bluuebunny/crossref_metadata_2025 huggingface dataset:
The UREThRAL stricture score: A novel method for describing
Authors: Wiegand Lucas R. , Brandes Steven B.
Published: October 2016

Background: Urethral stricture description is not standardized. Thismakes surgical decision-making less reproducible and increasesthe difficulty of objectively analyzing urethroplasty literature. Wedeveloped a standardized system, the UREThRAL stricture score(USS), to quantify the characteristics of anterior urethral stricturedisease based on preoperative imaging and intraoperative findings.Methods: To develop the USS, we retrospectively analyzed 95consecutive patients with urethral strictures who underwent openurethroplasty by a single surgeon (SBB) at Barnes-Jewish Hospitalfrom 2009 to 2011. The USS is a numerical score based on fivecomponents of anterior urethral stricture disease that help dictateoperative decision-making: (1) (UR)ethral stricture (E)tiology; (2) (T)otal number of strictures; (3) (R)etention (luminal obliteration); (4)(A)natomic location; and (5) (L)ength. Stricture management wascategorized by increasing surgical complexity: excision/primaryanastomosis (EPA), buccal mucosal graft urethroplasty (BMG), augmented anastomotic urethroplasty (AAU), flap urethroplasty, and acombination of flaps and/or grafts. Multinomial logistic regressionanalysis was used to compare USS to surgical complexity.Results: The mean USS for EPA, BMG, AAU, flap, and combinationflaps/grafts was 5.78, 8.82, 9.23, 11.01, and 14.97, respectively.Increasing USS was significantly associated with surgical complexity(p < 0.0001).Interpretation: The USS describes the essential factors in determiningsurgical treatment selection for urethral stricture disease.The USS is a concise, easily applicable system that delineates theclinically significant features of urethral strictures. Valuable comparison of anterior urethral stricture treatments in clinical practiceand in the urological literature could be facilitated by using this novel UREThRAL stricture score.
Pediatric renal inflammatory myofibroblastic tumours: A case report
Authors: Czerwinski Michael , Dave Sumit
Published: October 2016

Inflammatory myofibroblastic tumours (IMTs) have been describedin lung, bladder, spleen, breast, pancreas, liver, colon, spermaticcord, prostate, peripheral nerves, orbit and kidney. Traditionallybelieved as having a reactive pathogenesis, IMTs are now viewedmore as a neoplasm. This report describes a case of a renal IMT ina 14-year-old girl with spina bifida associated neurogenic bladderand a history of recurrent urinary tract infections. This represents aunique case as pediatric renal IMTs are very rare in the literature.We discuss how this patient was managed and how she presented compared to other reported cases.
PSA density is superior than PSA and Gleason score for adverse
Authors: Sfoungaristos Stavros , Perimenis Petros
Published: October 2016

Introduction: Prostate-specific antigen (PSA) and its kinetics have changed prostate cancer screening and diagnosis. The aim of the present study was to evaluate their value in prostate cancer prognosis by determining the predictive potential of PSA density for adverse pathologic features after radical prostatectomy, in terms of positive surgical margins (PSM), extracapsular disease (ECD), seminal vesicle invasion (SVI) and/or lymph node invasion (LNI), and to compare their predictive ability with preoperative PSA and biopsy Gleason score.Methods: We retrospectively analysed 285 patients diagnosed with prostate cancer and underwent a retropubic radical prostatectomy for clinically localized disease. Data concerning preoperative PSA, biopsy Gleason score and PSA density were collected and analyzed. PSA density was calculated by dividing preoperative PSA and the pathological volume of the prostate.Results: There was a significant difference in PSA density valuesbetween patients with PSM, ECD, SVI and LNI. Areas under thecurve for PSA density were higher than those of PSA and Gleason score for all parameters of adverse pathology. In multivariate analyses, it was shown that PSA density and Gleason score were the only statistically significant predictors for PSM and ECD, PSA density and PSA for SVI and only PSA density for LNI.Conclusion: PSA density is an accurate predictor for adverse pathology prediction in patients undergoing radical prostatectomy. Theseresults demonstrate that this parameter is useful to determine the aggressiveness of prostate cancer and can be used as an adjunct in predicting outcomes after surgery.
PCPT, MTOPS and the use of 5ARIs: a Canadian consensus regarding implications for clinical practice
Authors: Klotz Laurence , Saad Fred
Published: October 2016

Objectives: Two large, recently published, definitive trials evaluated the benefitsof 5-alpha reductase inhibitors (5ARIs). The Prostate Cancer Prevention Trial(PCPT) tested the effect of finasteride for prostate cancer prevention and the Medical Therapy of Prostatic Symptoms (MTOPS) tested its effect in benign prostatic hyperplasia(BPH). Both trials were strongly positive. However, the role of 5ARIs inthe clinical management of patients remains controversial. The consensus conference,which forms the basis for this report, attempted to develop an expertopinion, based on these studies, as to the optimal use of 5ARIs in patient management.Methods: The Canadian Consensus Meeting, organized by the Canadian Urology Research Consortium and the Canadian Urologic Oncology Group, held inToronto on May 7, 2006, focused on the new data from the PCPT and the MTOPS study. Internationally recognized experts and clinicians discussedthe implications of these data on clinical practice and issued a recommendationon the optimal management of patients with BPH.Results: The Consensus meeting agreed on the following recommendations:1. The overall results from the PCPT and MTOPS studies are of importanceto the urologic, as well as to the greater medical, community.2. Prostate management guidelines should be updated to include the resultsfrom both the MTOPS and the PCPT studies.3. In the PCPT, the incidence of high-grade cancer was higher in the finasteridetreatedgroup (6.4%), compared with the placebo group (5.1%). Subsequentanalyses strongly suggest that this increased prevalence was owing to a detectionbias caused by the reduction in prostate volume in patients takingfinasteride, compared with patients taking placebo. This resulted in animproved detection at biopsy of high-grade cancer in the finasteride group.4. In men who have large prostates and lower urinary tract symptoms (LUTS),5ARIs should be considered, both for the treatment of BPH and for prostatecancer risk reduction.5. For men who are concerned about prostate cancer, it is appropriate to discusschemoprevention with finasteride.6. Urologists are encouraged to disseminate these recommendations amongother healthcare professionals.
Interleukin-2 in the treatment of unresectable or metastatic renal cell cancer: a systematic review and practice guideline
Authors: Hotte Sebastien , Waldron Tricia , Canil Christina , Winquist Eric
Published: October 2016

Objective: We performed a systematic review of randomized controlled trials (RCTs) to assess the efficacy of interleukin-2 (IL-2) for the treatment of patientswith unresectable or metastatic renal cell carcinoma (RCC).Methods: We searched the literature to identify RCTs or meta-analyses of RCTscomparing treatment regimens with IL-2 to those without. Outcomes of interestincluded overall or progression-free survival, response rate, toxicity andquality of life.Results: We identified 36 RCTs, and 6 met the eligibility criteria (1098 patients).We studied IL-2 alone and in combination with other agents, including interferon-alpha (IFN-a), 5-fluorouracil (5-FU), and 13-cis-retinoic acid or tamoxifen.No trials comparing high-dose IL-2 to non-IL-2 regimens were identified.A meta-analysis of 1-year mortality data from the 6 trials did not show a differencebetween IL-2-based regimens and non-IL-2 controls. Two of the 6trials detected statistically significant longer survival with IL-2 combinedwith IFN-a and 5-FU. Of the 4 trials that assessed progression-free survival, 3 reported significantly longer progression-free intervals with IL-2-based regimens.Five trials reported response rates; pooling the rates from these trialsgave an overall weighted response rate of 13.3% (range 9%–39%) and 5.3%(range 0%–20%) for IL-2-containing regimens and non-IL-2 regimens, respectively.IL-2-based regimens were more toxic than were non-IL-2 controls;the most frequently reported grade 3–4 toxicities were hypotension (range6%–68%), fever (2%–56%), nausea or vomiting or both (6%–34%), diarrhea(1%–28%) and cardiac toxicity (11%–25%). None of the trials reported healthrelatedquality-of-life data.Conclusion: Non-high-dose IL-2 containing regimens do not provide superiortreatment efficacy over non-IL-2-based regimens, with added toxicity, and thereforeshould not be used as standard treatment for patients with unresectableor metastatic RCC. High-dose IL-2 should only be used by experienced physiciansin the context of a clinical trial or investigative setting.
Endoscopic treatment of vesicoureteric reflux with Deflux: a Canadian experience
Authors: Guerra Luis A. , Khanna Priya , Levasseur Michele , Pike John G. , Leonard Michael P.
Published: October 2016

Introduction: Vesicoureteric reflux is a common problem encountered in urologicalpractice. Traditionally, if medical management with low-dose antibioticprophylaxis failed, the only alternative was ureteroneocystostomy. Recently,promising results with subureteric injection of dextranomer/hyaluronic acidcopolymer (Deflux) have renewed interest in the endoscopic treatment ofvesicoureteric reflux (VUR).Objective: We reviewed the outcome of the subtrigonal injection (STING)procedure with Deflux at a single pediatric hospital and included the rate ofVUR resolution and complications.Methods: An Institutional Review Board approved the retrospective review ofall cases of STING performed with Deflux at the Children’s Hospital of EasternOntario, from April 2003 to October 2005. We used voiding cystourethrogram (VCUG) or radionuclide cystogram (RNC) for diagnosis of VUR. The most commonindications for surgery were breakthrough infection, progression ofrenal scars and parental preference. A subureteral or intra-ureteral injection,at the 6 o’clock position, delivered the material to support the ureter andcorrect VUR.Results: We reviewed the cases of 64 patients, 47 girls (73%) and 17 boys(27%), with a mean age of 6 years (range 1–17 yr) and a mean followupof 8 months (range 2–23 mo). A total of 26 patients (41%) had bilateralVUR and 38 (59%) had unilateral VUR (90 renal units were treated). Overall cure rate was 79.7% (51/64) per child and 74% (67/90) perrenal unit. Among the 64 patients treated, 62.5% (40/64) were cured witha single injection, and a second and third injection raised the cure rateto 78% (50/64) and 79.7% (51/64), respectively. Contralateral low-gradede novo VUR was present in 7.9% (3/38) of the 38 unilateral cases.Postoperatively, de novo hydronephrosis developed in 3.3% (3/90) ofthe ureters, in 2 patients.Conclusions: The endoscopic treatment of VUR with Deflux is a feasible outpatientprocedure, requires minimal operating room time and is associated withlow morbidity. In our study, it demonstrated a cure rate of 80% of patientsand 74% of renal units. Dysfunctional voiding and neurogenic bladder (NB) donot seem to adversely affect results. STING should be considered for failed openreimplants, because it is much less morbid than redo reimplants. Further experiencewith the material and increased use of intraureteral injection may improveour cure rates.
Redo hypospadias repair: experience at a tertiary care children’s hospital
Authors: Al-Sayyad Ahmed , Pike John G. , Leonard Michael P.
Published: October 2016

Objective: Treatment of patients with failed hypospadias repairs can be challenging.Our study aimed to determine the best type of redo repair dependingon the location and size of the urethral meatus, the status of the urethralplate and genital skin, the severity of residual chordee and the amount ofscar tissue.Methods: The Institutional Review Board approved our retrospective chart reviewof patients who had a redo hypospadias repair at our institution over the past6 years. We recorded the type and number of previous repair(s), the type andnumber of redo procedure(s),as well as the complications and functional outcomes.Results: There were 28 patients, aged 1–12 (mean 3.8) years, with failed hypospadiasrepairs. The initial severity of the hypospadias were as follows: perineal(1), penoscrotal (9), proximal shaft (1), mid-shaft (9), distal shaft (4), coronal(3) and mega-meatus (1). Of all the patients, 24 had 1 repair, 3 had 2 repairsand 1 had 3 repairs. The initial repairs comprised 11 tubularized island flaps(TIFs), 8 Snodgrass tubularized incised plate (TIP) techniques, 5 Mathieu repairs,1 Meatal Advancement and GlanuloPlasty Incorporated (MAGPI) technique,1 Pyramid, 1 Arap technique and 1 Thiersch-Duplay repair. Twenty-one of 28 patients had 1 redo operation, 5 had 2 redo operations, 1 had 3 redo operationsand 1 had 4 redo operations, for a total of 38 redo operations. Of these,26 were TIP techniques (68.4%), 3 were Mathieu (7.9%), 3 were TIF repairs(7.9%), 2 were onlay island flaps (5.3%) and 4 were buccal mucosal grafts(10.5%). Follow-up was 1–5 years (mean 3.5 yr). The final locations of urethralmeatus included glans (18), corona (6), mid-shaft (3) and penoscrotal (1).Complications after redo surgery comprised 4 urethrocutaneous fistulae, 2 meatalstenoses, 1 urethral stricture and 3 dehiscences. Sixteen patients were followedwith yearly uroflow with a Q-mean (mean uroflow) range of 3–14 mL/s (mean8.1 mL/s).Conclusion: The majority of hypospadias failures can be salvaged with one operation.The TIP repair is our procedure of choice in most cases. In the settingof a poor urethral plate, TIF or buccal mucosa may be necessary. Complicationsare not infrequent in redo procedures.
Robotic uretero-ureterostomy of the retrocaval ureter without excision of the retrocaval segment
Authors: Alkhudair Waleed K. , Seyam Raouf , Al Zahrani Hassan M. , Al Otaibi Mohammed F. , Al Taweel Waleed
Published: October 2016

Robotic reconstruction of the retrocaval ureter is gaining momentum as the method of choice for surgically treating this rare condition. Maintaining the retrocaval ureteric segment further facilitates the procedure. We report a case of a 23-year-old man who underwent intraperitoneal robotic resection anastomosis and repositioning of the retrocaval ureter. We also discuss the advantages of this technique.
Stimulation of a non-functioning pituitary macroadenoma after administration of goserelin acetate for locally advanced prostate cancer causing a sustained elevation in PSA and testosterone
Authors: Youssef Fady R. , Robinson Robert T. , Boucher Nigel R.
Published: October 2016

Long-acting luteinizing hormone-releasing hormone (LHRH) agonists, such as goserelin, have been used for locally advanced and metastatic prostate cancer for many years and are the main forms of androgen deprivation therapy (ADT). Acting on pituitary LHRH receptors, they initially stimulate a transient rise in serum follicle stimulating hormone (FSH) and LH. Long-term administration of an LHRH analogue will eventually lead to down regulation of LHRH receptors, thus suppressing FSH and LH secretion. This in turn suppresses testosterone production hence achieving and maintaining androgen deprivation. This case highlights the potential anomaly of a sustained elevated serum testosterone in the context of newly diagnosed locally advanced prostate cancer with a co-existing pituitary macroadenoma after administration of LHRH analogues. Alternative methods of androgen deprivation must be considered in such patients.
A rare testicular solid mass in children: juvenile granulosa cell tumour of testis
Authors: Couture Julie , Bolduc Stéphane
Published: October 2016

Juvenile granulosa cell tumour (JGCT) of the testis is a benign neoplasm rarely seen in children. It usually presents as a unilateral scrotal mass and can be associated with genital ambiguity and chromosomal anomalies. Radical orchiectomy is the treatment of choice. We present an infant with a JGCT of the testis and were view the typical findings of the disease.
Dystrophic calcified nodule of the testicle: a case report
Authors: Goel Raj K. , Norman Richard W. , Gupta Rekha
Published: October 2016

Dystrophic calcified nodule of the testis was first reported by Minkowitz andcolleagues in 1965, with few subsequent reports. The etiology of this lesion iscontroversial and unknown partly owing to its rarity. We report the case of a29-year-old man who presented with generalized right testicular pain. His ultrasounddemonstrated a discrete calcified lesion. A right radical orchiectomywas performed identifying a 1.8 × 0.8 × 0.9-cm intratesticular calcific lesion withno evidence of intratubular germ cell tumour and negative tumour markers.
Sensitivity and specificity of 24-hour urine chemistry levels for detecting elevated calcium oxalate and calcium phosphate supersaturation
Authors: Rossi M. Adrian , Singer Eric A. , Golijanin Dragan J. , Monk Rebeca D. , Erturk Erdal , Bushinsky David A.
Published: October 2016

Objectives: The gold standard for determining likelihood of calcium oxalate(CaOx) and calcium phosphate (CaPhos) stone formation in urine is supersaturationof CaOx and CaPhos. Our objective was to investigate whether traditionalmeasurement of total calcium, oxalate and phosphate in a 24-hour urinecollection is sufficiently sensitive and specific for detecting elevated supersaturationto preclude the more expensive supersaturation test.Methods: We performed a retrospective review of 150 consecutive patients withnephrolithiasis who underwent measurement of CaOx supersaturation (CaOxSS)and CaPhos supersaturation (CaPhosSS), as well as total calcium, oxalate andphosphate in a 24-hour urine collection. We used various cut-off values to determinesensitivity and specificity of 24-hour urine measurements for detectingelevated CaOxSS and CaPhosSS.Results: In men and women, the sensitivity of 24-hour calcium for detectingelevated CaOxSS was 71% and 79%, respectively; for oxalate, sensitivity was59% and 36%, respectively. In men and women, the sensitivity of 24-hour calciumfor detecting elevated CaPhosSS was 74% and 88%, respectively; for phosphate,sensitivity was 57% and 8%, respectively. In men and women, the specificityof 24-hour calcium for detecting elevated CaOxSS was 55% and 48%,respectively; it was 60% for detecting elevated CaPhosSS in both men andwomen.Conclusion: Traditional 24-hour urine analysis is sensitive, but not specific, fordetecting elevated CaOxSS and CaPhosSS. Most patients with abnormal 24-hour urine analysis have normal supersaturation, and treatment decisions basedon traditional urine analysis would lead to overtreatment in these patients.
Hemiparesis of bladder caused by tethered cord
Authors: Payne Ryan A. , O’Connor Corey , Guralnick Michael L.
Published: October 2016

Conventional teaching has maintained that the detrusor musculature is wellcoupledand unilateral innervation should prompt a coordinated detrusorcontraction. We present the case of a 17-year-old girl with a tethered spinalcord, unilateral neurologic symptoms and fluoroscopic evidence of ipsilateralhemiparesis of the bladder unresponsive to cord detethering. This adds to asmall body of evidence that the bladder smooth muscle is less well-coupled thanonce believed.
Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time
Authors: Pouliot Frédéric , Pantuck Allan , Imbeault Annie , Shuch Brian , Calimlim Brian , Audet Jean-François , Finley David S. , Dujardin Thierry
Published: October 2016

Background: Partial nephrectomy (PN) is now the gold standardfor the surgical treatment of small renal masses. We evaluated theeffect of WIT and other factors on RDF assessed by preoperativeand postoperative renal scintigraphy.Methods: Between 2003 and 2008, 182 consecutive laparoscopicPN (LPN) were performed in an academic centre. Among those,56 had mercaptoacetyl triglycine (MAG3) lasix renal scintigraphypreoperatively and postoperatively.Results: Medians for age, preoperative estimated glomerular filtrationrate and computed tomography scan tumour size were 62years, 82 mL/min/1.73m2 and 26 mm, respectively. Median WITand preoperative RDF were 30 minutes and 50%, respectively.Median loss of RDF after surgery was 14%. Linear regression curvesshowed that loss in RDF rate was 0.2% per minute when WIT was<30 minutes and 0.7% per minute when WIT was ≥30 minutes.In multivariate analysis, length of WIT and endophytic tumourlocation were associated with a statistically significant loss of RDF(p < 0.05), but only in the group who experienced >30 minutesof WIT.Interpretation: Our results suggest that the factors associated withloss of RDF are not the same before and after 30 minutes of WITand that the rate of loss in RDF increases after 30 minutes. Since,the effect of WIT is small up to 30 minutes, we believe that surgeryshould focus on limiting the resection of normal parenchymaand to ensure negative margins and hemostasis, rather than onpremature unclamping.
Competence in pediatric urology upon graduation from residency: perceptions of residents, program directors and pediatric urologists
Authors: Mickelson Jennifer J. , MacNeily Andrew E. , Samarasekera Dinesh , Beiko Darren , Afshar Kourosh
Published: October 2016

Objective: We aimed to clarify the scope of pediatric urological procedures that Canadian urology residents are perceived to be competent to perform upon graduation.Methods: We conducted a survey from April 2005 to June 2006 of urology residency program directors (UPDs), senior urology residents (SURs) and Pediatric Urologists of Canada (PUC) members from all 12 Canadian training programs. Questions focused on which of 23 pediatric urological procedures the 3 study groups perceived urology residents would be competent to perform upon completion of residency without further fellowship training. Procedures were based on the “A,” “B” and “C” lists of procedures (least complex to most complex) as outlined in the Royal College of Physicians and Surgeons of Canada Objectives of Training in Urology.Results: Response rates were 12/12 (100%), 41/53 (77%) and 17/23 (74%) for UPDs, SURs and PUC members, respectively. Average exposure to pediatric urology during residency was 5.4 (range 3–9) months and considered sufficient by 75% of UPDs and 69% of SURs, but only 41% of PUC members (p = 0.05). Overall, the 3 groups disagreed on the level of competence for performing level “A” and “B” procedures, with significant disagreement between PUC members and UPDs as well as SURs (p < 0.005).Conclusion: PUC members perceive Canadian urology residents’ exposure to pediatric urology as insufficient and their competence for procedures of low to moderate complexity as inadequate. Further investigation regarding exposure to and competence in other emerging subspecialty spheres of urology may be warranted. Ongoing assessment of the objectives for training in pediatric urology is required.
Emerging novel therapies in the treatment of castrate-resistant prostate cancer
Authors: Abdulla Alym , Kapoor Anil
Published: October 2016

The treatment options for patients with castration-resistant prostatecancer (CRPC), until very recently, only included docetaxel.In the past 10 months, newly Federal Drug Administration (FDA)approved agents in the United States have shown survival benefitfor patients with CRPC. This review takes a closer look atthese newer agents: sipuleucel-T (immune therapy) and cabazitaxel(cytotoxic therapy). We also review the evidence supportingthe FDA’s approval of denosumab (bone-targeted therapy)as a treatment option for men with CRPC and bony metastases.Newer agents currently being investigated in phase III clinical trialsfor their potential role in metastatic CRPC are also reviewed.These agents include abiraterone (hormonal therapy), TAK-700(hormonal therapy), MDV3100 (hormonal therapy), ipilimumab(immune therapy), zibotentan (endothelin-A receptor antagonist)and dasatinib (tyrosine kinase inhibitor). As ongoing studies usingall the aforementioned agents continue to evolve, our understandingof how and where these agents fit into the treatment paradigmfor patients with CRPC will become clearer.
Delayed presentation of a detached resectoscope beak and treatment with thulium laser
Authors: Davis Niall F. , McGuire Barry B. , Flood Hugh D.
Published: October 2016

Intraoperative detachment of a resectoscope beak is an extremelyrare and unusual event. Retrieval of the ceramic beak can be difficultdue to the sheath’s large size relative to the urethral lumen. Ourreport describes the retrieval of a calcified ceramic resectoscopebeak from the urinary bladder 4 years after transurethral resectionof the prostate (TURP). The calcified beak was successfully fragmentedinto 3 separate pieces with a thulium laser. This methodallowed for safe removal of each fragment through the urethra.
Late chronic inflammatory reaction post-silastic sling insertion masquerading as an invasive bladder tumour
Authors: Ahmad Muhammad Shabi , Aslam Muhammad Zeeshan , Thorpe Andrew Christopher
Published: October 2016

There are various surgical techniques to treat female stress urinaryincontinence. We present the case of a long-term complication ina lady, where a silastic sling caused a massive retropubic fibrousreaction, masquerading, clinically and radiologically, as a muscleinvasive bladder cancer.
Summary of the first annual Genitourinary Medical Oncology Conference Renal Cell Carcinoma Forum
Authors: Wood Lori A. , Escudier Bernard , Reaume Neil
Published: October 2016

The first annual Canadian Genitourinary Medical Oncology Conference washeld in June 2006 before the Canadian Urology Association Annual Meeting.This article summarizes 3 presentations that took place as part of the Renal CellCarcinoma Forum: “Treatment of Metastatic Renal Cell Carcinoma: 2006 andBeyond” was presented by Dr. Bernard Escudier; “Practical Experience withTargeted Therapy,” by Dr. Lori Wood; and “Sarcomatoid Renal Cell Carcinoma,”by Dr. Neil Reaume.
The Canadian Benign Prostatic Hyperplasia Audit Study (CanBas)
Authors: Nickel J. Curtis , Downey Joe , Bénard Francois , Chetner Michael , Grantmyre John , So Alan , Whelan Paul
Published: October 2016

Objective: To determine the prevalence, diagnostic patterns and management of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) in Canadian urology outpatient practice.Methods: Representative urologists were randomly selected from lists provided by the Canadian and Quebec Urological Associations. Each patient identified with a BPH diagnosis during a typical 2-consecutive-week period during April, May or June 2007 was asked to complete a corresponding International Prostate Symptom Score (IPSS) questionnaire. Each day, the participant urologist completed an outpatient log and a detailed programmed chart review to transcribe demographics, investigations and treatments associated with each BPH patient.Results: Eighty-six urologists were invited to participate. Thirty-eight (44.2%) agreed, and 27 of those (71.1%) submitted evaluable data for the audit. Of the 5616 patients seen in outpatient practice (average 208 per urologist), 4324 (77%) were male. A BPH diagnosis was identified in 19.6% of the men (n = 849; mean age 69.5, standard deviation [SD] 10, yr; age range 40–100 yr; mean duration of symptoms 4.8, SD 4.2, yr; mean IPSS score 12.3, SD 7.4; mean prostate specific antigen [PSA] 3.9, SD 3.9, ng/mL). Twenty-four percent of patients had prostates that were rated as large, 50% as medium and 26% as small. PSA level correlated positively with prostate volume. Twenty-two percent were initial consultations for LUTS and 78% were repeat visits. Diagnostic evaluation tended to follow those examinations and tests recommended by the Canadian BPH guidelines. Treatment choices tended to follow an evidence-based algorithm with respect to treatment choices for men in the various prostate-volume and PSA groups.Conclusion: This prospective audit indicates that BPH remains a common condition managed by urologists in outpatient practice. Investigations and treatments confirm that Canadian urologists appear to be following Canadian BPH guidelines as well as the most recent evidence from the literature.
Recent developments in kidney cancer
Authors: Leveridge Michael J. , Jewett Michael A.S.
Published: October 2016

Renal cell carcinoma (RCC) diagnosis and management haveundergone significant shifts in the recent past. The increasing rateof diagnosis of small renal masses, often in patients at high risk ofmorbidity with operative treatment, has led to studies, trials anddiscoveries in renal mass biopsy, active surveillance and minimallyinvasive thermal ablation. At the other end of the disease spectrum,targeted systemic therapies for metastatic RCC have supplantedcytokine-based treatment, with significant benefits to progressionand survival. Recent reviews and trials have also cemented the roleof partial nephrectomy as standard surgical management for mostlow-stage masses, and the roles of regional lymphadenectomy andadrenalectomy concomitant with nephrectomy have been clarified.This review aims to highlight recent evidence that has emerged inthe management of this complicated oncologic issue.Le diagnostic d’hypernéphrome et la prise en charge de cettemaladie ont fait l’objet d’importants changements au cours desdernières années. Le taux accru de cas de petites masses rénales,souvent chez des patients présentant un risque élevé de morbiditéavec le traitement chirurgical, a amené la conduite d’étudeset d’essais qui ont entraîné des découvertes touchant la biopsiedes masses rénales, la surveillance active et l’ablation thermiqueminimalement invasive. À l’autre bout du spectre pathologique, lestraitements généraux ciblés de l’hypernéphrome métastatique ontsupplanté le traitement à base de cytokines, ce qui a amené desavantages significatifs sur le plan de la progression et de la survie.Des articles de synthèse et des essais récents ont aussi confirméle rôle de la néphrectomie partielle en tant que prise en chargechirurgicale standard pour la plupart des masses de faible stade,et les rôles de la lymphadénectomie régionale et de la surrénalectomieen concomitance avec une néphrectomie ont été clarifiés.Le présent article vise à faire ressortir les données récentes dans laprise en charge de ce problème oncologique complexe
Ureteral erosion of a transvaginal tape
Authors: Miraliakbari Homan , Tse Edward
Published: October 2016

The transvaginal tape (TVT) has gained acceptance as an effectivesurgical treatment of female stress incontinence. The popularity ofthis procedure is due to its relatively high success rate, short operativetime and low incidence of complications. However, this procedureis not without potential for complications; the erosion of synthetictape materials into adjacent pelvic structures has been reported. Thisreport represents the first published case of ureteral erosion of TVT.
Current status of cytokine therapy in management of patients with metastatic renal cell carcinoma
Authors: Kapoor Anil K. , Hotte Sébastien J.
Published: October 2016

Cytokine therapy with interferon-a and interleukin-2 has arguably been the standard treatment for patients with metastatic renal cell carcinoma for more than 20 years. In this paper, the current evidence for the use of cytokine therapy in this patient population is discussed, including the significant toxicity associated with these agents. A low overall response rate and a marginal survival advantage are observed with interferon-a and interleukin-2; however,these therapies have significant toxicity and impair quality of life. Unlike thecurrent tyrosine-kinase inhibitors, complete tumour responses may be seen with interleukin-2, but again this therapy has significant morbidity and mortality.Newer anti-angiogenesis agents may be combined with current standard cytokinetherapy for patients with metastatic renal cell carcinoma.
Identification of lymphatic pathway involved in the spreading of prostate cancer by fluorescence navigation approach with intraoperatively injected indocyanine green
Authors: Inoue Shogo , Shiina Hiroaki , Arichi Naoko , Mitsui Yozo , Hiraoka Takeo , Wake Koji , Sumura Masahiro , Honda Satoshi , Yasumoto Hiroaki , Urakami Shinji , Matsubara Akio , Igawa Mikio
Published: October 2016

Objective: The objective of this study was to identify lymphaticvessels draining from the prostate by using a fluorescence navigation(FN) system.Methods: Fourteen subjects were candidates for radical retropubicprostatectomy (RRP) and pelvic lymph node dissection (PLND).After an indocyanine green solution was injected into the prostateduring RRP, lymphatic vessels draining from the prostate were analyzedusing a FN system. After PLND based on lymphatic mappingby the FN system (in vivo probing) was performed in the externaliliac, obturator and internal iliac regions; the fluorescence of theremoved lymph nodes (LNs) was analyzed on the bench (ex vivoprobing).Results: Under in vivo and ex vivo probing, the fluorescence intensityof internal iliac nodes was greater than that of external iliacor obturator nodes.Conclusion: The current study suggests that using a FN systemafter injecting indocyanine green is a safe and rational approachfor detecting the lymphatic channel draining from the prostate.The major lymphatic pathway involved in the spreading of prostatecancer appears to relate to internal iliac LNs, which wouldmean that the standard PLND covering external iliac and obturatorregions would not keep the cancer from spreading.Objectif : L’objectif de l’étude était de repérer les vaisseaux lymphatiquesquittant la prostate à l’aide d’un système d’imagerie parfluorescence (IF).Méthodologie : Quatorze sujets devaient subir une prostatectomieradicale rétropubienne (PRR) et une lymphadénectomie pelvienne.Après injection d’une solution de vert d’indocyanine dansla prostate pendant la PRR, les vaisseaux lymphatiques drainant laprostate ont été analysés par IF. Une lymphadénectomie pelviennefondée sur la cartographie lymphatique par IF (exploration in vivo)a ensuite été réalisée dans les régions de la fosse iliaque externe,de l’obturateur et de la fosse iliaque interne; la fluorescence desganglions lymphatiques retirés a été analysée sans délai (explorationex vivo).Résultats : Lors de l’exploration in vivo et ex vivo, l’intensité dela fluorescence des ganglions iliaques internes était plus forte quecelle des ganglions iliaques externes ou des ganglions obturateurs.Conclusion : Cette étude porte à croire que l’IF après injectionde vert d’indocyanine est une méthode sûre et rationnelle pourrepérer les vaisseaux lymphatiques drainant la prostate. La principalevoie lymphatique de propagation du cancer de la prostatesemble être reliée aux ganglions lymphatiques iliaques internes, cequi signifie que la lymphadénectomie pelvienne standard retirantles ganglions iliaques externes et obturateurs n’empêcherait pasle cancer de se propager.
Early versus delayed repair of vesicouterine fistula
Authors: Bettez Mathieu , Breault Guy , Carr Lesley , Tu Le Mai
Published: October 2016

Vesicouterine fistulas (VUF) are a pathological and uncommonconnection between the uterus and the bladder. Although rare,they are usually related to cesarean section. Nowadays, theirincidence increases because of the increase in Cesarean sections.Patients with VUF may have various clinical presentations. Themain symptoms are urinary incontinence, which may be associatedwith hematuria. Vesicouterine fistulas are usually associated withpsychological distress and have a negative effect on quality of life.The accurate and early diagnosis of VUF can be difficult. There aremultiple ways to investigate VUF and several examinations may berequired to confirm the diagnosis; these examinations may includea cystoscopy, a retrograde cystography, methylene blue test and acomputed tomography scan. We present 3 cases of vesicouterinefistula with successful surgical repair in which 2 patients had anearly repair. One patient had an early surgical repair because ofintractable pain and the other patient because of the large sizeof the fistula. The fistula repair surgeries were uneventful andthe patients had an unremarkable recovery. We report that earlysurgical management is technically feasible without significantlyincreasing the difficulty of the surgery, with an excellent outcomein selected patients.
Surgical management of bladder transitional cell carcinoma in a vesicular diverticulum: case report
Authors: Raheem Omer A. , Besharatian Behdad , Hickey David P.
Published: October 2016

We report a case of primary transitional cell carcinoma (TCC) ofa bladder diverticum along with a literature review. A 55-year-oldmale presented with painless gross hematuria. A histological diagnosisof TCC within a bladder diverticulum was made followingcystoscopical examination. Initially transurethral resection of bladdertumour with subsequent intravesical chemotherapy followed.As a result of recurrence and in view of bladder-sparing therapy, adistal partial cystectomy was performed. This report demonstratesthat conservative bladder-sparing treatment can be achieved andsubsequently followed by vigilant cystoscopy.
Locally advanced renal cell carcinoma
Authors: Al Otaibi Mohammed , Tanguay Simon
Published: October 2016

Despite the observed stage migration and earlier detection of renal masses, patients still present with locally advanced renal cell carcinoma. These patients represent a difficult oncologic challenge. Despite our ability to do surgical resectionto cure the disease, survival often remains limited. In this paper, we describethe role and indication for surgical resection for patients with enlarged retroperitoneallymph nodes, invasion of adjacent organs, invasion into the vena cavaor locally recurrent disease. The development of new strategies, including effective drugs to be used in association with surgical resection, will clearly be an essential step to further improve the outcome of these patients.
Vesical nephrogenic adenoma: an unusual presentation of a bladder tumour
Authors: Martínez-Sanchíz Carlos , Martínez-Ruiz Jesús , Anguita-Fernandez Pedro J. , Giménez-Bachs José M. , Atiénzar-Tobarra Manuel , Virseda Rodríguez Julio Antonio , Salinas-Sánchez Antonio S.
Published: October 2016

Vesical nephrogenic adenoma is a rare, benign entity that appearsmost commonly in middle-aged males. Its etiology is unknown,but it has been linked to chronic irritating factors, such as infection,trauma, urological surgery, kidney stones, foreign bodies andchemical agents, such as Bacille Calmette-Guerin. We report 2new cases with a history of transurethral resection of the bladderand the prostate and a history of prolonged voiding symptoms. Inboth cases, the findings of encysted tubular structures lined withflattened cuboidal cells without atypia were consistent with thediagnosis of vesical nephrogenic adenoma.
A unique case of a sarcoma arising in a testicular non-seminomatous mixed germ cell tumour with a predominant yolk sac component
Authors: Lavallée Luke T. , Roustan Delatour Nicolas LD , Cagiannos Ilias , Bélanger Eric C. , Mai Kien T.
Published: October 2016

We present a unique case of a sarcoma arising in a testicularnon-seminomatous mixed germ cell tumour with a predominantyolk sac tumour (YST) component. This is the first case reported inwhich a sarcoma is linked to YST of the testis in a patient not havingundergone prior chemotherapy. This finding confirms the ability ofYST to contain sarcoma; it underlies its importance for urologists,oncologists and pathologists to be aware of this phenomenon andto modify treatment strategies appropriately.
Polyorchidism: sonographic and magnetic resonance imaging findings
Authors: Yalçınkaya Soner , Şahin Coskun , Şahin Ali Feyzullah
Published: October 2016

Polyorchidism is a rare anomaly and frequently associated withcriptorchidism, inguinal hernia and testicular torsion. It is alsoreported as increased risk of testicular malignancy. We report acase of 23 year old man with left supernumerary testis in the lefthemiscrotum. He presented with painless mass in his left hemiscrotum.Normal physical examination and laboratory tests includingspermiogram were examined. Both ultrasound and MRI examinationsrevealed polyorchidism without malignancy or any otherconcomitant features. In most cases sonography alone is diagnostic.MRI may provide additional information in complicated cases ofpolyorchidism. Conservative treatment with sonographic follow-upis the choice of treatment in uncomplicated cases.
Pathophysiology of the urothelium and detrusor
Authors: Tyagi Pradeep
Published: October 2016

Conventional wisdom now agrees that symptoms of overactivebladder (OAB) seem to emanate from an aberration in the voidingreflex, leading to involuntary detrusor contractions of eitherneurogenic or myogenic origin. Furthermore, emerging evidencealso encourages us to adopt a new paradigm, in which bladderurothelium is not just a simple barrier but an active contributor tobladder function. In this paradigm, aberration in sensory mechanismsemanating from the urothelium can also contribute to OABsymptoms through altered excitability of afferents in the bladderleading to increased bladder sensation. The high density of muscarinicreceptors expressed on urothelium can not only mediaterelease of urothelium-derived inhibitory factor, but can also be seenas an alternative site of action for antimuscarinic drugs. Urotheliumalso expresses a host of other receptors such as TRPV1 and TRPM8,whose functional role is yet to be confirmed.
Drugs and future candidates
Authors: Andersson Karl-Erik
Published: October 2016

Antimuscarinic drugs are still first-line treatment for the symptomsof overactive bladder (OAB) and are associated with good initialresponse rates. Adverse effects and decreasing efficacy overthe longer term do, however, limit their overall effectiveness. Assuch, alternatives to antimuscarinics are needed. The recognitionof the functional contribution of the urothelium, the spontaneousmyocyte activity during bladder filling, and the diversity of nervetransmitters involved in the symptoms of the OAB has sparkedinterest in pharmacologic manipulation of both peripheral andcentral pathophysiology. Some of the treatments currently underinvestigation are discussed in this review.
Symptom-based diagnosis of overactive bladder: an overview
Authors: Wein Alan
Published: October 2016

The current definition of overactive bladder (OAB) is “urgency,with or without urge incontinence, usually with frequency andnocturia in the absence of an underlying metabolic or pathologiccondition.” Urgency, in turn, is defined as a “sudden, compellingdesire to pass urine that is difficult to defer.” While these definitionsprovide the framework for making a clinical diagnosis ofOAB, they rely on subjective assessment of the symptoms by thepatient. As well, the symptoms of OAB can be similar to thoseseen in other conditions, such as urinary tract infection, benignprostatic enlargement and bladder cancer. These other potentialdiagnoses should be ruled out in a noninvasive manner beforemaking a diagnosis of OAB.
Clinical testing for overactive bladder
Authors: Nitti Victor
Published: October 2016

While the diagnosis of overactive bladder (OAB) is made clinically,simple office testing (e.g., urinalysis and culture, assessmentof post-void residual urine) should be part of the work-up of allpatients with these symptoms. There are certain situations in whichtesting should be undertaken before initiating treatment or for monitoringresponse. Supplemental testing should be considered incases where routine evaluation raises the suspicion of a problemor condition that either needs further evaluation or may predisposethe patient to failure of therapy. Further testing may also be consideredfor patients who are refractory to treatment and those withsignificant neurological disease. Depending on the particular case,supplemental testing may include comprehensive urodynamic testing,endoscopic evaluation of the lower urinary tract, imaging ofthe upper urinary tract, neurologic evaluation or spine imaging.
Systematic review of therapy for neurogenic detrusor overactivity
Authors: Fowler Clare J.
Published: October 2016

While many neurologic diseases predispose patients to neurogenicdetrusor overactivity (NDO), the only populations that have beensystematically studied are adults with multiple sclerosis (MS), adultswith spinal cord injury (SCI) and children and young adults withmyelodysplasia. First-line pharmacotherapy for NDO is an antimuscarinicdrug. However, the evidence base for these agents inthis indication is poor. There is some high-quality evidence for theefficacy of detrusor injections of botulinum toxin A in the treatmentof NDO, with significant reduction in urgency incontinence episodes,improved urodynamic parameters, and improved quality oflife. While few adverse events have been reported with this therapy,there is a need for intermittent self-catheterization in these groups.
Overactive bladder: Symptom complex or separate entity?
Authors: Herschorn Sender
Published: October 2016

In addition to the series of lectures summarized in the articleson the preceding pages, the 2011 Canadian UrologyForum also included a series of workshops intended tohelp answer the question: “Does overactive bladder (OAB)exist as a separate entity or is it a symptom complex thatmay be associated with other conditions?”In an effort to arrive at an answer to this question, theparticipants were divided into groups and asked to examinea particular subset of patients with OAB. The subsets were:females, males, neurogenic and elderly. In each of theseworkshops, the participants were asked to answer the followingquestions:• What is the most likely underlying cause?• Are there unique phenotypes that can be identifiedclinically that are linked to a common underlyingpathophysiology?• What is the likelihood of associated disorders of theoutlet or pelvic floor?• What are the most effective treatments?Each of the groups then reported their answers back tothe entire group of participants, after which time they wereasked to vote on the key question. This review provides asummary of the discussions that took place in each groupand concludes with the results of the vote.
The association between tumour density and prostate cancer recurrence following radical prostatectomy
Authors: Lavallée Luke T. , Breau Rodney H. , Preston Mark A. , Raju Gayanna , Morash Christopher , Doucette Steve , Gerridzen Ronald G. , Eastham James , Cagiannos Ilias
Published: October 2016

Purpose: Tumour density (TD) may be an independent prognosticfactor in men with prostate cancer. The purpose of this study wasto evaluate the association between prostate cancer TD and recurrencefollowing radical prostatectomy.Materials and Methods: Between 1995 and 2007, 645 patientsfrom The Ottawa Hospital or Memorial Sloan-Kettering CancerCenter who had cancer and prostate volumes measured from radicalprostatectomy specimens. Tumour density was defined as therelative tumour to prostate volume (tumour volume/prostate volume)and recurrence was defined as a prostate-specific antigen(PSA) >0.2 ng/mL and rising, or postoperative use of radiation orhormonal therapy. Associations between TD and recurrence areadjusted for preoperative PSA, prostatectomy Gleason sum, tumourstage and margin status.Results: Median follow-up was 40.8 months. Tumour density wasassociated with preoperative PSA, Gleason sum, tumour stage andsurgical margin status (all p < 0.0001). As a continuous variable,TD predicted recurrence-free survival (adjusted HR 1.34 per 10%increase in TD; p = 0.04). As a categorical variable, the groupof patients with a TD of >10% had a 2.7 times greater hazard ofrecurrence compared to patients with a TD <5% (95%CI 1.41,5.19; p = 0.003). Despite the independent association betweenTD and recurrence, the clinical value of TD remains in question asthe discriminative performance (area under the curve) of predictivemodels only improved from 0.865 to 0.876.Conclusions: Prostate cancer TD is associated with known prognosticfactors and is also independently predictive of recurrencefollowing radical prostatectomy.