bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful use of sacral neuromodulation after failed bladder augmentation
Authors: Rasmussen Nathan T. , Guralnick Michael L. , O’Connor R. Corey
Published: October 2016

Sacral neuromodulation has become a standard minimally invasivetherapy for refractory urinary urge/frequency and urge incontinence.Prior to the widespread use of sacral neuromodulation,augmentation cystoplasty was a standard treatment for refractoryoveractive bladder (OAB). The use of sacral neuromodulation followingbladder augmentation has not been previously reportedin the literature. We report 2 cases of successful sacral neuromodulationin patients with OAB refractory to bladder augmentation.
Intermittent self-catheterization and the risk of squamous cell cancer of the bladder: An emerging clinical entity?
Authors: Casey Rowan G. , Cullen Ivor M. , Crotty Tom , Quinlan David M.
Published: October 2016

There are only 7 cases reported in the literature of squamous cellcancer of the bladder in patients performing intermittent selfcatheterization(ISC). We report on an eighth case, and the firstcase described in a patient with a Mitrofanoff continent appendicovesicostomy.A description of the case and review of the literatureare presented. Risk factors for squamous cell cancer includerecurrent urinary tract infections, keratinising squamous metaplasia(leukoplakia) and local mucosal trauma from intermittent selfcatheterization.There is no recognized or validated monitoringprogram for patients performing ISC who may also have theserisk factors. Reasonable protocols may include regular urinarycytology and cystoscopy with random or targeted bladder biopsies.Squamous cell cancer may present late in this cohort of patientsand is associated with a dismal prognosis.
A dog bite to the adult scrotum
Authors: Saleh Dr. D. , Shaw Dr. David , Biyani Dr. Chandra Shekhar
Published: October 2016

Dog bites are a common presentation to emergency departmentsworldwide. However, presenting symptoms may fail to reveal theseverity of an injury. We present such a case.
Primary intratesticular leiomyosarcoma
Authors: Yoshimine Shunsuke , Kono Hidaka , Nakagawa Ken , Kikuchi Eiji , Miyajima Akira , Kameyama Kaori , Mukai Makio , Oya Mototsugu
Published: October 2016

This report presents a case of primary intratesticular leiomyosarcoma.A 73-year-old male presented with a 6-year history of leftscrotal swelling. A radiological examination revealed a left testiculartumour with multiple metastases in the lung, para-aorticlymph node and other organs. A radical orchiectomy was carriedout and the pathology revealed an intratesticular leiomyosarcoma.The patient received additional chemotherapy. Cases of primaryintratesticular leiomyosarcoma are rare. This is, to the best of ourknowledge, only the tenth case of leiomyisaocoma in an adultreported in the literature, and the first case involving multiplemetastases.
Urolithiasis in adults with congenital megaureter
Authors: Rosenblatt Gregory S. , Takesita Ken , Fuchs Gerhard J.
Published: October 2016

The primary presentation of congenital megaureter in adults israre. Development of urolithiasis may lead to this unusual underlyingdiagnosis. Urinary tract stones can form either within thedilated ureteral segment or in a part of the upper urinary tractproximal to the abnormal ureteral segment. We report two casesof nephrolithiasis that occurred in adults found to have segmentalmegaureter. The first case is that of a 58-year-old man whopresented with left lower quadrant pain. Computed tomographyscan revealed a 2-cm stone in the distal left ureter within an areaof isolated segmental distal ureteral dilation. The second case isa 48-year-old man who developed recurrent renal urolithiasisassociated with isolated distal megaureter.Although a rare condition in adults, congenital megauretermay present when kidney stones develop as a result of the ureteralabnormality. Typically, stones will develop within the dilatedsegment of ureter. Atypically, stones may develop away from thesite of the underlying abnormality. Congenital megaureter is adiagnosis that urologists and radiologists need to consider in thesetting of isolated distal ureteral dilation, as the diagnosis of adultmegaureter may require more involved surgical measures to preventrecurrence of adverse symptoms.
Natural history of pT3-4 or node positive bladder cancer treated with radical cystectomy and no neoadjuvant chemotherapy in a contemporary North-American multi-institutional cohort
Authors: Power Nicholas E. , Kassouf Wassim , Bell David , Aprikian Armen , Fradet Yves , Lacombe Louis , Chin Joseph , Izawa Jonathan , Estey Eric , Fairey Adrian , Cagiannos Ilias , Lattouf Jean-Baptiste , Drachenberg D. , Rendon Ricardo
Published: October 2016

Background: The present study documents the natural history and outcomes of high-risk bladder cancer after radical cystectomy (RC) in patients who did not receive neoadjuvant chemotherapy during a contemporary time period.Methods: We analyzed 1180 patients from 1993 to 2008 with >pT3N0 or pT0-4N+ bladder cancer who underwent RC ± standard (sLND) or extended (eLND) lymph node dissection from 8 Canadian centres.Results: Of the 1180 patients, 55% (n = 643) underwent sLND, 34% (n = 402) underwent ePLND and 11% did not undergo a formal LND. Of the total number of patients, 321 (27%) received adjuvant chemotherapy. The median follow-up was 2.1 years (range: 0.6 to 12.9). Overall 30-day mortality was 3.2%. Clinical and pathological stages T3-4 were present in 6.1% and 86.7% of the patients, respectively; this demonstrates a dramatic understaging. Overall survival (OS) at 2 and 5 years was 60% and 43%, respectively. Patients who received adjuvant chemotherapy hada 2- and 5-year disease-specific survival (DSS) of 72% and 57% versus 64% and 51% for those who did not (log-rank p = 0.0039). The 2- and 5-year OS for high-risk node-negative disease was 67%and 52%, respectively, whereas for node-positive patients, the OS was 52% and 32%, respectively (p < 0.001). The OS, DSS and RFS for patients with pN0 were significantly improved compared to those who did not undergo a LND (log-rank p = 0.0035, 0.0241 and 0.0383, respectively).Interpretation: This series suggests that bladder cancer outcomes inadvanced disease have improved in the modern era. The need for improved staging investigations, use of neoadjuvant chemotherapyand performance of complete LND is emphasized.
Perioperative chemotherapy for muscle-invasive bladder cancer
Authors: Black Peter , So Alan
Published: October 2016

Considerable debate exists concerning the combined use of systemicchemotherapy and radical surgery for muscle-invasive bladdercancer. While there is evidence for a survival benefit afterneoadjuvant chemotherapy, the benefit is modest and the potentialtoxicity and delay of time to surgery prior to cystectomy appearsto be deterring many surgeons from its administration. The evidencefor adjuvant chemotherapy, on the other hand, is less compellingand substantial. Furthermore, the role of adjuvant comparedto salvage chemotherapy requires further investigation.Similarly, research continues on identifying molecular and clinicalmarkers to best stratify patients for optimal perioperative therapy.In this article, the evidence for radical cystectomy andchemotherapy, given either in a neoadjuvant or adjuvant setting,will be reviewed.
Conservative treatment of concomitant extraperitoneal bladder rupture and intrabladder blood clot formation: Case report of application of ureteral catheterization
Authors: Fu Chih-Yuan , Shih Chun-Han , Chang Po-Yen , Hsiao Chi-Hao , Wang Yu-Chun , Chen Ray-Jade
Published: October 2016

Most extraperitoneal bladder ruptures can be treated conservatively with catheter drainage only. However, in patients with concomitant intra bladder blood clot formation and extraperitoneal bladder rupture, surgery for blood clot evacuation and bladder repair are usually needed due to occlusion of the urinary catheter. In our patient, we used a ureteral catheter to bypass the clots in the bladder to provide adequate urinary drainage. This procedure serves as a valuable tool in the conservative treatment of extraperitoneal bladder injury.
An unusual cause of hematospermia: Primary adenocarcinoma of the seminal vesicle
Authors: Eken Alper , Izol Volkan , Aridogan I. Atilla , Erdogan Seyda , Acikalin Arbil , Tansug Zuhtu
Published: October 2016

Adenocarcinoma of the seminal vesicles is one of the rare causes of hematospermia. Primary seminal vesicle adenocarcinoma is extremely rare and difficult to diagnose due to frequent invasion of adenocarcinomas of the surrounding organs, especially the prostate. In the present study, a case of a primary seminal vesicle adenocarcinoma will be discussed in the light of the current literature.
A case of clinically silent giant right pheochromocytoma and review of literature
Authors: Li Changfu , Chen Yongsheng , Wang Wentao , Teng Lichen
Published: October 2016

Clinically silent giant cystic pheochromocytoma is a rare adrenal disease; complete resection is the only curative treatment. Due to the serious surgical risk, successful resection is very difficult. We report a case of a patient with giant cystic pheochromocytoma, which was successfully resected. There were no intraoperative and postoperative complications. We analyze and report our experience.
Laparoscopic repair of traumatic intraperitoneal bladder rupture: Case report and review of the literature
Authors: Kim Brian , Roberts Matthew
Published: October 2016

We present a case of intraperitoneal bladder rupture in a 42-year old man repaired by a laparoscopic approach. Details of the case and a description of the operative procedure are outlined. We also review the literature on laparoscopic repair of traumatic bladder rupture.
Spontaneous ventral urethral fistula in a young healty man and a modified surgical technique of urethral fistula repair
Authors: Akkoc Ali , Metin Ahmet
Published: October 2016

Urethral fistula is rare and is usually a complication of penile and urethral surgery. A few congenital cases have been reported. Also, one acquired spontaneous case in a diabetic man has been reported. We present the first case in the literature of a healthy man with a spontaneous ventral urethral fistula, with unknown etiology. We performed a modified technique of urethral fistula repair (four-layer technique).
What causes stress incontinence: Fallacies, fascias and facts
Authors: DeLancey John
Published: October 2016

The traditional view of the pathophysiology of stress urinary incontinence (SUI) was that a loss of urethral support was the primary abnormality present. Recent research has challenged this hypothesis, demonstrating that impaired urethral function plays the key causative role. Improving our understanding of the underlying pathologic mechanisms is important to identifying the cause of treatment failures and for developing novel therapies to treat SUI.
Complications of midurethral slings and their management
Authors: Nitti Victor W.
Published: October 2016

While midurethral slings are associated with a low rate of morbidity, complications can arise intraoperatively or following the procedure. Management of midurethral sling complications is relatively straightforward and urgency is dictated by the severity of the complications, potential for long-term negative effects, and bother to the patient.
Evaluation and management of the patient with a failed midurethral synthetic sling
Authors: Gormley E. Ann
Published: October 2016

While most women will do well following placement of a midurethral sling (MUS), a substantial minority do experience surgical failure. There are several risk factors that can help identify a patient at higher risk for failure, including body mass index greater than 25 kg/m2, mixed incontinence, previous continence surgery, intrinsic sphincter deficiency, and diabetes. At the present time, there is no evidence-based guidance for which intervention to use following failure. Careful evaluation of patient characteristics will help guide subsequent management.
Benign prostatic hyperplasia and lower urinary tract symptom guidelines
Authors: Roehrborn Claus
Published: October 2016

Lower urinary tract symptoms (LUTS) are very common in men,with incidence increasing with age. Several clinical practice guidelines are available as decision-making aids for men with LUTS and the recommendations are based on the presumed etiology of the symptoms (due to obstruction, overactive bladder or a combination of the two). This review presents the various pharmacologic treatment options and summarizes key clinical trial data supporting their use.
The dilemma of nocturia
Authors: Drake Marcus J.
Published: October 2016

Patients with nocturia are often referred to urologists, but the underlying cause most often lies outside the urinary tract. Nocturia should be considered a systemic disorder and investigated and treated as such. Comprehensive assessment of the symptoms, optimally including a frequency volume chart, can help to determine the potential underlying cause and help to direct the patient to the most suitable medical professional for further management.
Recurrent nephrogenic adenoma in bladder diverticulum:case report and literature review
Authors: Boscolo-Berto Rafael , Lamon Claudio , Gardi Mario , Vezzaro Roberto , Gardiman Marina
Published: October 2016

Nephrogenic adenoma is an uncommon benign lesion of the urinary tract induced by chronic irritation of the vesical mucosa, due to infection, trauma, surgery, calculi, foreign bodies and chemical agents. A 68-year-old male was admitted to our linic for a periodical cystoscopic evaluation as part of a follow-up initiated due to a past transitional cell carcinoma. The scheduled cystoscopy revealed, within a bladder diverticulum, an unexpected and completely asymptomatic nephrogenic adenoma that we removed by transurethral resection. We followed up the patient at 24 months, then later we made the diagnosis of nephrogenic adenoma. During this time, the patient experienced three relapses within the same diverticulum, always involving a nephrogenic adenoma we persistently treated by transurethral resections. As the nephrogenic adenoma is considered a benign lesion without any direct evidence of a possible evolution to an overt cancer, we successful attempted a half-yearly cystoscopic follow-up to control the growth of a highly recurrent benign entity, interposing between controls a periodical imaging. This paper represents the second report of a nephrogenic adenoma within a bladder diverticulum, but the first case of a nephrogenic adenoma highly recurrent within the same diverticulum and managed conservatively by regular transurethral resection scheduled over the time
The combination therapy of prednisolone and tacrolimus for severe painful bladder syndrome/interstitial cystitis
Authors: Kaneko Gou , Koshiro Koshiro , Ito Yujiro , Uchida Atsushi
Published: October 2016

A 47-year-old woman visited our hospital with complaints of frequent urination and intensive pelvic pain. Painful bladder syndrome/ interstitial cystitis (PBS/IC) was suspected based on her symptoms. Hydrodistention was performed, and crack and petechial hemorrhage were found, and she was treated with tricyclic antidepressants and antihistamine. However, these treatments were ineffective. An allergy or autoimmune reaction was suspected as the pathogenesis due to eosinophilia and elevation of serum IgE levels. The patient was then treated with immunosuppressive agents. Although her symptoms were not sufficiently improved by single-agent therapy with prednisolone or tacrolimus, they were completely improved by their combined administration. This is the first case to report the effectiveness of combination therapy consisting of prednisolone and tacrolimus to treat PBS/IC.
Occult infiltrating bi-ventricular papillary renal cell carcinoma metastasis found during coronary artery bypass graft surgery
Authors: Mollberg Nathan M. , Johnson Nicholas B. , Ying Shan-Chinga , Abdelhady Khaled , Massad Malek G. , Chung Doreen E.
Published: October 2016

Metastatic papillary renal cell carcinoma (RCC) to the heart has never been reported. We report the case of a 73-year-old patient with papillary RCC metastatic to the left and right ventricles, found during a triple vessel coronary artery bypass graft surgery
Pelvic congenital arteriovenous malformation diagnosed by transrectal ultrasonography: A case report
Authors: Suzuki Kenjiro , Tanaka Nobuyuki , Ebine Takashi , Momma, Tetsuo
Published: October 2016

Arteriovenous malformations (AVMs) of the pelvis are relatively rare and difficult to treat because of multiple and extensive feeding vessels. We report the case of a 69-year-old male with pelvic congenital AVM that was detected during tests for dysuria. He visited our hospital complaining of voiding difficulty. Digital rectal examination revealed a pulsating mass that was palpable on the right side of the prostate. Transrectal ultrasonography showed multiple hypoechoic lesions adjacent to the prostate and colour Doppler ultrasonography revealed the flow regions corresponded to the hypoechoic lesions. Computed tomography demonstrated large-to-small tubular vessels adjacent to the prostate, while pelvic angiography showed many small feeder arteries extending mainly from the right internal iliac artery. He was diagnosed as having pelvic congenital AVM. Uroflowmetry revealed slight voiding difficulty without residual urine. The patient decided against treatment and requested we monitor his clinical course.
Adenocarcinoma following urinary diversion
Authors: Jian Peter Yicum , Godoy Guilherme , Coburn Michael , Lynch Garrett , Ro Jae Y , Zhai Qihui “Jim” , Nishino Michiya , Lerner Seth P.
Published: October 2016

The use of bowel segments in urinary diversions has been associated with an increased risk of neoplasia. This report describes three cases of intestinal adenocarcinoma following urinary diversion. In the first case, a 73-year-old woman developed moderately-differentiated colonic adenocarcinoma in her Indiana pouch 10.5 years after cystectomy. The second case involved a 77-year-old man with well-differentiated adenocarcinoma in his Indiana pouch 9 years after radical cystoprostatectomy and en bloc urethrectomy. The third case involved a 38-year-old man with moderately-differentiated adenocarcinoma arising in his ileal conduit 33 years after the creation of the conduit. These cases highlight the diagnostic signs of adenocarcinoma arising in urinary diversions and emphasize the importance of lifelong surveillance in these patients.
Salvage radiotherapy after high-intensity focused ultrasound treatment for localized prostate cancer: feasibility, tolerance and efficacy
Authors: Ripert Thomas , Bayoud Younes , Messaoudi Rabah , Ménard Johann , Azémar Marie-Dominique , Duval François , Nguyen Tan Dat , Staerman Frédéric
Published: October 2016

Background: The objective of this study is to evaluate the feasibility,tolerance and efficacy of salvage external beam radiotherapy(EBRT) in persistent or recurrent prostate cancer after failed highintensity focused ultrasound (HIFU) therapy.Methods: We reviewed data on tolerance and oncologic outcomesfor all patients with biopsy-proven locally recurrent or persistentprostate cancer who underwent salvage EBRT in our departmentbetween April 2004 and June 2008. Minimum follow-up for inclusionwas 2 years. Failure with EBRT was defined as biochemicalrelapse (Phoenix definition) or introduction of androgen deprivationtherapy (ADT). Gastrointestinal and urinary toxicity and urinary stressincontinence were scored at 12 and 24 months (Radiation TherapyOncology Group and Ingelman Sundberg rating, respectively).Results: The mean age of the patients was 68.8 years (range: 60-79).Mean prostate-specific antigen (PSA) before EBRT was 5.57 ng/mL(range: 2.5-14.8). Median follow-up was 36.5 ± 10.9 months(range: 24-54). No patient received adjunctive ADT. The EBRTcourse was well-tolerated and completed by all patients. The meanPSA nadir was 0.62 ng/mL (range: 0.03-2.4) and occurred after amedian of 22 months (range: 12-36). One patient experiencedbiochemical failure and was prescribed ADT 30 months after EBRT.The disease-free survival rate was 83.3% at 36.5 months. Therewas no major EBRT-related toxicity at 12 or 24 months.Conclusions: Our early clinical results confirm the feasibilityand good tolerance of salvage radiotherapy after HIFU failure.Oncological outcomes were promising. A prospective study withlonger follow-up is needed to identify factors predictive of successfor salvage EBRT therapy after HIFU failure.
Open removal as a first-line treatment of magnetic intravesical foreign bodies
Authors: Levine Max A. , Evans Howard
Published: October 2016

Intravesical foreign bodies are an uncommon, but significant, cause of urologic consultation. We present 3 patients who all inserted magnetic beads per urethra into the urinary bladder, which subsequently became retained. Endoscopic attempts were unsuccessfully tried in the first 2 cases, necessitating open cystotomy to remove the beads. The third went straight to open removal. Given the failure of minimally invasive techniques, we believe that open removal should be the first-line treatment for these types of foreign bodies.
Review of the efficacy and safety of cryoablation for the treatment of small renal masses
Authors: Kapoor Anil , Touma Naji J. , El Dib Regina
Published: October 2016

Purpose: Small renal masses are increasingly being discovered incidentally on imaging for another reason. The standard of care of these masses involves excision by open or laparoscopic techniques. Recently, ablative techniques, such as radiofrequency ablation (RFA) and cryoablation, have taken a more prominent role in the treatment algorithm of these masses. We evaluate the effectiveness and safety of cryoablation to treat renal tumours.Methods: A review of the literature was conducted. There was no language restriction. Studies were obtained from the following sources: the Cochrane Library, PUBMED, EMBASE and LILACS.Results: There was no clinical trial identified in the literature. Thus, we described the results from 23 case series and retrospective studies with a reasonable sample size (number of reported patients in each study ≥30), with a total of 2104 analyzed tumours from 2038 patients. There was wide variability in the outcomes reported, but success rates were generally good. Follow-up was generally short, but some series reported outcomes at 5 years. The most common complications reported were hemorrhage (some of the patients requiring transfusion), perinephric hematoma and urine leaks.Conclusion: Cryoablation presents a feasible treatment for patients with small renal masses. Only short-term data are available and, assuch, meaningful conclusions regarding long-term cancer control cannot be made. More rigorous studies are needed.
Varicocele surgery or embolization: Which is better?
Authors: Cassidy Darby , Jarvi Keith , Grober Ethan , Lo Kirk
Published: October 2016

Introduction: Varicocele remains the most commonly identifiedcorrectable cause of male factor infertility. Surgical correction isthe most commonly performed technique to treat varicoceles with a technical failure rate of less than 5%. An attractive alternative to surgery is the selective catheterization and embolization of the gonadal vein. This data are limited by small series.Methods: We reviewed a total of 158 patients. These patientsunderwent embolization for clinical varicoceles and male factorinfertility between 2004 and 2008. Of these, 56% underwentattempted bilateral embolization, 43% unilateral left-sided embolization and 1.3% unilateral right-sided embolization.Results: Of these patients who underwent attempted bilateralembolization, 19.3% did not experience a successful obliterationof the right gonadal vein and 2.3% (2/88) experienced a failure rate in the embolization of the left gonadal vein. Of the 2 attempts at unilateral right-sided embolization, there were no failures. Of the 68 unilateral left-sided embolization attempts, there was a 4.4% failure rate. Of all of the right-sided embolization attempts, 18.9% failed, while 3.2% of the left-sided attempts failed.Conclusion: This review represents the largest contemporary series of varicocele embolization outcomes currently in the literature. Our 19.3% technical failure rate for bilateral varicocele embolization is higher than the current published rate of 13% and is largely related to failure to successfully occlude the right gonadal vein. This supports our belief that bilateral varicoceles are best managed with a primary microsurgical approach, where technical failure rates are expected to be less than 5% based on published data. Men withunilateral left-sided varicoceles should be offered both options as they have similar failure rates, but with embolization offering some clear advantages to the patient.
Synergetic effect of testosterone and phophodiesterase-5 inhibitors
Authors: Alhathal Naif , Elshal Ahmed M. , Carrier Serge
Published: October 2016

Testosterone deficiency seems to impair the clinical response tophophodiesterase-5 (PDE-5) inhibitors in patients with erectile dysfunction (ED). In hypogonadal men, testosterone repletion was associated with enhanced sexual function in patients who failed initial treatment with sildenafil or tadalafil. We conducted a systematic review of studies that evaluated combination therapy of testosterone and PDE-5 inhibitors in patients with ED and low, low-normal testosterone levels who failed monotherapy. The studies we examine are heterogeneous with several methodological drawbacks and that, overall, the addition of testosterone to PDE-5 inhibitors might benefit patients with ED associated with testosterone <300 ng/dL (10.4 nmol/L) who failed monotherapy. Further studies, with a randomized placebo-controlled and double blind design, are needed to describe the appropriate target patient group, testosterone cut-off and to define the optimal dose and duration of combination therapy.
Giant adrenal germ cell tumor in a 59-year-old woman: A case report and review of the literature
Authors: Chen Lei
Published: October 2016

Adrenal germ cell tumor is very rare. We report a case of a 59-year-old woman who presented with right flank discomfort. The laboratory examinations were basically normal. Chest computed tomography showed right pleural effusion. Abdominal computed tomography scan revealed a large mass on the right adrenal gland. The patient underwent adrenalectomy. Histopathologic examination and immunohistochemical findings were consistent with mixed germ cell tumor. Three months later following operation, the patient was admitted to our hospital again with chest tightness and shortness of breath. The chest CT showed right pleural effusion recurrence and enlargement of mediastinal lymph nodes and right hilar lymph nodes. The patient had the right supraclavicular lymphadenectasis on physical examination. Fine needle aspiration cytology from the supraclavicular lymph nodes showed groups of malignant tumor cells. The patient died within 6 months postoperatively. In this case, the lymph node pathway plays an important role in the metastatic procedure.
Petroleum jelly-induced penile paraffinoma with inguinal
Authors: Sejben István , Rácz András , Svébis Mihály , Patyi Márta , Cserni Gábor
Published: October 2016

Chronic granulomatous inflammation may develop after injectingforeign oily substances into the penis. The disorder affects mainlythe site of administration, but regional lymphadenopathy or evensystemic disease can occur. We present a 39-year-old man withpetroleum jelly-induced penile lesion and unilateral inguinal lymphadenitis mimicking incarcerated inguinal hernia. At hernioplasty no hernial sac was found, but enlarged lymph nodes suspicious for malignancy were identified. The histopathologic findings of these nodes were consistent with mineral oil granuloma. Paraffinoma of the male genitalia can cause various clinical features posing a differential diagnostic dilemma. Regional lymphadenitis may be the main clinical characteristic. Patient’s history, physical and histopathological examination are required to establish the diagnosis.
Simultaneous bilateral tubeless percutaneous nephrolithotomy:
Authors: Yu Alice , Shahrour Walid , Andonian Sero
Published: October 2016

Percutaneous nephrolithotomy (PCNL) is currently the standardof care to remove large renal calculi. Traditionally, a large-borenephrostomy tube is placed postoperatively. However, the necessityof this practice has been recently challenged. Theoretically, bilateral tubeless PCNL offers advantages of lower postoperative discomfort, shorter hospital stay and thus lower cost. We review the literature and present two cases of simultaneous bilateral tubeless PCNL from two patients who were referred to a tertiary stone centre from remote areas.
Metastatic signet ring cell adenocarcinoma of the bladder:
Authors: Singh Jessica , Zherebitskiy Viktor , Grynspan David , Czaykowski Piotr Marek
Published: October 2016

Signet ring cell variant of mucinous adenocarcinoma of the urinarybladder is an exceptionally rare urologic malignancy, generally feltto be resistant to chemotherapy and radiotherapy. We describe acase of this malignancy with unusual sites of metastasis and anunexpectedly good response to treatment.
Percutaneous drainage and sclerotherapy as definitive treatment of
Authors: Valerio Massimo , Meuwly Jean-Yves , Tawadros Cecile , Jichlinski Patrice
Published: October 2016

We report the technique and outcome of percutaneous drainageand sclerotherapy as primary treatment of renal lymphangiomatosis. Between January and May 2009, two patients presenting with symptomatic renal lymphangiomatosis were treated in our department by a minimally invasive modality combining percutaneous drainage with repeated sclerotherapy. We retrospectively analysed recurrence, complications and patient satisfaction. In this limited case series, percutaneous drainage and repeated sclerotherapy proved to be safe and effective for treating renal lymphangiomatosis. This procedure provides a minimally invasive option for selected patients, potentially avoiding a surgical procedure and any risk of complications.
A case of metastatic urachal adenocarcinoma treated with several
Authors: Elser Christine , Sweet Joan , Cheran Sendhil K. , Haider Masoom A. , Jewett Michael , Sridhar Srikala S.
Published: October 2016

Urachal cancer is a rare form of bladder cancer that arises fromthe urachus, a vestigial musculofibrous band that extends from thedome of the bladder to the umbilicus. Urachal cancer often presentsat an advanced stage and has a dismal prognosis. We presenta case of a young woman with urachal cancer that recurred rapidlypost-partial cystectomy. The patient was treated with up to 6 different chemotherapy regimens, including an oral antiangiogenic drug as part of a clinical trial. Our case illustrates the aggressive nature of this disease, the difficulty in accessing drugs for the treatment of rare cancers and the lack of late stage clinical trials to help guide therapeutic decisions.
Urinary PSA: a potential useful marker when serum PSA is between 2.5 ng/mL and 10 ng/mL
Authors: Bolduc Stéphane , Lacombe Louis , Naud Alain , Grégoire Mireille , Fradet Yves , Tremblay Roland R.
Published: October 2016

Introduction: Our objective was to evaluate the usefulness of urinary prostatespecific antigen (PSA) in the differential diagnosis of benign prostatic hyperplasia(BPH) and prostate cancer.Methods: We undertook a prospective study and obtained informed consent from170 men. They provided blood samples to measure serum PSA and 50 mL of firstvoidedurine to measure urinary PSA. Seventy-seven men were diagnosed with BPH; 42 patients had newly diagnosed prostate cancer; and 51 were selected as age-matched control subjects. Data were analyzed using Wilcoxon signed rank tests, receiver operating characteristic (ROC) curves and logistic regression.Results: Prostate volume was 35 cm3 and 45 cm3 (p < 0.05), serum PSA was9.7 ng/mL and 4.5 ng/mL (p < 0.001) and PSA density was 0.28 and 0.11 (p < 0.01) for prostate cancer and BPH patients, respectively. Overall, urinary PSA was not significantly different, but PSA ratio (urinary:serum) was significantly different at 6.7 and 30.6 (p < 0.001) for prostate cancer and BPH patients, respectively. A subgroup with serum PSA between 2.5 ng/mL and 10.0 ng/mL was selected and urinary PSA was significant: 52.6 ng/mL (n = 29) and 123.2 ng/mL (n = 35) (p < 0.05) for prostate cancer and BPH patients, respectively. PSA ratios were also significant (p = 0.007). ROC curves identified a cutoff for urinary PSA at > 150 ng/mL, with a sensitivity of 92.5%. When comparingprostate cancer patients with age-matched control subjects, serum PSA, urinaryPSA and PSA ratio were different (p = 0.004).Conclusion: Our study supports urinary PSA as a useful marker in the differentialdiagnosis of prostate cancer and BPH, especially when serum PSA is between2.5 ng/mL and 10 ng/mL. Low urinary PSA and PSA ratios point toward prostatecancer. A urinary PSA threshold of > 150 ng/mL may be used to decrease thenumber of prostatic biopsies.
A case report of collecting duct carcinoma of the kidney coexistent with giant adrenal myelolipoma
Authors: Li Bingkun , Ding Qiang
Published: October 2016

Collecting duct carcinoma (CDC) of the kidney coexistent with giant adrenal myelolipoma is rare. We report a case of 70-year oldfemale who presented with a history of gross hematuria and back pain. On investigation, she had a mass in the left kidney and left adrenal gland, respectively. The patient underwent left radical nephrectomy with left adrenalectomy. Pathological findings revealed a renal CDC with partial aquamous metaplasia, in addition to an adrenal myelolipoma. Interleukin-2 was administered for 3 months after operation. Neither signs of recurrence nor metastasis has developed after a 4-year follow-up.
Confirming routine stentograms after cystectomy is unnecessary
Authors: Touma Naji , Spodek Jeffrey , Kuan James , Shepherd Robert R. , Hayman W. Philip , Chin Joseph L.
Published: October 2016

Objective: In the current trend of earlier discharge from hospital and minimizingcosts with selective intervention instead of routine “standard” orders, mostinstitutions have abolished routine radiographic imaging of the collecting system before stent removal in postcystectomy patients, although clear supportivedata from the recent literature is scarce. We retrospectively reviewed ourexperience with routine postoperative stentograms in 100 cystectomies to confirmthat our decision to omit the stentogram procedure does not compromisepatient safety and well-being.Methods: We retrospectively reviewed the records of 100 patients who underwentradical cystectomy for bladder cancer. All 100 patients (87 with ileal conduitand 13 with orthotopic neobladder reconstruction) had their ureteroenteric anastomosesstented with feeding tubes that were exteriorized. Retrograde stentogramwas performed under fluoroscopic monitoring on postoperative days 7 to 9. Theradiology reports were reviewed for any mention of extravasation.Results: Extravasation was detected on the stentograms of 5 of 197 (2.5%) ureteroentericanastomoses. Clinical signs suggestive of an anastomotic leak had precededthe imaging studies in 4 of the 5 cases. After expectant management, only 1patient (1.0%) required intervention with percutaneous nephrostomy.Conclusions: The relatively low extravasation rate and the infrequent need foractive intervention coupled with the fact that an anastomotic leak can usuallybe diagnosed on clinical grounds confirms that routine use of stentogram afterureteroenteric anastomoses is not justified. Our decision to perform postoperativestentograms selectively is appropriate.
Transperitoneal laparoscopic repair of a dorsal lumbotomy incisional hernia
Authors: Faddegon Stephen , Wright Jamie , Nguan Christopher
Published: October 2016

Hernias are a rare complication following muscle-splitting dorsal lumbotomysurgery. At our centre, before the introduction of laparoscopic surgery, donornephrectomy for renal transplantation was performed via a dorsal lumbotomyapproach. We present a case of transperitoneal laproscopic repair of a dorsallumbotomy incisional hernia following donor nephrectomy using a quilted2-sided expanded polytetrafluoroethylene (ePTFE) mesh. The procedure wasuncomplicated and required 2 hours operating time to complete. A 2-daystay in hospital was observed for convalescence and the patient quickly returnedto routine activity after discharge. Advantages of the laparoscopic approachinclude excellent visualization and wide coverage of the hernia defect underdirect vision. This case illustrates the benefits of laparoscopic repair of a rarelumbotomy complication.
Finasteride monotherapy maintains stable lower urinary tract symptoms in men with benign prostatic hyperplasia following cessation of alpha blockers
Authors: Nickel J. Curtis , Barkin Jack , Koch Caroline , Dupont Charles , Elhilali Mostafa
Published: October 2016

Objective: Our Canadian multicentre open-label study sought to evaluate, inpatients with moderate/severe lower urinary symptoms (LUTS) secondary tobenign prostatic hyperplasia, the effect on symptoms of 9 months of monotherapywith finasteride 5 mg following 9 months of combination treatment (finasteridewith an α-blocker) as quantified according to the International ProstateSymptom Score (IPSS).Methods: The primary outcome measure for efficacy was the maintenance ofIPSS response after cessation of the α-blocker. Subjects were treated with acombination of finasteride and an α-blocker for 9 months and then with finasteridealone for 3 or 9 months.Results: Results showed that the IPSS scores after 3 months of monotherapy werewithin the criteria for equivalence to those after 9 months of combination therapy.Symptom control equivalence was also found after 9 months of monotherapy.The IPSS response rate was also similar for combination and monotherapy.The safety profile was similar and as expected with these medications.Conclusion: Control of LUTS associated with BPH thus appears to be maintainedfor at least 9 months with finasteride alone, following a 9-month course of combinationtherapy with finasteride and an α-blocker, with similar safety profiles.
Long-term functional outcome and satisfaction of patients with hypospadias repaired in childhood
Authors: Hoag Chris C. , Gotto Geoff T. , Morrison Kevin B. , Coleman Gerald U. , MacNeily Andrew E.
Published: October 2016

Introduction: Potential long-term sequelae of hypospadias and its surgical correctioninclude difficulties in voiding, sexual function, psychosexual adjustmentand self-appraisal. These difficulties often evolve long after surgical repairas children grow to adulthood. Despite this, patient-driven data on long-termfunctional outcomes and satisfaction are limited, leaving the true success ofhypospadias surgery essentially unknown. The aim of this study was to addressthese deficiencies.Methods: We conducted a chart review for all patients operated on by a singleurologist from 1981 to 1988. Extensive efforts were made to obtain accuratecurrent address information for patients. A database of patient demographicsand pathology, operative details and complications was created. A 22-itemquestionnaire was mailed to study subjects. Telephone follow-up by an independentresearch nurse bolstered response rates. Responses from returned questionnaireswere pooled and analyzed.Results: The chart review included 115 patients. Of 100 patients (with addressinformation) who were sent questionnaires, 28 ultimately responded. The chartreview group was comparable to groups in other published studies. Despitea slightly higher initial major complication rate (57.2%), respondents reportedfew long-term complications (11% fistula, 29% persistent chordee and 10%stricture) and excellent urinary and sexual functional results. The most commonfunctional complaints were spraying and hesitancy during micturition.Overall, 86% of patients were satisfied with their surgical result, and 52% wishedthey had been provided longer follow-up.Conclusion: Long-term outcomes data are critical to an honest account of successrates for hypospadias surgery. Obtaining these data remains challenging. In thisseries, despite high initial complication rates, most patients reported excellentlong-term functional results and were quite satisfied with their overall outcome.
Fellow or foe: the impact of fellowship training programs on the education of Canadian urology residents
Authors: Grober Ethan D. , Elterman Dean S. , Jewett Michael A.S.
Published: October 2016

Objective: Throughout North America, increasing emphasis is being placed onsurgical fellowships. Surgical educators and trainees have raised concerns thatthe escalating focus on fellowships may threaten the educational mission of morenovice trainees. Our objective was to collect opinions from multiple perspectives(faculty, fellows and residents) regarding fellowship structure, fellow selectionand the impact of clinical fellowships on urology resident training.Methods: We anonymously surveyed 52 members of a major academic urologytraining program (University of Toronto) with established fellowship trainingprograms for their opinions regarding fellowship structure, fellow selection,and the impact on resident training and education.Results: The overall response rate was 88%. We identified significant differencesof opinion among faculty, fellows and residents regarding fellowshipstructure, fellow selection and the impact on resident education. Specifically,faculty and fellows supported the addition of more fellows, felt that certain complexcases should be designated as “fellow cases” and that residents’ researchopportunities were not restricted. Residents felt that fellows “steal” operativecases, that performing operations with the fellow is not equivalent to performingoperations with faculty alone and that fellowship candidates shouldperform an operation with division faculty as part of the application process.There was agreement that fellowship programs add value to residents’ overalleducation, that fellows should participate in the call schedule and thatfellows’ role in the operating room needs to be better defined with respect tocase volume and selection. Proficiency in technical skills, clinical knowledge,teaching and teamwork were cited as the most attractive characteristicsof an effective clinical fellow.Conclusion: Residency and fellowship program directors must clearly definethe role of the fellow and outline the limits of surgical practice, establish clearand consistent guidelines outlining responsibilities (operative, clinical andon-call), and open lines of communication to ensure that all opinions arerecognized and addressed. Finally, they must select fellows with proficient technicalskills, clinical knowledge, teaching ability and work ethic to ensure thatthey focus on “specialized” training.
Changes in blood glucose and cholesterol levels due to androgen deprivation therapy in men with non-metastatic prostate cancer
Authors: Mohamedali Hassanabbas Z. , Breunis Henriette , Timilshina Narhari , Alibhai Shabbir M.H.
Published: October 2016

Objective: To investigate the effects of androgen deprivation therapy(ADT) on blood glucose and cholesterol over 12 months in aprospective matched cohort study.Methods: English-speaking patients with non-metastatic prostatecancer attending the Princess Margaret Hospital were invited toparticipate in this study. Patients were divided into two cohorts:ADT users and controls. Androgen deprivation therapy users werefrequency matched to controls on age, education and body massindex (BMI). The study consisted of two visits. Sociodemographicand clinical information, medication use, physical fitness, heightand weight were collected before initiation of ADT. Twelve monthslater, fasting morning blood work was obtained to measure plasmaglucose, total cholesterol, high-density lipoprotein (HDL), low-densitylipoprotein (LDL) and triglycerides. Statistical analyses includedunivariate and multivariable linear regression.Results: We recruited 75 patients (mean age 68.9), 38 of whomwere undergoing ADT. Twelve patients with prior diabetes and 29patients taking cholesterol-lowering medication at baseline wereexcluded from the glucose and cholesterol analysis, respectively.In adjusted analyses, ADT users had a significantly higher glucoselevel compared to controls (5.88 vs. 5.52 mmol/L, p = 0.024).Overall, ADT users had higher levels of total cholesterol, HDL,LDL, and triglycerides than controls, although none of the differencesreached statistical significance.Conclusion: One year of ADT use is associated with elevated fastingglucose levels and may increase all lipid fractions in men withprostate cancer.
Embryonal rhabdomyosarcoma of the testis
Authors: Kelly Brian , Lundon Dara , Rowaiye Babatunde , Daly Padraig , Walsh Kilian
Published: October 2016

Rhabdomyosarcoma (RMS), arising from mesenchymal cells, isthe most common soft tissue tumour in children and accounts forup to half of all sarcomas. We present the case of a 33-year-oldmale presented to the urology department of the University CollegeHospital Galway (Ireland) in March 2009 with a 2-month historyof a left scrotal swelling, increasing in size.
Clear cell myomelanocytic tumour: minimally invasive treatment of a rare bladder tumour
Authors: Pianezza Michael L. , Slatnik Jack , Evans Howard J.
Published: October 2016

Clear cell myomelanocytic tumours are extremely rare neoplastic growths considered to be members of the family of perivascular epithelioid cell tumours (PEComas), which have in common the coexpression of melanocytic and smooth muscle immunohistochemical markers. These tumours are known to be ubiquitous with uncertain tumour biology and to have unpredictable clinical behaviour. They have been reported in the genitourinary tract, including the kidney and prostate. There are only 3 reported cases of clear cell myomelanocytic tumours originating in the urinary bladder. We report a case of a 24-year-old woman with chronic pelvic pain who underwent laparoscopic partial cystectomy and total excision of a bladder mass. Pathological examination revealed primary PEComa of the urinary bladder. Subsequent follow-up procedures, including cystoscopy and imaging, have not revealed any evidence of disease recurrence. The patient remains clinically free of disease 3 months after surgery.
Current understanding of the molecular mechanisms of kidney cancer: a primer for urologists
Authors: Lim Darwin L. , Ko Raymond , Pautler Stephen E.
Published: October 2016

Renal cell carcinoma (RCC), the fifth leading malignant condition for menand tenth for women, accounts for 3% of all malignancies in Canada. It is aheterogeneous epithelial malignancy with different subtypes and varied tumourbiology. Although most cases of RCC are sporadic, up to 4% of patients havean inherited predisposition for the disease. In this article, we review the currentmolecular genetics of the different subtypes in hereditary and sporadic RCC. Significant developments in understanding the underlying genetic basis of RCC over the last 2 decades are attributed to intensive research about rareinherited renal cancer syndromes and the identification of the genes responsiblefor them. Many of these genes are also found in sporadic RCC. Understanding the molecular mechanisms involved in the pathogenesis of RCC has aided the development of molecular-targeted drugs for this disease.