy evaluation in the post-RT setting. We present the case of a poorly differentiated prostate adenocarcinoma following proton beam RT in a 45-year-old man with pre-RT Gleason 4 + 3 = 7 disease diagnosed in the setting of an elevated serum prostate-specific antigen level.
  3,825 290 -
A case series of two cases of juxta-adrenal schwannoma presenting as adrenal mass lesion and review of the literature
Shivashankar Damodaran, Griffin Mahimairaj, Kamaraj Velaichamy
April-June 2015, 7(2):254-258
DOI:10.4103/0974-7796.152940  PMID:25837378
Schwannomas are rare tumors in the retroperitoneal location. They can pose a diagnostic dilemma when presenting as an adrenal mass lesion due to their imaging characteristics. We report two cases of juxta-adrenal schwannomas presenting as symptomatic adrenal mass lesions. In both the cases, the clinical examination and functional evaluation was unremarkable and the radiological examination revealed a mixed intense adrenal mass lesion in one case with predominantly hyperintense areas and a very hyperintense lesion in another, in T2-weighted images, mimicking a adrenocortical malignancy and a pheochromocytoma respectively. Both cases were treated by surgical excision. Histopathological examination established the correct diagnosis of schwannoma, which was confirmed by immunohistochemical staining. Juxta-adrenal schwannoma is rare tumors of the retroperitoneum, which should also be borne in mind whenever encountering large nonsecreting adrenal tumors. We report a unique imaging characteristic, which helps in preoperative identification these rare lesions.
  3,611 240 -
Bilateral primary adrenal non-Hodgkin's lymphoma without adrenal insufficiency
William Greg Simpson, Paurush Babbar, Lynnetta Faith Payne
April-June 2015, 7(2):259-261
DOI:10.4103/0974-7796.152942  PMID:25837497
We are presenting a rare case of bilateral adrenal non-Hodgkin's lymphoma (NHL) that presented as a primary malignancy. An 83-year-old man presented with newly discovered bilateral adrenal incidentalomas, fatigue, and 30 pound weight loss. Of the 116 cases of primary adrenal NHL reported, over half have presented bilaterally and occur with adrenal insufficiency. Therefore, the finding of bilateral adrenal masses requires an urgent work-up of the functional status of the adrenal gland as well as a thorough analysis of the imaging characteristics seen on noncontrast computed tomography (CT) in order to maximize patient survival. Adrenal function testing was normal. Repeat CT imaging revealed rapidly growing lesions with high attenuations; both masses >10 HU. Histological examination of core biopsies discovered malignant lymphoma with no known past history of lymphoma. Our case coincides with the literature, which states that a mass with attenuation >10 HU in the adrenal glands has a high risk of malignancy.
  3,517 281 -
Antibiotics prophylaxis before prostate biopsy in practice: Review of online clinical guidelines
Julia V Fiuk, Bradley C Holland, Danuta I Dynda, Shaheen R Alanee
April-June 2015, 7(2):279-280
DOI:10.4103/0974-7796.152954  PMID:25835059
  3,273 274 -
Author reply on: Relationship between development of urethral stricture after transurethral resection of prostate and glycemic control
Irfan A Shaikh, RP Chaudhari, A Sharma, HR Pathak
April-June 2015, 7(2):280-280
DOI:10.4103/0974-7796.152957  PMID:25835086
  3,065 167 -
Latex urinary catheters for the short-time drainage
Sim Sai Tin, Viroj Wiwanitkit
April-June 2015, 7(2):280-281
DOI:10.4103/0974-7796.153028  PMID:25835131
  3,030 174 -
A comparative study of open, laparoscopic and robotic partial nephrectomy in obese patients
Mohamad W Salkini
April-June 2015, 7(2):234-235
  2,979 176 -
Factors effective on survival after radical prostatectomy: To what extent is pre-operative biopsy Gleason scoring is confident in predicting the prognosis?
Onur Açikgöz, Eymen Gazel, Yusuf Kasap, Metin Yigman, Zeki Ender Günes, Erkan Ölçücüoglu
April-June 2015, 7(2):159-165
DOI:10.4103/0974-7796.150527  PMID:25837974
In the present study, the effect of different grades on independent survival from the biochemical relapse was investigated through comparison of the histological grades of the biopsy and prostatectomy materials in patients undergoing radical prostatectomy (RP). A total of 152 patients undergoing RP following biopsy were retrospectively investigated in an attempt to reveal the effect of discordance between needle biopsy Gleason score and RP Gleason score on prostate specific antigen relapse-free survival. Accordingly, while 58.3% (14/24) survival was seen in the patients in Group 1 (high-graded) with Gleason score 7, 93.7% (15/16) survival has been seen in the patients in Group 2 (low-graded) and Group 3 (same Gleason scores) with Gleason score 7. The difference in-between has been statically found significant (P < 0.001). Similarly, while a 10% (1/10) survival is seen in the patients in Group 1 with Gleason score 8 and above, 75% (3/4) survival has been observed in the patients in Group 2 and 3 with Gleason score 8 and above. Also in this comparison, the difference in-between has been statically found significant (P = 0.041). Eventually, different grading, particularly determination of Gleason score higher than the RP specimen biopsy also bring about bad pathologic parameters and shortened survival periods.
  1,481 92 -
A narrowing range of bone scan in newly diagnosed prostate cancer patients: A retrospective comparative study
Berat Cem Özgür, Sinan Gültekin, Musa Ekici, Demet Yilmazer, Murat Alper
April-June 2015, 7(2):193-198
DOI:10.4103/0974-7796.150479  PMID:25835063
Objectives: The objective of the following study is to clarify a suitable group whereby a bone scan could be spared at the initial staging of prostate cancer, we wished to identify the possible relationship between bone metastasis and clinical and pathological parameters including serum total prostate specific antigen (PSA) concentration, alkaline phosphatase (ALP), biopsy Gleason Score (GS), and percentage of pathological cores. Materials and Methods: We reviewed the results of 220 bone scintigraphies, which were done between January 1, 2011 and June 30, 2013 in patients with newly diagnosed prostate cancer. These parameters were evaluated together with standard clinicopathological data to determine the prediction ability of the bone scan by univariate and multivariate analyses. Results: Bone metastases were seen in 44 patients of all 220 patients (20%, 95% confidence interval, 17-24%). In univariate analysis, PSA and biopsy GS were useful in predicting the bone scan result, but ALP and percentage of pathological cores was not. In multivariate analysis, the single most useful parameter in predicting the bone scan result was PSA (P < 0.001). Conclusions: A bone scan seems to be impractical in newly diagnosed prostate cancer patients with serum PSA level <20 ng/ml and GS up to seven and pre-treatment PSA is the best predictor of the need for the bone scan according to results of this study.
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