Scielo RSS <![CDATA[International braz j urol]]> vol. 41 num. 3 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[Bladder Neck Reconstruction in Radical Prostatectomy: What we still can learn and improve?]]> <![CDATA[Best videos of the year for the International Brazilian Journal of Urology 2014]]> <![CDATA[Opinion: Why I prefer the infrapubic access]]> <![CDATA[Opinion: Why I prefer the penoscrotal access]]> <![CDATA[Efficacy of Antibiotic Prophylaxis in Cystoscopy to Prevent Urinary Tract Infection: a Systematic Review and Meta-Analysis]]> <title>ABSTRACT</title><sec><title>Objective:</title><p>To estimate the efficacy of antibiotic prophylaxis to prevent urinary tract infection in patients (both gender) who undergo a cystoscopy with sterile urine.</p></sec><sec><title>Materials and Methods:</title><p>Search strategy (January 1980-December 2013) in Medline via PubMed, CENTRAL, and EMBASE. Additionally, we searched databases for registered trials and conference abstracts, as well as reference lists of systematic reviews and included studies. Seven published randomized clinical trials (January 1, 1980 to December 31, 2013) were included in quantitative analyses with no language restrictions. Two independent reviewers collected data. Risk of bias was evaluated with the Cochrane Collaboration tool. We performed a fixed effect analyses due to statistical homogeneity. The primary outcome was urinary tract infection and the secondary was asymptomatic bacteriuria. The effect measure was the risk difference (RD) with 95% confidence interval. The planned interventions were: Antibiotic vs placebo; Antibiotic vs no intervention and Antibiotic vs any other intervention.</p></sec><sec><title>Results:</title><p>3038 patients were found in seven studies. For the primary outcome, we included 5 studies and we found a RR 0.53 CI95% (0.31, 0.90) and a RD-0.012 CI95% (-0.023,-0.002), favoring antibiotic prophylaxis. For asymptomatic bacteriuria we included 6 studies and we found a RR 0.28 CI95% (0.20, 0.39) and a RD-0.055 CI95% (-0.07,-0.039), was found favoring prophylaxis. According to GRADE evaluation, we considered moderate quality of evidence for both outcomes. The subgroup analysis showed that only two studies were classified as having low risk of bias: Cam 2009 and García-Perdomo 2013. They showed no statistical differences (RD-0.009 CI95% -0.03, 0.011).</p></sec><sec><title>Conclusions:</title><p>Based on studies classified as low risk of bias, we found moderate evidence to not recommend the use of antibiotic prophylaxis to prevent urinary tract infection and asymptomatic bacteriuria in patients who undergo cystoscopy with sterile urine in an ambulatory setting.</p></sec> <![CDATA[Optimal duration of androgen deprivation therapy following radiation therapy in intermediate- or high-risk non-metastatic prostate cancer: A systematic review and meta-analysis]]> <title>ABSTRACT</title><sec><title>Objectives:</title><p>To investigate current evidence on the optimal duration of adjuvant hormone deprivation for prostate cancer treated with radiation therapy with curative intent.</p></sec><sec><title>Materials and Methods:</title><p>A systematic search was performed in electronic databases. Data from randomized trials comparing different durations of hormone blockade was collected for pooled analysis. Overall survival, disease-free survival, disease-specific survival and toxicity were the outcomes of interest. Meta-analyses were performed using random-effects model.</p></sec><sec><title>Results:</title><p>Six studies met the eligibility criteria. For overall survival, the pooled data from the studies demonstrated a statistically significant benefit for longer hormone deprivation (Hazard Ratio 0.84; 95% CI 0.74 – 0.96). A statistically significant benefit was also found for disease-free survival (Hazard Ratio 0.74; 95% CI 0.62 – 0.89), and disease-specific survival (Hazard Ratio 0.73; 95% CI 0.62 – 0.85). Studies with longer blockade duration arm demonstrated greater benefit. Toxicity was low, with no increase in cardiovascular events.</p></sec><sec><title>Conclusions:</title><p>Longer duration of androgen deprivation combined to radiotherapy prolongs OS, DFS and DSS in patients with intermediate and high-risk non-metastatic prostate cancer. However, this evidence is based on trials using older radiation techniques, and further research of combination of androgen deprivation and new RT technologies may be warranted.</p></sec> <![CDATA[Dosimetric Coverage of the Prostate, Normal Tissue Sparing, and Acute Toxicity with High-Dose-Rate Brachytherapy for Large Prostate Volumes]]> <title>ABSTRACT</title><sec><title>Purpose</title><p>To evaluate dosimetric coverage of the prostate, normal tissue sparing, and acute toxicity with HDR brachytherapy for large prostate volumes.</p></sec><sec><title>Materials and Methods</title><p>One hundred and two prostate cancer patients with prostate volumes &gt;50 mL (range: 5-29 mL) were treated with high-dose-rate (HDR) brachytherapy ± intensity modulated radiation therapy (IMRT) to 4,500 cGy in 25 daily fractions between 2009 and 2013. HDR brachytherapy monotherapy doses consisted of two 1,350-1,400 cGy fractions separated by 2-3 weeks, and HDR brachytherapy boost doses consisted of two 950-1,150 cGy fractions separated by 4 weeks. Twelve of 32 (38%) unfavorable intermediate risk, high risk, and very high risk patients received androgen deprivation therapy. Acute toxicity was graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.</p></sec><sec><title>Results</title><p>Median follow-up was 14 months. Dosimetric goals were achieved in over 90% of cases. Three of 102 (3%) patients developed Grade 2 acute proctitis. No variables were significantly associated with Grade 2 acute proctitis. Seventeen of 102 (17%) patients developed Grade 2 acute urinary retention. American Urological Association (AUA) symptom score was the only variable significantly associated with Grade 2 acute urinary retention (p=0.04). There was no ≥ Grade 3 acute toxicity.</p></sec><sec><title>Conclusions</title><p>Dosimetric coverage of the prostate and normal tissue sparing were adequate in patients with prostate volumes &gt;50 mL. Higher pre-treatment AUA symptom scores increased the relative risk of Grade 2 acute urinary retention. However, the overall incidence of acute toxicity was acceptable in patients with large prostate volumes.</p></sec> <![CDATA[Prostate cancer volume estimations based on transrectal ultrasonography-guided biopsy in order to predict clinically significant prostate cancer]]> <title>ABSTRACT</title><sec><title>Introduction:</title><p>Tumor diameter is a reliable parameter to estimate tumor volume in solid organ cancers; its use in prostate cancer is controversial since it exhibits a more irregular pattern of growth. This study aimed to examine the association between the tumor volume estimations based on transrectal ultrasound (TRUS) guided biopsy results and the tumor volume measured on the pathological specimen.</p></sec><sec><title>Materials and Methods:</title><p>A total of 237 patients who underwent radical retropubic prostatectomy (RRP) were included in this retrospective study. The differences and correlations between cancer volume estimations based on TRUS guided biopsy findings and cancer volume estimations based on post-prostatectomy pathology specimens were examined. In addition, diagnostic value of TRUS guided biopsy-based volume estimations in order to predict clinically significant cancer (&gt;0.5 cc) were calculated.</p></sec><sec><title>Results:</title><p>The mean cancer volume estimated using TRUS biopsy results was lower (5.5±6.5 cc) than the mean cancer volume calculated using prostatectomy specimens (6.4±7.6 cc) (p&lt;0.041). TRUS guided biopsy examination resulted in 5 false positive and 15 false negative cases. There was a significant but weak correlation between the two parameters (r=0.62, p&lt;0.001). The sensitivity and specificity of TRUS guided biopsy in predicting the presence of clinically significant cancer was 93.4% (95% CI, 89.1-96.1) and 50.0% (95% CI, 20.1-79.9), respectively.</p></sec><sec><title>Conclusions:</title><p>TRUS guided biopsy-derived estimations seem to have a limited value to predict pathologically established tumor volume. Further studies are warranted to identify additional methods that may more accurately predict actual pathological characteristics and prognosis of prostate cancer.</p></sec> <![CDATA[Probability of Extraprostatic Disease According to the Percentage of Positive Biopsy Cores in Clinically Localized Prostate Cancer]]> <title>ABSTRACT</title><sec><title>Objective</title><p>Prediction of extraprostatic disease in clinically localized prostate cancer is relevant for treatment planning of the disease. The purpose of this study was to explore the usefulness of the percentage of positive biopsy cores to predict the chance of extraprostatic cancer.</p></sec><sec><title>Materials and Methods</title><p>We evaluated 1787 patients with localized prostate cancer submitted to radical prostatectomy. The percentage of positive cores in prostate biopsy was correlated with the pathologic outcome of the surgical specimen. In the final analysis, a correlation was made between categorical ranges of positive cores (10% intervals) and the risk of extraprostatic extension and/or bladder neck invasion, seminal vesicles involvement or metastasis to iliac lymph nodes. Student's t test was used for statistical analysis.</p></sec><sec><title>Results</title><p>For each 10% of positive cores we observed a progressive higher prevalence of extraprostatic disease. The risk of cancer beyond the prostate capsule for &lt;10% positive biopsy cores was 7.4% and it increased to 76.2% at the category 90-100% positive cores. In patients with Gleason grade 4 or 5, the risk of extraprostatic cancer prostate was higher than in those without any component 4 or 5.</p></sec><sec><title>Conclusion</title><p>The percentage of positive cores in prostate biopsy can predict the risk of cancer outside the prostate. Our study shows that the percentage of positive prostate biopsy fragments helps predict the chance of extraprostatic cancer and may have a relevant role in the patient's management.</p></sec> <![CDATA[A new technique of bladder neck reconstruction during radical prostatectomy in patients with prostate cancer]]> <title>ABSTRACT</title><sec><title>Purpose:</title><p>To evaluate continence after radical prostatectomy in prostate cancer patients, in whom a new method of the bladder neck reconstruction (BNR) using deep dorsal stitch was implemented (deep single stitch through all bladder layers directly dorsal to the bladder opening after “tennis racket” reconstruction) and to provide justification for its use by means of anatomical study in cadavers.</p></sec><sec><title>Material and Methods:</title><p>Open radical retropubic prostatectomy was performed in 84 patients: 39 patients with a new BNR method used to improve continence and control group of 45 patients with standard “tennis racket” BNR. Median follow-up was 14 months in control group and 12 months in study group. Continence recovery was accessed early postoperatively and every 3 months thereafter. Anatomical study was performed on 2 male fresh cadavers reproducing two different BNR techniques to clarify any underlying continence related mechanisms.</p></sec><sec><title>Results:</title><p>Patients with new BNR achieved full continence significantly faster (p=0.041), but the continence rates after 12 months were similar between groups. The severity of incontinence up to month 9 was significantly reduced in BNR group. The anastomotic stricture rate was not affected. Applying new BNR to the cadaver model revealed effects on early continence, namely presence of proximal passive closure mechanism in area of bladder neck.</p></sec><sec><title>Conclusions:</title><p>Continence in patients with the new BNR method using deep dorsal stitch recovered significantly faster. Moreover, a reduced grade of residual incontinence was documented. The effect was non-significant at month 12 of follow-up, meaning that only early effect was present.</p></sec> <![CDATA[Anesthesiologic Effects of Transperitoneal Versus Extraperitoneal Approach During Robot-Assisted Radical Prostatectomy: Results of a Prospective Randomized Study]]> <title>ABSTRACT</title><sec><title>Objectives:</title><p>To compare the effects of CO<sub>2</sub> insufflation on hemodynamics and oxygen levels and on acid-base level during Robot-Assisted Radical Prostatectomy (RARP) with transperitoneal (TP) versus extra-peritoneal (EP) accesses.</p></sec><sec><title>Materials and Methods:</title><p>Sixty-two patients were randomly assigned to TP (32) and EP (30) to RARP. Pre-operation data were collected for all patients. Hemodynamic, respiratory and blood acid-base parameters were measured at the moment of induction of anesthesia (T0), after starting CO<sub>2</sub> insuffation (T1), and at 60 (T2) and 120 minutes (T3) after insufflation. In all cases, the abdominal pressure was set at 15 mmHg. Complications were reported according to the Clavien-Dindo classification. Student's two–t-test, with a significance level set at p&lt;0.05, was used to compare categorical values between groups. The Mann-Whitney U-test was used to compare the median values of two nonparametric continuous variables.</p></sec><sec><title>Results:</title><p>The demographic characteristics of the patients in both groups were statistically comparable. Analysis of intra-operative anesthesiologic parameters showed that partial CO<sub>2</sub> pressure during EP was significantly higher than during TP, with a consequent decrease in arterial pH. Other parameters analysed were similar in the two groups. Postoperative complications were comparable between groups. The most important limitations of this study were the small size of the patient groups and the impossibility of maintaining standard abdominal pressure throughout the operational phases, despite attempts to regulate it.</p></sec><sec><title>Conclusions:</title><p>This prospective randomized study demonstrates that, from the anesthesiologic viewpoint, during RARP the TP approach is preferable to EP, because of lower CO<sub>2</sub> reabsorption and risk of acidosis.</p></sec> <![CDATA[Utilization and perioperative complications of laparoscopic cryoablation vs. robotic partial nephrectomy for localized renal tumors]]> <title>ABSTRACT</title><sec><title>Objective:</title><p>To compare the utilization, perioperative complications and predictors of LCA versus RPN in the treatment of localized renal tumors.</p></sec><sec><title>Methods:</title><p>From the Nationwide Inpatient Sample we identified patients undergoing RPN or LCA for the treatment of localized renal tumors from October 2008 through 2010. Patient and hospital-specific factors which predict postoperative complications and use of LCA were investigated.</p></sec><sec><title>Results:</title><p>14,275 patients with localized renal tumors were identified: 70.3% had RPN and 29.7% had LCA. LCA was more common in older patient and at hospitals without robotic consoles. No difference was identified in perioperative complications (0.2% vs. 0.2%), transfusion (5.1% vs. 6.2%), length of stay (2.9 vs. 3.0 days) or median cost ($41,753 vs. $44,618) between the groups, LCA vs. RPN. On multivariate analysis sicker patients were more likely to have LCA (OR 1.34, p=0.048) and sicker patients had greater postoperative complications (OR 3.30, p&lt;0.001); LCA did not predict more complications (OR 1.63, p=0.138) and LCA was performed at hospitals without RCs (OR 0.02, p&lt;0.001). Limitations include observational study design, inability to assess disease severity, operative time, or body mass index, which may affect patient selection and outcomes.</p></sec><sec><title>Conclusions:</title><p>More patients had RPN vs. LCA; surgical technique was not predictive of postoperative complications. As technology develops to treat localized renal tumors, it will be important to continue to track outcomes and costs for procedures including RPN and LCA.</p></sec> <![CDATA[Feasibility, complications and oncologic results of a limited inguinal lymph node dissection in the management of penile cancer]]> <title>ABSTRACT</title><sec><title>Purpose:</title><p>In patients with penile cancer (PeCa) and increased risk of inguinal lymphatic dissemination, inguinal lymphadenectomy offers a direct histological staging as the most reliable tool for assessment of the nodal metastasic status and a definitive oncologic treatment simultaneously. However, peri- and/or postoperative mutilating sequalae often occurn. We report on clinical outcome and complications of a limited inguinal lymph node (LN) dissection.</p></sec><sec><title>Materials and Methods:</title><p>Clinical and histopathological data of all patients with PeCa who underwent limited inguinal lymphadenectomy (LIL) at our institution between 1986 and 2012 were comprehensively analyzed. Perioperative results were presented in relation to one-sided procedures, if appropriate, which were assessed without cross comparison with contralateral LILs.</p></sec><sec><title>Results:</title><p>29 consecutive patients with PeCa aged 60±10.3 years were included in the current study with 57 one-sided LIL performed. Mean operative time for one-sided LIL was 89.0±37.3 minutes with 8.1±3.7 LNs removed. A complication rate of 54.4% (n=31), including 16 minor and 15 major complications was found in a total of 57 procedures with leg oedema being the most prevalent morbidity (15.8%). 4 patients with clinically positive LNs developed inguinal lymphatic recurrence within 9 months after surgery.</p></sec><sec><title>Conclusions:</title><p>Our technique of limited inguinal LN dissection provided an acceptable complication rate without aggravating morbidity. We experienced no recurrences in clinically LN negative patients, so that the approach might be a reasonable option in this scenario. In patients with enlarged LNs, radical inguinal lymphadenectomy still appears to represent the gold standard.</p></sec> <![CDATA[Percutaneous nephrolithotomy in patients with solitary kidney: a critical outcome analysis]]> <title>ABSTRACT</title><sec><title>Purpose:</title><p>To describe our experience with percutaneous nephrolithotomy (PCNL) in patients with solitary kidneys and analyze factors that can impact on intra-operative bleeding and postoperative complications.</p></sec><sec><title>Materials and Methods:</title><p>We reviewed our stone database searching for patients with solitary kidney who underwent PCNL from Jan-05 through Oct-13. Demographic data, stone characteristics, and intra- and postoperative outcomes were recorded. Spearman correlation was performed to assess which variables could impact on bleeding and surgical complications. Linear and logistic regressions were also performed.</p></sec><sec><title>Results:</title><p>Twenty-seven patients were enrolled in this study. The mean age and BMI were 45.6 years and 28.8Kg/m<sup>2</sup>, respectively; 45% of cases were classified as Guys 3 (partial staghorn or multiple stones) or 4 (complete staghorn) – complex cases. Stone-free rate was 67%. Eight (29.6%) patients had postoperative complications (five of them were Clavien 2 and three were Clavien 3). On univariate analysis only number of tracts was associated with increased bleeding (p=0.033) and only operative time was associated with a higher complication rate (p=0.044). Linear regression confirmed number of access tracts as significantly related to bleeding (6.3, 95%CI 2.2-10.4; p=0.005), whereas logistic regression showed no correlation between variables in study and complications.</p></sec><sec><title>Conclusions:</title><p>PCNL in solitary kidneys provides a good stone-free rate with a low rate of significant complications. Multiple access tracts are associated with increased bleeding.</p></sec> <![CDATA[Studying inhibition of calcium oxalate stone formation: an in <italic>vitro</italic> approach for screening hydrogen sulfide and its metabolites]]> <title>ABSTRACT</title><sec><title>Purpose:</title><p>Calcium oxalate urolithiasis is one of the most common urinary tract diseases and is of high prevalence. The present study proposes to evaluate the antilithiatic property of hydrogen sulfide and its metabolites like thiosulfate &amp; sulfate in an in vitro model.</p></sec><sec><title>Materials and Methods:</title><p>The antilithiatic activity of sodium hydrogen sulfide (NaSH), sodium thiosulfate (Na<sub>2</sub>S<sub>2</sub>O<sub>3</sub>) and sodium sulfate (Na<sub>2</sub>SO<sub>4</sub>) on the kinetics of calcium oxalate crystal formation was investigated both in physiological buffer and in urine from normal and recurrent stone forming volunteers. The stones were characterized by optical and spectroscopic techniques.</p></sec><sec><title>Results:</title><p>The stones were characterized to be monoclinic, prismatic and bipyramidal habit which is of calcium monohydrate and dihydrate nature. The FTIR displayed fingerprint corresponding to calcium oxalate in the control while in NaSH treated, S=O vibrations were visible in the spectrum. The order of percentage inhibition was NaSH&gt;Na<sub>2</sub>S<sub>2</sub>O<sub>3</sub>&gt;Na<sub>2</sub>SO<sub>4</sub>.</p></sec><sec><title>Conclusion:</title><p>Our study indicates that sodium hydrogen sulfide and its metabolite thiosulfate are inhibitors of calcium oxalate stone agglomeration which makes them unstable both in physiological buffer and in urine. This effect is attributed to pH changes and complexing of calcium by S<sub>2</sub>O<sub>3</sub><sup>2</sup>-and SO<sub>4</sub><sup>2</sup>- moiety produced by the test compounds.</p></sec> <![CDATA[Antilithiatic Activity of phlorotannin rich extract of <italic>Sarghassum Wightii</italic> on Calcium Oxalate Urolithiais – <italic>In Vitro</italic> and <italic>In Vivo</italic>Evaluation]]> <title>ABSTRACT</title><sec><title>Purpose:</title><p>Urolithiasis is a common urological disorder responsible for serious human affliction and cost to the society with a high recurrence rate. The aim of the present study was to systematically evaluate the phlorotannin rich extract of <italic>Sargassum wightii</italic> using suitable in vitro and in vivo models to provide scientific evidence for its antilithiatic activity.</p></sec><sec><title>Materials and Methods:</title><p>To explore the effect of <italic>Sargassum wightii</italic> on calcium oxalate crystallization, in vitro assays like crystal nucleation, aggregation and crystal growth were performed. Calcium oxalate urolithiasis was induced in male Sprague dawley rats using a combination of gentamicin and calculi producing diet (5% ammonium oxalate and rat pellet feed). The biochemical parameters like calcium, oxalate, magnesium, phosphate, sodium and potassium were evaluated in urine, serum and kidney homogenates. Histopathological studies were also done to confirm the biochemical findings.</p></sec><sec><title>Results:</title><p>The yield of <italic>Sargassum wightii</italic> extract was found to be 74.5 gm/kg and confirmed by quantitative analysis. In vitro experiments with <italic>Sargassum wightii</italic> showed concentration dependent inhibition of calcium oxalate nucleation, aggregation and growth supported by SEM analysis. In the in vivo model, <italic>Sargassum wightii</italic>reduced both calcium and oxalate supersaturation in urine, serum and deposition in the kidney. The biochemical results were supported by histopathological studies.</p></sec><sec><title>Conclusion:</title><p>The findings of the present study suggest that <italic>Sargassum wightii</italic> has the ability to prevent nucleation, aggregation and growth of calcium oxalate crystals. <italic>Sargassum wightii</italic> has better preventive effect on calcium oxalate stone formation indicating its strong potential to develop as a therapeutic option to prevent recurrence of urolithiasis.</p></sec> <![CDATA[Flowmetry/pelvic floor electromyographic findings in patients with detrusor overactivity]]> <title>ABSTRACT</title><p>To evaluate different flowmetry/EMG patterns in patients with proven detrusor overactivity (DO) and compare them with that of a group of patients with lower urinary tract symptoms (LUTS) but without DO.</p><sec><title>Materials and Methods</title><p>We retrospectively evaluated the records of 100 patients with frequent urinary tract infection or any kind of storage or voiding symptoms that had undergone urodynamic testing: 50 cases with proven DO on cystometry who had a good quality flowmetry/EMG and 50 patients without DO. EMG lag time (the time distance between pelvic floor EMG inactivation and the start of urine flow) and different flow curve pattern were recorded and compared.</p></sec><sec><title>Results</title><p>The age and gender distribution were not statistically significant between the two groups. A negative lag time (≤ 0 sec) and an obstructive pattern were the only parameters that were more commonly seen in the DO group. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of a lag times &lt;2 sec for diagnosing DO were 70%, 96%, 96% and 72%, respectively. For a negative lag time, they were 52%, 100%, 100% and 63%, respectively.</p></sec><sec><title>Conclusions</title><p>A lag time &lt; 2 sec is a useful flowmetric finding that effectively rules out patients with LUTS that do not have DO (specificity and PPV=96%). With the cutoff of zero or less, specificity and PPV will be 100%. It has lower sensitivity and NPV, however, and is not measurable in a considerable population of patients with DO that have concomitant DV.</p></sec> <![CDATA[Detrusor after-contraction: a new insight]]> <title>ABSTRACT</title><sec><title>Aims:</title><p>Detrusor after-contractions (DAC) are non-common in adults. Both definition (nothing in ICS reports) and significance (artefact, link with detrusor overactivity (DO) or bladder outlet obstruction (BOO)) remain discussed. Our purpose was to carry out an analysis of the urodynamic parameters during voidings with DAC and, using the VBN model, to simulate pathophysiological conditions able to explain both voiding phase and DAC.</p></sec><sec><title>Materials and Methods:</title><p>From large urodynamic database of patients referred for evaluation of lower urinary tract dysfunction, DAC were observed in 60 patients (5.7%). Criteria for DAC were post-void residual &lt;30mL and increase of detrusor pressure &gt;10cmH<sub>2</sub>O. VBN model was used for analysis of both pressure and flow curves, and simulations of pathophysiological conditions.</p></sec><sec><title>Results:</title><p>Onset of DAC (ODAC) occurred when Q=7.3±5.7mL/s and bladder volume=17.9±15.4mL. Urgency-frequency syndrome and urodynamic diagnosis of DO were the more frequent scenarios associated with DAC. ODAC was associated to an inversion of the slope of detrusor pressure curve without any perturbation in flow curve. Among tested pathophysiological hypothesis (great, abnormal, detrusor force, sphincter contraction), none allowed restoring all recorded curves (flow rate, voiding pressure and DAC).</p></sec><sec><title>Conclusion:</title><p>No urodynamic characteristic of the first part of voiding is an index of occurrence of DAC. ODAC is a significant phenomenon linked with the bladder collapse. DAC is not associated with BOO but more probably with DO and appears as the result of local conditions in an almost empty bladder (concentration of stresses around a transducer); thus DAC seems of weak clinical significance.</p></sec> <![CDATA[Patient and partner outcome of inflatable and semi-rigid penile prosthesis in a single institution]]> <title>ABSTRACT</title><sec><title>Introduction:</title><p>Penile prostheses are subject to a continuous development and have gained better mechanical reliability and safety during the last decades. In this study, we aimed to investigate the outcomes and satisfaction rates of inflatable penile prosthesis (IPP) and semirigid penile prosthesis (SPP) implantation.</p></sec><sec><title>Materials and Methods:</title><p>From August 2001 to June 2012, 257 men with erectile dysfunction (ED) underwent penile prosthesis implantation (PPI) at our institution. Of the 257 patients, 118 underwent implantation of IPP and 139 underwent SPP implantation. The pre-operative and post-operative erectile status of the patients were assessed by international index of erectile function (IIEF) questionnaire. The satisfaction of patients and partners were evaluated by a telephone interview using the erectile dysfunction inventory of treatment satisfaction (EDITS) questionnaire and EDITS partner survey.</p></sec><sec><title>Results:</title><p>The overall major complication rate was higher in IPP group. PPI led to a significant improvement in IIEF scores in both groups. For IPP and SPP groups the average EDITS scores were 78±11and 57±8, respectively, and that for the partners were 72±10 and 49±7, respectively (p&lt;0.05).</p></sec><sec><title>Conclusion:</title><p>Although the IPP implantation have better satisfaction rates, the SPP implantation is still a viable treatment option in the surgical treatment of ED because of low cost and high durability with acceptable satisfaction rates.</p></sec> <![CDATA[Quality of life evaluation of patients with neurogenic bladder submitted to reconstructive urological surgeries preserving the bladder]]> <title>ABSTRACT</title><p>Treatment of neurogenic bladder (BN) aims to upper urinary tract protection. When the conservative clinical measures are insufficient, surgical treatment is indicated. Though admittedly important, the quality of life (QoL) has been little studied in these patients, there are even contradictory results. The aim of this study was to evaluate QoL before and after bladder augmentation in patients with BN refractory to medical treatment. We analyzed, prospectively, the data of 67 patients who underwent surgical treatment for BN by questionnaire SF-36® and Qualiveen® QoL before and after six months of operation. Comparisons using paired t-tests and Wilcoxon and the assumption of normality was assessed using the Shapiro-Wilk test were made. According to the analysis of the SF-36® questionnaire, the patients had higher QoL indices in the postoperative period in the areas functional capacity, general state of health, vitality, social aspects, emotional aspects and mental health (n = 67; p &lt;0.05). The questionnaire also revealed Qualiveen® best result in quality of life index in the postoperative period, and show lower specific negative impact by urinary problems (n = 36; p &lt;0.05). The results show that, despite not being the main objective, the bladder augmentation results in significant improvement in QoL, probably related to the perception of better health and the resolution of urinary incontinence. Thus, the bladder augmentation associated with other urologic reconstruction techniques allows the upper urinary tract protection, and contribute to a better quality of life of patients with BN.</p> <![CDATA[Relationship between pseudoexfoliation syndrome and erectile dysfunction: a possible cause of endothelial dysfunction for development of erectile dysfunction]]> <title>ABSTRACT</title><sec><title>Objectives:</title><p>Pseudoexfoliation syndrome (PES) is a common age-related fibrillopathy related to accumulation of pseudoexfoliation material (PEM) in certain places in the body, especially blood vessels. Erectile dysfunction (ED) is another condition related to vascular pathology and in this study it is aimed to identify the relationship between ED and PES.</p></sec><sec><title>Materials and Methods:</title><p>Data of 92 patients were investigated. There were 34 patients in the PES group and 58 patients in the control group. Presence of diabetes, hypertension, smoking history, BMI, and serum levels of lipids and testosterone were recorded. The groups were compared for ED rates and severity. Also logistic regression analysis was performed to identify independent risk factors for development of ED.</p></sec><sec><title>Results:</title><p>Mean age of the population was 67.3. No significant difference was observed between the two groups regarding the presece of DM, HT, smoking, BMI and laboratory measurements. ED rate was significantly higher in the PES group (70.6% vs 48.3%, p=0.002). Also, severe ED rate was higher in the PES group (p=0.002). PES was detected as an independent risk factors for the development of ED.</p></sec><sec><title>Conclusion:</title><p>ED is a possible consequence of PES. ED rate and severity is found to be higher in the PES group and PES is detected as an independent risk factor for development of ED. Patients with PES should be informed about development of ED and further prospective trials with objective measurements of penile blood flow should be conducted to verify the erectile status and penile blood fow in PES patients.</p></sec> <![CDATA[Do Foley Catheters Adequately Drain the Bladder? Evidence from CT Imaging Studies]]> <title>ABSTRACT</title><sec><title>Introduction:</title><p>The Foley catheter has been widely assumed to be an effective means of draining the bladder. However, recent studies have brought into question its efficacy. The objective of our study is to further assess the adequacy of Foley catheter for complete drainage of the bladder.</p></sec><sec><title>Materials and Methods:</title><p>Consecutive catheterized patients were identified from a retrospective review of contrast enhanced and non-contrast enhanced computed tomo-graphic (CT) abdomen and pelvis studies completed from 7/1/2011-6/30/2012. Residual urine volume (RUV) was measured using 5mm axial CT sections as follows: The length (L) and width (W) of the bladder in the section with the greatest cross sectional area was combined with bladder height (H) as determined by multiplanar reformatted images in order to calculate RUV by applying the formula for the volume (V) of a sphere in a cube: V=(ϖ/6)*(L*W*H).</p></sec><sec><title>Results:</title><p>RUVs of 167 (mean age 67) consecutively catheterized men (n=72) and women (n=95) identified by CT abdomen and pelvis studies were calculated. The mean RUV was 13.2 mL (range: 0.0 mL-859.1 mL, standard deviation: 75.9 mL, margin of error at 95% confidence:11.6 mL). Four (2.4%) catheterized patients had RUVs of &gt;50 mL, two of whom had an improperly placed catheter tip noted on their CT-reports.</p></sec><sec><title>Conclusions:</title><p>Previous studies have shown that up to 43% of catheterized patients had a RUV greater than 50 mL, suggesting inadequacy of bladder drainage via the Foley catheter. Our study indicated that the vast majority of patients with Foley catheters (97.6%), had adequately drained bladders with volumes of &lt;50 mL.</p></sec> <![CDATA[Ultrasound evaluation of obstructive uropathy and its hemodynamic responses in southwest Nigeria]]> <title>ABSTRACT</title><sec><title>Purpose:</title><p>To determine the renal arterial hemodynamic changes induced by obstructive uropathy using Doppler ultrasonography.</p></sec><sec><title>Materials and Methods:</title><p>60 adult subjects with suspected obstructive uropathy and 60 asymptomatic apparently healthy controls with normal renal ultrasound features were evaluated.</p><p>B-mode sonography of the kidneys and spectral Doppler examination of the renal interlobar arteries of all the participants were performed. The mean resistive indices (mRI) of both interlobar arteries were obtained and compared to that of the controls. The mRI of bilaterally obstructed kidneys were also compared with the mRI of unilaterally obstructed kidneys.</p></sec><sec><title>Results:</title><p>The mRI of the right and left kidneys of subjects were 0.72±0.04 and 0.69±0.06 while those of the controls were 0.64±0.04 and 0.63±0.03 respectively. The mRI for the grades of caliectasis increased from grade I (0.72±0.03) to grade II (0.73±0.03) and grade III (0.73±0.02) but fell within the most severe levels of obstruction (0.69±0.07). There was no statistically significant relationship between the grades of caliectasis and unilateral or bilateral obstruction for both kidneys. The results show a sensitivity and specificity of 86.7% and 90% respectively when mRI≥0.7 was used to determine presence of obstruction.</p></sec><sec><title>Conclusion:</title><p>Renal duplex sonography is highly sensitive and specific for diagnosis of obstructive uropathy. Increased resistive index of the obstructed kidney may be a useful diagnostic tool in situations where intravenous urography cannot be done or is contraindicated.</p></sec> <![CDATA[To tell or not: parental thoughts on disclosure of urologic surgery to their child]]> <title>ABSTRACT</title><sec><title>Purpose:</title><p>Literature pertaining to surgical disclosure to the pediatric patient is lacking. We hypothesized parents would find it difficult to disclose urologic surgery to a child.</p></sec><sec><title>Materials and Methods:</title><p>Parents of patients &lt;5 years old undergoing urologic surgery were contacted for telephone survey. Parents were asked about future plans of surgical disclosure, comfort with disclosure, and any support received.</p></sec><sec><title>Results:</title><p>98 parents consented to study participation. 87% of surgeries were on the genitalia with 62% being minor genitalia surgery (i.e. circumcision). 70% of parents would tell their child about minor genital surgery while 84% would tell about major genital surgery (p=0.07). 4 of 20 parents of children undergoing hypospadias repair (major genital surgery) did not plan to tell their child about surgery. All parents of children undergoing non-genital surgery would tell. Of all parents planning to tell their children about surgery, only 14% were nervous. 34% of parents would find guidance in talking to their child helpful despite the majority (90%) stating no guidance had ever been provided.</p></sec><sec><title>Conclusions:</title><p>Parents seem comfortable discussing urologic surgeries with a child but about 1/3 would appreciate further counseling. 20% of parents of children undergoing hypospadias repair hope to avoid telling their child.</p></sec> <![CDATA[Metabolic and Testicular Effects of the Long-Term Administration of Different High-Fat Diets in Adult Rats]]> <title>ABSTRACT</title><sec><title>Purpose:</title><p>To evaluate the effects of different high-fat diets on body mass, carbohydrate metabolism and testicular morphology in rats seven months old.</p></sec><sec><title>Materials and Methods:</title><p>Male Wistar rats were divided into four groups: SC (standard chow), HF-S (high fat diet rich in saturated fatty acids), HF-P (high fat diet rich in polyunsaturated fatty acids), HF-SP (high fat diet rich in saturated and polyunsaturated fatty acids). The rats were fed for 16 weeks. Blood samples, testes and genital fat deposits were collected for analysis. Data were analyzed by one-way ANOVA and Bonferroni post hoc test, considering p&lt;0.05 as statistically significant.</p></sec><sec><title>Results:</title><p>Different high-fat diets promoted an increase in the body mass (p&lt;0.0001). The genital fat deposits were higher in the high-fat groups (HF-S, HF-P, HF-SP) (p=0.0004). Regarding serum parameters, the animals in the HF-S and HF-SP groups presented hyperglycemia (p=0.0060), hyperinsulinemia (p=0.0030) and hypercholesterolemia (p=0.0021). All of the hyperlipidemic groups showed hyperleptinemia (p=0.0019). Concerning the testis, the HF-S group showed a reduction on the seminiferous epithelium height (p=0.0003) and cell proliferation (p=0.0450). Seminiferous tubule diameter was lower in the HF-SP than in the SC group (p=0.0010).</p></sec><sec><title>Conclusions:</title><p>The high fat diet administration, independent of the lipid quality, promotes overweight. Diet rich in saturated fatty acids (lard) alters the carbohydrate metabolism and the testicular morphology with reductions of seminiferous epithelium height, seminiferous tubule diameter and cell proliferation which could be related to a disturbance of spermatogenesis.</p></sec> <![CDATA[Beneficial effect of pentoxifylline into the testis of rats in an experimental model of unilateral hindlimb ischemia/reperfusion injury]]> <title>ABSTRACT</title><sec><title>Objective</title><p>The objective of the present study was to investigate the role of pentoxifylline (PTX) on remote testicular injury caused by unilateral hind limb ischemia/reperfusion of rats.</p></sec><sec><title>Materials and Methods</title><p>Twenty healthy male Wistar rats were allocated randomly into two groups: ischemia/reperfusion (IR group) and ischemia/reperfusion + pentoxifylline (IR+PTX group). Ischemia was induced by placement of a rubber tourniquet at the greater trochanter for 2h. Rats in IR+PTX group received PTX (40 mg/kg IP) before the reperfusion period. At 24h after reperfusion, testes were removed and levels of superoxide dismutase (SOD), malondialdehyde (MDA), catalase (CAT) and myeloperoxidase (MPO) activity were determined in testicular tissues. Three rats of each group were used for wet/ dry weight ratio measurement. Testicular tissues were also examined histopathologically under light microscopy.</p></sec><sec><title>Results</title><p>Activities of SOD and CAT in testicular tissues were decreased by ischemia/ reperfusion (P&lt;0.05). Significantly increased MDA levels in testicular tissues were decreased by PTX treatment (P&lt;0.05). MPO activity in testicular tissues in the IR group was significantly higher than in the IR+PTX group (P&lt;0.05). The wet/dry weight ratio of testicular tissues in the IR group was significantly higher than in the IR+PTX group (P&lt;0.05). Histopathologically, there was a statistically significant difference between two groups (P&lt;0.05).</p></sec><sec><title>Conclusions</title><p>According to histological and biochemical findings, we conclude that PTX has preventive effects in the testicular injury induced by hind limb ischemia/reperfusion.</p></sec> <![CDATA[A Novel Approach for the Treatment of Radiation-Induced Hemorrhagic Cystitis with the GreenLight<sup>™</sup> XPS Laser]]> <title>ABSTRACT</title><sec><title>Introduction:</title><p>The treatment of pelvic malignancies with radiotherapy can develop severe sequelae, especially radiation-induced hemorrhagic cystitis. It is a progressive disease that can lead to the need for blood transfusion, hospitalizations, and surgical interventions. This tends to affect the quality of life of these patients, and management can at times be difficult. We have evaluated the GreenLight Xcelerated Performance System (XPS) with TruCoag, although primarily used for management of benign prostatic hypertrophy (BPH), for the treatment of radiation-induced hemorrhagic cystitis.</p></sec><sec><title>Materials and Methods:</title><p>After International Review Board (IRB) approval, a retrospective chart review was performed in addition to a literature search. A series of four male patients, mean age of 81 years, with radiation-induced hemorrhagic cystitis secondary to radiotherapy for pelvic malignancies (3 prostate cancer, 1 rectal cancer) were successfully treated with the GreenLight laser after unsuccessful treatment with current therapies described in the literature.</p></sec><sec><title>Results:</title><p>All four patients treated with the GreenLight laser had resolution of their hematuria after one treatment and were discharge from the hospital with clear urine.</p></sec><sec><title>Conclusion:</title><p>The GreenLight XPS laser shows promising results for the treatment of patients with radiation-induced hemorrhagic cystitis, and deserves further evaluation and validation, especially since there is limited data available in the literature regarding the use of this technology for the treatment of this devastating condition.</p></sec> <![CDATA[Testicular calculus: A rare case]]> <title>ABSTRACT</title><sec><title>Background:</title><p>Testicular calculus is an extremely rare case with unknown etiology and pathogenesis. To our knowledge, here we report the third case of testicular calculus. A 31-year-old man was admitted to our clinic with painful solid mass in left testis. After diagnostic work-up for a possible testicular tumour, he underwent inguinal orchiectomy and histopathologic examination showed a testicular calculus.</p></sec><sec><title>Case hypothesis:</title><p>Solid testicular lesions in young adults generally correspond to testicular cancer. Differential diagnosis should be done carefully.</p></sec><sec><title>Future implications:</title><p>In young adults with painful and solid testicular mass with hyperechogenic appearance on scrotal ultrasonography, testicular calculus must be kept in mind in differential diagnosis. Further reports on this topic may let us do more clear recommendations about the etiology and treatment of this rare disease.</p></sec> <![CDATA[Rapid intraoperative tissue expansion with Foley catheter in a challenging cripple Hypospadias]]> <title>ABSTRACT</title><p>Failed hypospadiass cases may result in hypovascular, scarred penis with residual penile chordee and leave the patient with minimal residual skin for penile resurfacing and urethroplasty. Local tissue expansion has become a good alternative to provide skin for penis by using expanders however they require long periods of time for expansion. Besides, rapid tissue expansion was also described in different tissues. We used rapid intraoperative expansion technique by using a Foley catheter in a failed hypospadias case who had minimal residual skin secondary to infection and we concluded that rapid intraoperative tissue expansion with Foley catheter is an effective, feasible reconstructive method for easy dissection and penile resurfacing in failed hypospadiass cases.</p> <![CDATA[Retroperitoneal Hygroma]]> <title>ABSTRACT</title><p>We present a 46-year-old white male with a retroperitoneal hygroma protruding from the right flank.</p> <![CDATA[Vesicoenteric fistula caused by bladder diverticulitis: MRI Findings]]> <title>ABSTRACT</title><p>We present a 46-year-old white male with a retroperitoneal hygroma protruding from the right flank.</p> <![CDATA[Distal spermatic cord peritoneal stripping: an adjunct technique during inguinal orchiopexy]]> <title>ABSTRACT</title><p>We present a 46-year-old white male with a retroperitoneal hygroma protruding from the right flank.</p> <![CDATA[Forgotten and fragmented ureteral j stent with stone formation: combined endoscopic management]]> <title>ABSTRACT</title><p>Objective : Ureteral stents are widely used in endo-urological procedures. However, ureteral stents can be forgotten and cause serious complications, including fragmentation, migration and urosepsis.</p><p>There are few reports about forgotten and fragmented ureteral stents with stone formation. We aimed to present this rare case with successful combined endo-urological management.</p> <![CDATA[RE: Validation of the brazilian version of the expanded prostate cancer index composite (EPIC) for patients submitted to radical prostatectomy]]> <title>ABSTRACT</title><p>Objective : Ureteral stents are widely used in endo-urological procedures. However, ureteral stents can be forgotten and cause serious complications, including fragmentation, migration and urosepsis.</p><p>There are few reports about forgotten and fragmented ureteral stents with stone formation. We aimed to present this rare case with successful combined endo-urological management.</p>