Urology Annals
About UA | Search | Ahead of print | Current Issue | Archives | Instructions | Online submissionReader Login
Urology Annals
  Editorial Board | Subscribe | Advertise | Contact
Users Online: 425   Home Print this page  Email this page Small font size Default font size Increase font size
Export selected to
Reference Manager
Medlars Format
RefWorks Format
BibTex Format
  Access statistics : Table of Contents
   2016| April-June  | Volume 8 | Issue 2  
    Online since March 23, 2016

  Archives   Previous Issue   Next Issue   Most popular articles   Most cited articles
Hide all abstracts  Show selected abstracts  Export selected to
  Viewed PDF Cited
Saudi oncology society and Saudi urology association combined clinical management guidelines for prostate cancer
Ashraf Abusamra, Esam Murshid, Hussain Kushi, Sultan Alkhateeb, Mubarak Al-Mansour, Ahmad Saadeddin, Danny Rabah, Shouki Bazarbashi, Mohammed Alotaibi, Abdullah Alghamdi, Khalid Alghamdi, Abdullah Alsharm, Imran Ahmad
April-June 2016, 8(2):123-130
DOI:10.4103/0974-7796.176872  PMID:27141178
This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with prostate cancer. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi oncology society and Saudi urological association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with adenocarcinoma of the prostate to.
  3,473 678 -
Large proximal ureteral stones: Ideal treatment modality?
B Kadyan, V Sabale, D Mane, V Satav, A Mulay, N Thakur, SP Kankalia
April-June 2016, 8(2):189-192
DOI:10.4103/0974-7796.157963  PMID:27141190
Background and Purpose: Ideal treatment modality for patients with large impacted proximal ureteral stone remains controversial. We compared laparoscopic transperitoneal ureterolithotomy (Lap-TPUL) and semirigid ureteroscopy for large proximal ureteric stones to evaluate their efficacy and safety. Patients and Methods: From November 2012 to December 2014, we enrolled 122 patients with large (≥1.5 cm) proximal ureteral stone in the study. Patients were randomly divided into two groups: Group A (60 patients), retrograde ureteroscopic lithotripsy using a semirigid ureteroscope; Group B (62 patients), transperitoneal LU (Lap-TPUL). Results: The overall stone-free rate was 71.6% and 93.5% for Group A and Group B respectively (P = 0.008). Auxiliary procedure rate was higher in Group A than in Group B (27.3% vs. 5.6%). The complication rate was 11.2% in Group B versus 25% in Group A. Mean procedure time was higher in laparoscopy group as compared to ureterorenoscopy (URS) groups (84.07 ± 16.80 vs. 62.82 ± 12.71 min). Hospital stay was 4.16 ± 0.67 days in laparoscopy group and 1.18 ± 0.38 days in URS group (P < 0.0001). Conclusion: Laparoscopic transperitoneal ureterolithotomy is a minimally invasive, safe and effective treatment modality and should be recommended to all patients of impacted large proximal stones, which are not amenable to URS or extracorporeal shock-wave lithotripsy or as a primary modality of choice especially if patient is otherwise candidate for open surgery.
  3,227 410 -
Use of autologous grafts in the treatment of acquired penile curvature: An experience of 33 cases
Abdul Rouf Khawaja, Tanveer Iqbal Dar, Suhael Zahur, Sheikh Tariq, Arf Hamid, MS Wani, BS Wazir, Arsheed Iqbal
April-June 2016, 8(2):218-222
DOI:10.4103/0974-7796.176875  PMID:27141196
Aim: The objective was to compare the use of autologous dermal and temporalis fascia grafts in the treatment of acquired penile curvatures. Materials and Methods: It was a prospective observational study of 33 cases, conducted in Sher-i-Kashmir Institute of Medical Sciences, Srinagar from March 2007 to September 2013. All the patients had stable Peyronies disease (PD). Dorsal, dorsolateral and vental curvatures with good preoperative erections were included. PD index with visual analog scales for curvature was used preoperatively. An informed written consent was taken from all the patients with main emphasis on erectile dysfunction. Results: After an average follow up of 2 years, complete straightening of penis was observed in all patients with satisfactory sexual intercourse in 30 patients (90%). Three patients (10%) required frequent use of type 5 phosphodiesterase inhibitors for adequate erections. Overall 91% of patients and partners were satisfied with the procedure and cosmetically donor site was better in temporalis fascia graft site. No rejection of any graft was noted and glans hypoesthesia was noticed in 4 patients (12%). None of the patients required penile prosthesis. Total operative time for harvesting and application of the graft was more in dermal grafts (>3 hrs) than for temporalis fascia graft (2 hrs). Conclusion: Tunical lengthening procedures by autologous free grafts represents a safe and reproducible technique. A good preoperative erectile function is required for tunical lengthening procedure. Temporalis fascia graft is thin, tough membrane and effective graft for PD with good cosmetic and functional results.
  3,286 267 -
Noninvasive treatments for iatrogenic priapism: Do they really work? A prospective multicenter study
Mohamad Habous, Mohammed Elkhouly, Osama Abdelwahab, Mohammed Farag, Khaled Madbouly, Talal Altuwaijri, Marco Spilotros, Carlo Bettocchi, Saleh Binsaleh
April-June 2016, 8(2):193-196
DOI:10.4103/0974-7796.176874  PMID:27141191
Objectives: Intracorporeal injections (ICIs) of vasoactive substances during penile Doppler ultrasound (PDU) are a common investigation for erectile dysfunction (ED) diagnosis. ICI can be responsible of priapism, a pathological condition of prolonged penile erection not related to sexual stimulation. The aim of our study is to investigate the effectiveness of physical exercise and medical treatment as noninvasive therapy to restore detumescence in prolonged erections after ICI. Materials and Methods: Data were prospectively collected on men undergoing PDU in three urological centers. Three hundred and sixty-nine patients underwent PDU for the investigation of ED. All the participants received an ICI of quadrimix; prostaglandine E1, papaverine, phentolamine, and atropine. The data of the patients have been analyzed to record their comorbidities, results of PDU, and the complications encountered. Results: Fifty-three patients (14.4%) developed prolonged erections. Physical exercise alone was successful in reversing prolonged erection within 30 min in 21 (39.6%) patients. Out of the remaining 32 patients, oral salbutamol induced detumescence in 18 (34%) within the observation period of 60 min. Nonresponders were managed successfully with aspiration and irrigation of corpora with saline (11 patients, 20.75%) or with Phenylephrine (three patients, 5.66%). Conclusions: Physical exercise and oral salbutamol are safe and effective in restoring detumescence of pharmacologically-induced priapism. Noninvasive therapy may save a significant number of these patients an invasive treatment.
  2,926 319 -
Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for urothelial cell carcinoma of the urinary bladder
Sultan Alkhateeb, Mubarak Al-Mansour, Mohammed Alotaibi, Ahmad Saadeddin, Ashraf Abusamra, Danny Rabah, Esam Murshid, Abdullah Alsharm, Imran Ahmad, Hussain Kushi, Abdullah Alghamdi, Khalid Alghamdi, Shouki Bazarbashi
April-June 2016, 8(2):131-135
DOI:10.4103/0974-7796.176873  PMID:27141179
This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with urothelial cell carcinoma of the urinary bladder. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with urothelial cell carcinoma of the urinary bladder.
  2,816 384 -
Perivesical unicentric Castleman disease initially suspected to be metastatic prostate cancer
Patrick J Guthrie, John V Thomas, Deniz Peker, Baris Turkbey, Soroush Rais-Bahrami
April-June 2016, 8(2):245-248
DOI:10.4103/0974-7796.177196  PMID:27141204
Unicentric Castleman disease (UCD) is a relatively rare lymphoproliferative disease, which commonly presents as a mediastinal mass and less frequently involves abdomen, pelvis, and retroperitoneum. We report a case of a 64-year-old man with newly diagnosed low-volume, Gleason 3 + 3 = 6 prostate adenocarcinoma, who in considering active surveillance versus treatment was found to have a left perivesical and iliac chain lymphadenopathy concerning for potential metastatic involvement. He underwent magnetic resonance imaging with ferumoxytol to assist in the diagnostic evaluation to better characterize his lymphadenopathy. Subsequently, he underwent robotic-assisted laparoscopic bilateral pelvic lymph node dissection and resection of left perivesical mass exhibiting hyaline vascular variant of UCD.
  2,611 341 -
Malignancies in a renal transplant population: The St. Michael's Hospital experience
R Saleeb, H Faragalla, GM Yousef, R Stewart, CJ Streutker
April-June 2016, 8(2):163-167
DOI:10.4103/0974-7796.165712  PMID:27141185
Introduction: Previous publications have shown an increased incidence of various malignancies amongst renal transplant populations. The objective of this study was to analyze the rate and types of malignancies occurring in the St. Michael's Hospital renal transplant population and to determine whether our results were comparable to those previously published. Methods: After approval by the hospital's research ethic board, review of the records and pathology of the 1584 patients in the renal transplant clinic database patients was performed. The reports dated back to the year 1970. Results: Amongst the 1584 renal transplant patients, 106 patients with 132 dysplastic and malignant posttransplant lesions were identified. The highest incidence amid the malignancies was in nonmelanoma skin malignancies squamous cell carcinoma (SCC), basal cell carcinoma, and Kaposi sarcoma, with a total of 32 patients having 54 separate tumors (2.02% of all patients, 43.2% of tumors). Following skin tumors in incidence were genitourinary (28 tumors), gastrointestinal tract (GIT) lesions (8 adenocarcinomas, 14 dysplastic lesions, 1 low grade neuroendocrine tumor/carcinoid), posttransplant lymphoproliferative disorders (PTLDs) (10 cases), gynecologic (6 carcinomas), cervical/anal/vulvar dysplasia and invasive (SCCs) (4), and thyroid (3 papillary tumors). Nine patients had tumors of multiple sites/types. With respect to outcome, 14 patients died of malignancy, with the highest mortality being in the GIT malignancies (six patients). Second in mortality were the PTLD and skin tumor groups. Discussion: Information on the incidence and outcome of various malignancies in renal transplant patients is important in designing guidelines for the follow-up of these patients regarding tumor screening and prevention. The rate of malignancies in our group is comparable to that reported in other centers.
  2,555 355 -
Renal stone in crossed fused renal ectopia and its laparoscopic management: Case report and review of literature
Santosh Agrawal, Saurabh Sudhir Chipde, Jaisukh Kalathia, Rajeev Agrawal
April-June 2016, 8(2):236-238
DOI:10.4103/0974-7796.176871  PMID:27141201
Management of renal stone in crossed fused renal ectopia (CFRE) is difficult because of abnormal location, malrotation, and its relations with vertebral column and small bowel. Management is not standardized because of the paucity of literature and variable anatomy. We managed an 8-year-old boy with multiple renal stones in right side crossed kidney by laparoscopic pyelolithotomy and nephro pyeloscopy with the help of ureteroscope. Until now, there is only one prior report of laparoscopic pyelolithotomy in CFRE. We share our experience in this case and review the literature regarding the management of kidney stones in this rare anomaly.
  2,635 261 -
Spontaneous retrograde migration of ureterovesical junction stone to the kidney; first ever reported case in the English literature in human
Ziauddin Khan, Alaeddin A Yaqoob, Tanweer A Bhatty
April-June 2016, 8(2):229-232
DOI:10.4103/0974-7796.176869  PMID:27141199
We present a case of spontaneous retrograde migration of ureterovesical junction stone to the kidney. A 26-year-old Bahraini male, diagnosed with left lower ureteric stone 7 months before this presentation. On his recent presentation, the stone has migrated down but not passed, confirmed on imaging. Operative removal was planned. X-ray kidney ureter bladder (KUB) in the morning of surgery did not reveal stone in the ureter, but the same shadow was seen in the kidney. An urgent computerized tomography-KUB was done, and this confirms the stone has migrated to the kidney. Surgery was canceled, and the stone was dealt with extracorporeal shockwave lithotripsy and was fragmented in the first session. This retrograde migration of lower ureteric stone to the kidney is not reported in the English literature in human before.
  2,586 242 -
A comparative study of lingual mucosal graft urethroplasty with buccal mucosal graft urethroplasty in urethral stricture disease: An institutional experience
Dilip Kumar Pal, Depak Kumar Gupta, Bastab Ghosh, Malay Kumar Bera
April-June 2016, 8(2):157-162
DOI:10.4103/0974-7796.172214  PMID:27141184
Aims: A prospective study to compare the outcomes of lingual versus buccal mucosal graft urethroplasty in patients with long segment anterior urethral strictures disease. Materials and Methods: The study included 30 patients for buccal mucosal graft urethroplasty (group I) and 30 patients for lingual mucosal graft urethroplasty (group II) for treatment of long segment (>3 cm) incomplete anterior urethral stricture disease using single-stage dorsal onlay free oral mucosal graft urethroplasty by Barbagli's technique between February 2013 to September 2014. All patients underwent complete evaluation of the stricture including inspection of the oral cavity. Results: The results of urethroplasty in between two group were not significant (P > 0.05) in terms of Qmax (P = 0.63), mean postoperative AUA symptom score (P = 0.83), operative time (P = 0.302) intra operative blood loss (P = 0.708), duration of postoperative hospitalization (P = 0.83), but slurring of speech complications was seen in group II, but not in group I. Long-term complications of salivary disturbance, tightness of the mouth, persistent pain at graft site, perioral numbness, seen only in group I (BMGU). Conclusion: LMG urethroplasty is an excellent alternative to BMG urethroplasty with comparable results of urethroplasty and minimal donor site complications.
  2,519 305 -
Single stage circumferential lingual mucosal graft urethroplasty in near obliterative bulbar urethra stricture: A novel technique
Umesh Sharma, Sher Singh Yadav, Vinay Tomar, Amit Garg
April-June 2016, 8(2):146-150
DOI:10.4103/0974-7796.172215  PMID:27141182
Aims: This is a prospective study of the use and efficacy of a novel technique of circumferential tubularised lingual mucosal graft (LMG) in obliterative and near obliterative bulbar urethral stricture of >2 cm where excisional and augmented anastomotic urethroplasty are not feasible. Materials and Methods: The stenotic urethral segment was opened dorsally in midline and fibrosed urethra was excised taking care to preserve the healthy spongiosum tissue. LMG (av. Length 3 cm) was placed from one end of corporal body towards spongy tissue in a circumferential manner. Another LMG was placed in similar manner to deal with longer stricture. The urethra was tubularised over 14 Fr silicone catheter. Results: A total of 12 men, of mean age 47 years underwent this procedure. The mean follow up period was 11 months starting from July 2014 till manuscript submission. Follow up included voiding cystourethrogram at 3 weeks, cystoscopy at 3 months (one patient didn't turned up) and subsequent follow up. Mean stricture length was 4.66 cm (range, 3–8.5 cm) and mean operative time was 195 min. (range, 160 to 200 min.). The technique was successful (normal voiding with no need for any post-operative procedure) in 11(91.6%) patients. One patient developed early recurrence at 4 month of surgery and had anastomotic stricture which was successfully managed by direct visual internal urethrotomy. Conclusion: Single stage circumferential tubularised graft urethroplasty is an excellent technique for strictures that include segments of obliterative and near obliterative diseased urethra. It provide a wider neourethra than patch graft urethroplasty.
  2,475 312 -
Spontaneous large renal pelvis hematoma in ureteropelvic junction obstruction presenting as an acute abdomen: Rare case report
Ajit Sawant, Gaurav Kasat, Prakash Pawar, Ashwin Tamhankar
April-June 2016, 8(2):239-241
DOI:10.4103/0974-7796.177197  PMID:27141202
Patients with ureteropelvic junction (UPJ) obstruction can present with flank pain or hematuria. We present 20-year-old male presenting with acute pain in lumbar and right fossa with tenderness and guarding, this case was clinically mimicking general surgical emergency. On computed tomography with urography and angiography, there was 15 cm × 11 cm × 10 cm size non-enhancing hyperdense lesion (average Hounsfield units - +64) in right renal pelvis suggestive of hematoma. Patient's diethylenetriaminepentaacetic acid diuretic renography was suggestive of right kidney glomerular function rate of 48.4 ml/min with the relative function of 43%, Peak to half peak was not achieved. The patient was managed by retrograde ureteropyelography and double J stenting. After 1 month, clot size decreased to 4 cm × 3 cm × 2 cm. The patient had undergone open reduction Anderson hynes dismembered pyeloplasty with the removal of pelvis clot after 6 weeks. We report the first case of UPJ obstruction presenting as an acute abdomen and spontaneous hematuria with large pelvis clot without rupture of the renal pelvis.
  2,493 243 -
Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for renal cell carcinoma
Abdullah Alghamdi, Sultan Alkhateeb, Khalid Alghamdi, Shouki Bazarbashi, Esam Murshid, Mohammed Alotaibi, Ashraf Abusamra, Danny Rabah, Imran Ahmad, Mubarak Al-Mansour, Ahmad Saadeddin, Abdullah Alsharm
April-June 2016, 8(2):136-140
DOI:10.4103/0974-7796.179239  PMID:27141180
This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with renal cell carcinoma (RCC). It is categorized according to the stage of the disease using the tumor node metastasis staging system 7th edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and healthcare policy makers in the management of patients diagnosed with RCC.
  2,405 312 -
Cystostomy–free open suprapubic transvesical prostatectomy: Is it a safe method?
Abbas Hassanpour, Mohammad Mehid Hosseini, Alireza Yousefi, Reza Inaloo
April-June 2016, 8(2):213-217
DOI:10.4103/0974-7796.162245  PMID:27141195
Aim: To compare open suprapubic transvesical prostatectomy (OSP) without insertion of suprapubic cystostomy, OSP with insertion of cystostomy, and transurethral resection of the prostate (TURP). Patients and Methods: A total of 104 patients with an indication for prostatectomy were retrospectively assigned to TURP (group 1), OSP with cystostomy (group 2), and OSP without cystostomy (group 3). They were evaluated for length of the operation, length of hospital stay, post-operative complications, hemoglobin drop, changes of blood pressure, and intraoperative blood loss. Results: Mean age was 67.2 ± 8.7 in group 1, 73.3 ± 8.4 in group 2, and 74.0 ± 5.7 in group 3. Prostatic volume was 35.9 ± 13.8, 74.1 ± 33.8, and 74.3 ± 31.8 in groups 1, 2, and 3, respectively. There was no significant difference in prostatic volume between groups 2 and 3 (P = 0.99), but in group 1 it was lesser than groups 2 and 3 (P = 0.00). Length of the operation was 1.2 ± 0.2 in group 3 and 1.1 ± 0.2 in group 2, without a significant difference (P = 0.45). Length of hospital stay in group 3 (2.3 ± 0.4 days) was lesser than that in group 2 (2.6 ± 0.7) (P = 0.01). The amount of hemoglobin drop was 1.1 ± 0.9 in group 1, 1.1 ± 0.7 in group 2, and 1.4 ± 0.91 in group 3 without a significant difference between all groups. The amount of bleeding during operation was 173 ± 103 in group 2 and 161 ± 78 in group 3 (P = 0.98). Conclusion: OSP without insertion of cystostomy tube is a relatively safe method; however, larger studies are needed. It is also comparable to TURP in terms of postoperative efficacy and complications.
  2,428 250 -
External iliac artery polytetrafluoroethylene graft interposition: An effective rescuer for kidney transplant in progressive intimal dissection of external iliac artery
Tanveer Iqbal Dar, Vipin Tyagi, Abdul Rouf Khawaja, Sudhir Chadha, Harsha Jauhari
April-June 2016, 8(2):223-225
DOI:10.4103/0974-7796.177199  PMID:27141197
Aims and Objective: The aim of this study is to highlight the use of polytetrafluoroethylene (PTFE) interposition graft as an important salvage procedure in case of irreparable intimal injury of external iliac artery during renal transplant recipient surgery. Materials and Methods: Since 1987, we encountered irreparable intimal dissection of external iliac artery in five cases just after opening the clamp. It was successfully managed by PTFE interposition graft with subsequent end to side anastomosis of donor renal artery to the vascular graft. Results: No patient had bleeding or infective complications related to the graft and three patients had immediate diuresis. Normal immediate graft function was present in three patients while the other two had delayed graft function. Conclusion: Polytetrafluoroethylene interposition graft is a successful procedure to salvage the kidney and lower limb in case of progressive intimal dissection of external iliac artery during renal transplant surgery.
  2,416 244 -
A rare case of concurrent penile and spinal schwannomas
Luke Wang, Asiri Arachchi, Antonios Makris
April-June 2016, 8(2):233-235
DOI:10.4103/0974-7796.176870  PMID:27141200
Schwannoma of the penis is extremely rare. This is the case of a young male who presented with pain on sexual intercourse, multiple lumps on the dorsal shaft of his penis, as well as a temporal headache. He was subsequently diagnosed with schwannoma affecting both his penile region and cauda equina. This clinical finding has not been previously described in the literature. Hence, its presentation is unique to our specialty.
  2,429 201 -
Diagnostic and prognostic role of computed tomography in extracorporeal shock wave lithotripsy complications
Michele Telegrafo, Davide Antonio Carluccio, Leonarda Rella, Amato Antonio Stabile Ianora, Giuseppe Angelelli, Marco Moschetta
April-June 2016, 8(2):168-172
DOI:10.4103/0974-7796.163792  PMID:27141186
Purpose: To evaluate the role of multidetector computed tomography (MDCT) in recognizing the complications of extracorporeal shock wave lithotripsy (ESWL) and providing a prognostic grading system for the therapeutic approach. Materials and Methods: A total of 43 patients who underwent ESWL because of urinary stone disease were assessed by 320-row MDCT examination before and after ESWL. Pre-ESWL CT unenhanced scans were performed for diagnosing stone disease. Post-ESWL CT scans were acquired before and after intravenous injection of contrast medium searching for peri-renal fluid collection or hyper-density, pyelic or ureteral wall thickening, blood clots in the urinary tract, peri- or intra-renal hematoma or abscess, active bleeding. A severity grading system of ESWL complications was established. Results: Patients were affected by renal (n = 36) or ureteral (n = 7) lithiasis. Post-ESWL CT examination detected small fluid collections and hyper-density of peri-renal fat tissue in 35/43 patients (81%), pyelic or ureteral wall thickening in 2/43 (4%), blood clots in the urinary tract in 9/43 (21%), renal abscesses or hematomas with a diameter of <2 cm in 10/43 (23%), large retroperitoneal collections in 3/43 (7%), active bleeding from renal vessels in 1/43 (2%). Mild complications were found in 30 cases; moderate in 9; severe in 4. The therapeutic choice was represented by clinical follow-up (n = 20), clinical and CT follow-up (n = 10), ureteral stenting (n = 9), drainage of large retroperitoneal collections (n = 3), and arterial embolization (n = 1). Conclusion: MDCT plays a crucial role in the diagnosis of urolithiasis and follow-up of patients treated with ESWL recognizing its complications and providing therapeutic and prognostic indications.
  2,334 292 -
Deterioration in the renal function and risk of microalbuminuria after radical, simple and donor nephrectomy: A long-term outcome
Shashi Verma, Sher Singh Yadav, Vinay Tomar, Nachiket Vyas, Neeraj Agarwal, Umesh Sharma
April-June 2016, 8(2):184-188
DOI:10.4103/0974-7796.164854  PMID:27141189
Objectives: Evaluation of deterioration in renal function and risk of micro albuminuria after radical, simple and donor nephrectomy. Materials and Methods: A total of 594 patients underwent nephrectomy (159 radical, 318 simple and 117 donors) from February 2009 to December 2012 in our institute. First 300 eligible patients were divided in 3 groups, each having equalled number of patients. Group 1 was consisted of patients who underwent radical, group 2 had simple and group 3 had donor nephrectomy. These patients were followed up to February 2015. Follow up of all the patients were done at first month following the surgery and then in every six months subsequently. The follow up included the measurement of serum creatinine and urinary micro albumin in a spot urine sample. CKD-EPI equation was used for calculation of e GFR. Results: At the end of our study, 35 patients (41.6%) in group 1 and 8 patients (8.69%) in group 2 developed CKD stage 3. During the follow-up period, 41% patients in group 1, 13% in group 2 and 4% in group 3 developed MA. Conclusion: Nephron-sparing surgery should be the standard treatment of renal tumors, wherever possible. There should be a regular follow up of the patients after radical, simple and donor nephrectomy because of risk of CKD. Early consultation with nephrologists should be done by the patients who are suffering from MA after nephrectomy.
  2,319 275 -
Middle calyx ureterocalicostomy in ectopic pelvic kidney with ureteropelvic junction obstruction: Only alternative for renal salvage
Jaisukh Kalathia, Santosh Agrawal, Saurabh S Chipde, Rajeev Agrawal
April-June 2016, 8(2):242-244
DOI:10.4103/0974-7796.177198  PMID:27141203
Anomalous kidneys are mostly asymptomatic and are often found incidentally during physical or radiological investigations for urological or other medical complaints. The associated genital anomalies ranges from 15% to 45%. Females are associated with bicornuate or unicornuate uterus, rudimentary or absent uterus while males have undescended testes, duplication of the urethra, and hypospadias. A 21 year old married female presented with on and off lower abdomen pain for the past one year with history of primary amenorrhea. On examination an ill defined tender lump palpated in the lower abdomen. USG showed left ectopic pelvic kidney with gross hydronephrosis. The computed tomography confirmed hydronephrotic left ectopic pelvic kidney in front of the sacrum with anteriorly directed renal pelvis with ureter located posteriorly. There was delayed excretion from the ectopic kidney but right kidney was in normal position and function. The diethylene triamine pentaacetic acid (DTPA) scan showed 33% function of the ectopic kidney. On diagnostic laparoscopy, the uterus was small hypoplastic with bilateral ovaries appearing normal. The patient was taken for open pyeloplasty where the ureter was transected below PUJ but for a dependent drainage, the middle calyx as was the most dependent calyx as seen on the CT-scan. So a middle calyx ureterocalicostomy was performed calyx with excellent outcome. The ectopic kidney always remains a challenge because of complex neurovascular anatomy, presence of viscera and associated UPJO, but for a dependent drainage, middle calyx ureterocalicostomy is a feasible option with excellent outcome as was in our case.
  2,304 227 -
Disparities in long-term radiographic follow-up after cystectomy for bladder cancer: Analysis of the SEER-Medicare database
Shaheen Alanee, Sabha Ganai, Priyanka Gupta, Holland Bradley, Danuta Dynda, Joel Slaton
April-June 2016, 8(2):178-183
DOI:10.4103/0974-7796.164852  PMID:27141188
Introduction: It is uncertain whether there are disparities related to receiving long-term radiographic follow-up after cystectomy performed for bladder cancer, and whether intensive follow-up influences survival. Materials and Methods: We analyzed 2080 patients treated with cystectomy between 1992 and 2004 isolated from the SEER-Medicare database. The number of abdominal computerized tomography scans performed in patients surviving 2 years after surgery was used as an indicator of long-term radiographic follow-up to exclude patients with early failures. Results: Patients were mainly males (83.18%), had a mean age at diagnosis of 73.4 ± 6.6 (standard deviation) years, and mean survival of 4.6 ± 3.2 years. Multivariate analysis showed age >70 (odds ratio [OR]: 0.796, 95% confidence interval [CI]: 0.651–0.974), African American race (OR: 0.180, 95% CI: 0.081–0.279), and Charlson comorbidity score >2 (OR: 0.694, 95% CI: 0.505–0.954) to be associated with lower odds of long-term radiographic follow-up. Higher disease stage (Stage T4N1) (OR: 1.873, 95% CI: 1.491–2.353), higher quartile for education (OR: 5.203, 95% CI: 1.072–9.350) and higher quartile for income (OR: 6.940, 95% CI: 1.444–12.436) were associated with increased odds of long-term radiographic follow-up. Interestingly, more follow-up with imaging after cystectomy did not improve cancer-specific or overall survival in these patients. Conclusion: There are significant age, race, and socioeconomic disparities in long-term radiographic follow-up after radical cystectomy. However, more radiographic follow-up may not be associated with better survival.
  2,229 288 -
Bilateral complete duplication of the ureters, with calculi simultaneously obstructing the four ureters
Ahmed Jalal Alsayyad
April-June 2016, 8(2):226-228
DOI:10.4103/0974-7796.179241  PMID:27141198
Bilateral complete duplication of the ureters is a rare condition. We report a case of an adult male patient with bilateral complete duplication of the ureters, with a single stone simultaneously obstructing each of the four ureteral limbs. Multiple bilateral renal stones were awlso demonstrated in the imaging studies. The ureteral stones ranged from 7 to 23 mm in length and 5–11 mm in width. Ureteroscopy and holmium laser lithotripsy for the ureteral stones were done sequentially in the four ureteral limbs, in a single session. Four double-J stents were inserted after removal of all ureteric stones, one in each ureter. The patient passed uneventful postoperative course. The patient has received extracorporeal shock wave lithotripsy sessions for the bilateral renal stones. The double-J stents were removed under local anesthesia after clearance of all stones. To the best of our knowledge, there are no data in the literature representing an identical case.
  2,254 261 -
Co-existing malakoplakia and xanthogranulomatous pyelonephritis of kidney: Two different spectrum of same disease process
Debi Prasad Das, Dilip Kumar Pal
April-June 2016, 8(2):252-254
DOI:10.4103/0974-7796.179242  PMID:27141206
Xanthogranulomatous pyelonephritis (XGP) and malakoplakia (MKP) are chronic inflammatory condition of kidney characterized by infiltration of inflammatory cells. We are presenting a rare case of concomitant XGP and MKP in the same kidney. This signifies that the two are different spectrums of the same disease process.
  2,244 257 -
Hemostatic agents for access tract in tubeless percutaneous nephrolithotomy: Is it worth?
Francisco Sepulveda, Alfredo Aliaga, Daniela Fleck, Mario Fernandez, Alejandro Mercado, Roberto Vilches, Francisco Moya, Rodrigo Ledezma, Diego Reyes, Fernando Marchant
April-June 2016, 8(2):208-212
DOI:10.4103/0974-7796.163796  PMID:27141194
Introduction: The role of hemostatic agents as an adjunct for closure of the nephrostomy tract in tubeless percutaneous surgery (tubeless percutaneous nephrolithotomy [tPNL]) has been previously evaluated, observing a potential benefit in terms of reduced bleeding and urinary leakage. We assessed the rate of postoperative complications after the use of hemostatic agents for sealing the nephrostomy tract in patients undergoing tPNL at our institution. Subjects and Methods: We performed a retrospective analysis of 52 consecutive patients undergoing tPNL at our center between January 2010 and December 2013. No substance was placed within the tract in 25 patients (Group 1). A cylinder of Surgicel® in addition to 1 unit of Gelita® were placed within the access tract in 27 patients (Group 2). We accounted for demographic variables, stone size, operative time, postoperative pain, development of hematoma, postoperative hematocrit drop, urinary leakage, residual lithiasis, and hospital stay length. Results: Age and sex differed significantly between the two groups (P = 0.0002 and P = 0.048 respectively). However, there were no significant differences in terms of body mass index and stone burden. No significant differences between groups were found with regards to operative time, postoperative hematocrit drop, postoperative pain and presence of residual lithiasis. Conclusion: The use of Gelita® and Surgicel® as hemostatic agents in tPNL is safe, but we were not able to demonstrate any significant benefit in terms of postoperative morbidity after comparing the use of these agents in tPNL. We concluded that the uses of hemostatic agents needed to be evaluated in prospective randomized trials to define its benefits.
  2,200 298 -
Is scoring system of computed tomography based metric parameters can accurately predicts shock wave lithotripsy stone-free rates and aid in the development of treatment strategies?
Yasser ALI Badran, Alsayed Saad Abdelaziz, Mohamed Ahmed Shehab, Hazem Abdelsabour Dief Mohamed, Absel-Aziz Ali Emara, Ali Mohamed Ali Elnabtity, Maged Mohammed Ghanem, Hesham Abdel Azim ELHelaly
April-June 2016, 8(2):197-202
DOI:10.4103/0974-7796.164842  PMID:27141192
Objective: The objective was to determine the predicting success of shock wave lithotripsy (SWL) using a combination of computed tomography based metric parameters to improve the treatment plan. Patients and Methods: Consecutive 180 patients with symptomatic upper urinary tract calculi 20 mm or less were enrolled in our study underwent extracorporeal SWL were divided into two main groups, according to the stone size, Group A (92 patients with stone ≤10 mm) and Group B (88 patients with stone >10 mm). Both groups were evaluated, according to the skin to stone distance (SSD) and Hounsfield units (≤500, 500–1000 and >1000 HU). Results: Both groups were comparable in baseline data and stone characteristics. About 92.3% of Group A rendered stone-free, whereas 77.2% were stone-free in Group B (P = 0.001). Furthermore, in both group SWL success rates was a significantly higher for stones with lower attenuation <830 HU than with stones >830 HU (P < 0.034). SSD were statistically differences in SWL outcome (P < 0.02). Simultaneous consideration of three parameters stone size, stone attenuation value, and SSD; we found that stone-free rate (SFR) was 100% for stone attenuation value <830 HU for stone <10 mm or >10 mm but total number SWL sessions and shock waves required for the larger stone group were higher than in the smaller group (P < 0.01). Furthermore, SFR was 83.3% and 37.5% for stone <10 mm, mean HU >830, SSD 90 mm and SSD >120 mm, respectively. On the other hand, SFR was 52.6% and 28.57% for stone >10 mm, mean HU >830, SSD <90 mm and SSD >120 mm, respectively. Conclusion: Stone size, stone density (HU), and SSD is simple to calculate and can be reported by radiologists to applying combined score help to augment predictive power of SWL, reduce cost, and improving of treatment strategies.
  2,206 264 -
Role of 64 slice multidetector computed tomography and angiography to establish relationship between tumor size, aneurysm formation and spontaneous rupture of renal angiomyolipomas: Single center experience
Shruti P Gandhi, Bipin Chandra Pal, Kajal N Patel, Harsh Sutariya, Hargovind L Trivedi
April-June 2016, 8(2):173-177
DOI:10.4103/0974-7796.172213  PMID:27141187
Objective: To evaluate the role of computed tomography (CT) angiography using 64 slice multidetector CT scan to establish relationships among tumor size, aneurysm formation, and spontaneous rupture of renal angiomyolipomas (AML). Materials and Methods: Total 27 patients were diagnosed as having renal angiomyolipoma (AML) at institute of kidney disease and research center from June 2008 to June 2015. All patients with renal AML underwent contrast-enhanced CT (CECT) with CT angiography with 64 slice multidetector CT scan. Kidneys were divided into two groups; unruptured and ruptured AML based on CT findings. The single largest lesion in each kidney was evaluated for tumor size on CECT. CT angiography images were evaluated for size of an aneurysm if present; in each group. Tumor and aneurysm sizes were compared, and multiple regression analysis was performed to identify factors affecting the rupture. Results: Total 34 kidneys were found to be affected by AML. Out of which 6 AML were ruptured and remaining 28 were unruptured. If tumor size of 4 cm or larger is used as predictor of rupture; sensitivity 20%, specificity 89%, positive predictive value 83.3%, and negative predictive value 28.5%; and If aneurysm size >5 mm is used as predictor of rupture; sensitivity 75%, specificity 90%, positive predictive value 50%, and negative predictive value 96.4% was found. Conclusion: Tumor size, aneurysm size and tumor multiplicity cannot use as a predictor of spontaneous rupture of the tumor.
  2,209 258 -
Deep sedation in GreenLight laser prostatectomy
Fotini Fligou, Panagiotis Kallidonis, Nicolaos Flaris, Abdulrahman Al-Aown, Iason Kyriazis, Marinos Vasilas, Vasilis Panagopoulos, Petros Perimenis, Evangelos Liatsikos, Theofanis Vrettos
April-June 2016, 8(2):203-207
DOI:10.4103/0974-7796.177195  PMID:27141193
Introduction: Evaluation of ketamine and propofol combination for the performance of photoselective vaporization of prostate (PVP). Patients and Methods: Twenty-six patients undergoing PVP for benign prostatic hyperplasia were included in the study. Co-morbidities were present in 24 patients. Midazolam 2 mg intravenous was administered for the induction to anesthesia. Propofol (10 mg/ml) and ketamine (1 mg/ml) were administered with the use of two pumps. An initial bolus dose of 0.03 ml/kg of propofol and 5 mg of ketamine was administered intravenously. The anesthesia was maintained by continuous infusion of 0.01 ml/kg/min of propofol and 2 ml/min of ketamine. Fentanyl was administered when deemed necessary. The level of sedation, peri-operative parameters and side-effects were recorded. Results: The average periods from the induction of anesthesia and intraoperative infusion were 12.38 ± 5.84 min and 59.5 ± 22.15 min, respectively. Average propofol and total ketamine dose were 85.5 ± 10.62 μg/kg/min and 144.9 ± 45.62 mg, respectively. The average dose of fentanyl administered was 29.81 ± 27.40 μcg. An average period between the end of the infusion and the discharge to the urology clinic was 34.62 ± 22.89 min. Ten patients experienced nausea and five eventually vomited. Hallucinations were observed in five cases while visual disturbances in two patients. Conclusion: The combined use of ketamine and propofol for the performance of PVP proved to be an efficient method for anesthesia. The “deep sedation” provided by these drugs was not associated with significant side-effects. Moreover, the use of the above method is indicated in patients with significant co-morbidities that should undergo PVP.
  2,183 244 -
Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for testicular germ cell tumors
Mohammed Alotaibi, Ahmad Saadeddin, Shouki Bazarbashi, Sultan Alkhateeb, Abdullah Alghamdi, Khalid Alghamdi, Esam Murshid, Ashraf Abusamra, Danny Rabah, Imran Ahmad, Mubarak Al-Mansour, Abdullah Alsharm
April-June 2016, 8(2):141-145
DOI:10.4103/0974-7796.179240  PMID:27141181
This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with testicular germ cell tumors. It is categorized according to the stage of the disease using the tumor-node-metastasis staging system 7th edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Considerations to the local availability of drugs, technology and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with testicular germ cell tumors.
  2,038 344 -
Undiagnosed prostatic malignancy at the time of radical cystoprostatectomy after prior prostatic radiation therapy
Pranav Sharma, Kamran Zargar-Shoshtari, Philippe E Spiess, Wade J Sexton, Michael A Poch
April-June 2016, 8(2):151-156
DOI:10.4103/0974-7796.163797  PMID:27141183
Purpose: We determined the prevalence of prostatic malignancy in patients undergoing radical cystoprostatectomy (RC) for urothelial carcinoma (UC) with a history of radiation therapy (XRT) treatment for prostatic adenocarcinoma (PCa). Materials and Methods: Fifty-three men who underwent a RC for UC that were previously treated for PCa with XRT were retrospectively identified. Pathology reports were reviewed to assess for residual PCa or prostatic UC at the time of surgery. Results: Thirteen (25%) patients had residual PCa, 16 (30%) had prostatic UC, and 8 (15%) had both. Sixteen (30%) patients had no evidence of prostatic disease. Patients with PCa had median tumor volume of 2.2 cc (interquartile range: 1.2–2.5 cc) and one-third had high-risk features (Gleason score >8 or pT3-T4 disease). Sixteen of 24 patients (67%) with prostatic UC had a stromal invasion, 5 (21%) had a ductal invasion, and 3 (13%) had carcinoma in situ. Tumors at bladder neck or trigone during transurethral resection were predictive of prostatic UC (odds ratio: 4.32, 95% confidence interval: 1.2–15.5, P = 0.025). Conclusions: Despite prior XRT for PCa, less than one-third of patients had no prostatic disease at the time of RC. Routine prostatic sampling should be considered in these patients especially if considering the orthotopic diversion.
  2,159 201 -
Prostate cancer nodal oligometastasis accurately assessed using prostate-specific membrane antigen positron emission tomography-computed tomography and confirmed histologically following robotic-assisted lymph node dissection
Dermot B O'Kane, Nathan Lawrentschuk, Damien M Bolton
April-June 2016, 8(2):255-257
DOI:10.4103/0974-7796.179237  PMID:27141207
We herein present a case of a 76-year-old gentleman, where prostate-specific membrane antigen positron emission tomography-computed tomography (PSMA PET-CT) was used to accurately detect prostate cancer (PCa), pelvic lymph node (LN) metastasis in the setting of biochemical recurrence following definitive treatment for PCa. The positive PSMA PET-CT result was confirmed with histological examination of the involved pelvic LNs following pelvic LN dissection.
  2,165 146 -
Buerger's disease presenting as a testicular mass: A rare presentation of an uncommon disease
Jay A Roberts, Meyer Jon-Paul
April-June 2016, 8(2):249-251
DOI:10.4103/0974-7796.179238  PMID:27141205
Thromboangiitis obliterans is an uncommon nonatherosclerotic segmental inflammatory disease that predominantly affects the small and medium-sized arteries and veins of the distal extremities. It was first described in 1879 and is also known as Buerger's disease. Buerger's usually begins with ischemia of small vessels producing digital infarcts and may progress to more proximal arteries and veins, producing claudication of the feet, legs, hands, or arms. Tobacco smoking is essential to the initiation and the progression of disease and it typically occurs in males under the age of 45 years. Although Buerger's most commonly affects the arms, hands, legs, and feet, it has also been reported in other vascular beds including cerebral, coronary, renal, mesenteric, and pulmonary arteries. There are also a small number of cases involving the male genitalia. To our knowledge, there has only been one English case of Buerger's involving the testis, published in 1940. Here, we present a new case of Buerger's presenting as a testicular mass in a 17-year-old cannabis smoker.
  1,975 267 -
RE: Emphysematous pyelonephritis: Is nephrectomy warranted?
Mohd Nazli Kamarulzaman, Siti Kamariah Che Mohamed
April-June 2016, 8(2):258-259
DOI:10.4103/0974-7796.179236  PMID:27141208
  1,636 257 -