bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of medical treatment in overcoming the ureteral double-J stent related symptoms
Authors: Kuyumcuoglu Ugur , Eryildirim Bilal , Tuncer Murat , Faydaci Gokhan , Tarhan Fatih , Ozgül Aydin
Published: October 2016

Background: We investigated whether the frequency of lower urinary tract symptoms (LUTS) increased in patients in whom double-J stents were applied. We also evaluated several medical therapy protocols to treat symptoms related with ureteral stents.Materials and Methods: A total of 108 patients, in whom unilateral double-j stent was applied during ureteral stone treatment, were included. Before the double-J stent was applied, all patients completed storage components of the “International Prostate Symptom Score” (IPSSs), quality of life components of the IPSS (IPSS-QOL) and “Overactive Bladder Questionnaire” (OABq) forms and scores were calculated. After the procedure, cases were randomized into 5 groups, an antiinflammatory was given to Group 1, spasmolytic to Group 2, anticholinergic to Group 3 and α-blocker to Group 4. No additional drug was given to Group 5 as this control group. During the fourth week of the procedure, IPSSs, IPSS-QOL and OABq forms were again completed and scores were compared with the previous ones.Results: When all the cases were evaluated, the IPSSs, IPSS-QOLand OABq scores of patients in whom the double-J stent was applied were statistically significantly higher the procedure. Compared to the control group, the cases where the double-J stent was applied showed a higher IPSSs, IPSS-QOL and OABq scores and none of the medical therapies could prevent this increase.Interpretation: The frequency of LUTS increased in cases where the ureteral stent was applied and discomfort continued as long as the stent stayed in the body.
Lower urinary tract symptoms associated with prostatitis
Authors: Nickel J. Curtis
Published: October 2016

Approximately 50% to 60% of men with chronic prostatitis experience troublesome lower urinary tract symptoms (LUTS). Individual interventions yield statistically significant but minimally important improvements in clinical trials. Research has shown that categorizing patients with prostatitis by phenotype is an effective way to rationally select therapy and maximize the impact on symptom reduction and improve quality of life.
Overview of interventional treatment options for benign prostatic hyperplasia
Authors: Elhilali Mostafa M.
Published: October 2016

Transurethral resection of the prostate (TURP) remains the gold standard surgical intervention for men with benign prostatic hyperplasia (BPH). However, there are other, newer technologies that have also demonstrated safety and efficacy at least equivalent to that of TURP (e.g., Holmium laser, photoselective vaporization of the prostate). These minimally invasive techniques may be particularly useful for selected patient populations (e.g., those on anticoagulant therapy).
Micropapillary carcinoma of the bladder presented with spontaneous intraperitoneal bladder rupture
Authors: Stojadinović Miroslav M. , Mitrović Slobodanka Lj. , Milovanović Dragan R
Published: October 2016

Spontaneous bladder perforation is a rare presenting feature of bladder malignancy. We describe an unusual case of a patient, admitted to emergency, with diffuse abdominal pain due to spontaneous bladder rupture in association with a micropapillary carcinoma. A diagnosis of an intraperitoneal bladder perforation was made during an emergency operation. Aspects of etiology, clinical presentation, diagnosis and management are described. Although cases of spontaneous carcinomatous bladder rupture are associated with high morbidity and mortality, prompt identification and treatment can lead to favourable outcomes.
Pseudomonas aeruginosa bacteremia and prostatitis in a patient with cystic fibrosis
Authors: Anand Anju , Tullis Elizabeth , Stephenson Anne , Nickel J. Curtis , Leveridge Michael J.
Published: October 2016

Patients with cystic fibrosis (CF) commonly suffer chronic respiratory infections, although systemic dissemination is relatively rare. Acute bacterial prostatitis presents dramatically and is believed to be mostly caused by local migration (with or without instrumentation) of the lower urinary tract and presents with a predictable microbial etiology. We report a case of a 26-year-old man presenting with acute Pseudomonas aeruginosa bacterial prostatitis due to hematogenous propagation from a chronic pulmonary infection.
An endothelialized urothelial cell-seeded tubular graft for urethral replacement
Authors: Imbeault Annie , Bernard Geneviève , Rousseau Alexandre , Morissette Amélie , Chabaud Stéphane , Bouhout Sara , Bolduc Stéphane
Published: October 2016

Introduction: Many efforts are used to improve surgical techniques and graft materials for urethral reconstruction. We developed an endothelialized tubular structure for urethral reconstruction.Methods: Two tubular models were created in vitro. Human fibroblasts were cultured for 4 weeks to form fibroblast sheets. Then, endothelial cells (ECs) were seeded on the fibroblast sheets and wrapped around a tubular support to form a cylinder for the endothelialized tubular urethral model (ET). No ECs were added in the standard tubular model (T). After 21 days of maturation, urothelial cells were seeded into the lumen of both models. Constructs were placed under perfusion in a bioreactor for 1 week. At several times,histology and immunohistochemistry were performed on grafted nude mice to evaluate the impact of ECs on vascularization.Results: Both models produced an extracellular matrix, without exogenous material, and developed a pseudostratified urothelium. Seven days after the graft, mouse red blood cells were present only in the outer layers in T model, but in the full thickness of ET model. After 14 days, erythrocytes were present in both models, but in a greater proportion in ET model. At day 28, both models were well-vascularized, with capillary-like structures in the wholethickness of the tubes.Conclusion: Incorporating endothelial cells was associated with an earlier vascularization of the grafts, which could decrease the necrosis of the transplanted tissue. As those models can be elaborated with the patient’s cells, this tubular urethral graft would be unique in its autologous property.
Detrusor underactivity is prevalent after radical prostatectomy: A urodynamic study including risk factors
Authors: Chung Doreen E. , Dillon Benjamin , Kurta Jordan , Maschino Alexandra , Sandhu Jaspreet S.
Published: October 2016

Introduction: The objective was to determine the prevalence of, and factors that predict, detrusor underactivity (DU) in patients presenting with incontinence or lower urinary tract symptoms (LUTS) following radical prostatectomy (RP). We also determined the prevalence of bladder outlet obstruction (BOO) and detrusor overactivity (DO) in this population.Methods: Patients who underwent urodynamics post-RP were identified. Detrusor underactivity was defined as a maximum flow rate (Qmax) of ≤15 mL/s and detrusor pressure (Pdet) Qmax <20 cmH20 or maximum Pdet <20 cmH20 during attempted voiding. Abdominal voiding (AV) was defined as sustained increase in abdominal pressure during voiding. Bladder outlet obstruction and DO were identified using the Abrams-Griffiths nomogram and the International Continence Society criteria. Univariate logistic regression was used to determine factors predicting DU. The following factors were analyzed: age, year of RP, procedure type (minimally-invasive surgery [MIS] or open), postoperative radiation, nerve-sparing, clinical stage, biopsy Gleason grade and interval between RP and evaluation.Results: Between 2005 and 2008, 264 patients underwent urodynamics post-RP. Detrusor underactivity was observed in 108 patients (41%; 95% CI 35%, 47%), of whom 48% demonstrated AV. Overall, BOO and DO were present in 17% (95% CI 12%, 22%) and 27% (95% CI 22%, 33%), respectively. On univariate analysis, only MIS RP was predictive of DU (univariate odds ratio 2.05 for MIS vs. open; p = 0.009).Conclusions: Detrusor underactivity and AV are common in patients presenting for evaluation of incontinence or LUTS following RP. The etiology of DU in this setting is likely related to the surgical approach. Because DU may affect the success of male incontinence treatment with the male sling or artificial urinary sphincter, it is useful to document its presence prior to treatment. More studies are needed to elucidate the influence of DU on treatment success for male urinary incontinence following RP.
Metastatic urothelial carcinoma to pericardia manifested by dyspnea from cardiac tamponade during systemic chemotherapy: case report and literature review
Authors: Hattori Seiya , Miyajima Akira , Maeda Takahiro , Takeda Toshikazu , Morita Shinya , Kosaka Takeo , Kikuchi Eiji , Oya Mototsugu
Published: October 2016

A 53-year-old man presented for further evaluation due to microscopic hematuria and left lumbar pain. Computed tomography revealed a large tumour in the left renal pelvis with multiple metastases. Despite effective systemic chemotherapy, he developed dyspnea, and was diagnosed with cardiac tamponade. Pericardial involvement in an advanced malignancy is common, but symptomatic cardiac metastasis from urothelial carcinoma is rare. Of the reports of symptomatic cardiac metastasis from urothelial carcinoma, only 3 cases presented as cardiac tamponade. We report here a rare case of cardiac tamponade caused by a renal pelvic carcinoma with positive cytodiagnosis of pericardial effusion. We also summarize and discuss the symptoms, treatment, and prognosis of the pathological condition, and present a brief review of previously published reports.
Construct validity of the LapSim virtual reality laparoscopic
Authors: Kovac Evan , Azhar Raed A. , Quirouet Adrienne , Delisle Josee , Anidjar Maurice
Published: October 2016

Objective: We assessed the construct validity of the LapSim laparoscopic surgical simulator in a urology residency training program.Methods: In total, 15 residents participated in the study betweenJuly 2007 and July 2008. The subjects were tested six times at onemonth intervals on three skill tasks (lifting and grasping, cuttingand clip application) using the LapSim laparoscopic simulator. Thetesting sessions were divided into the first three sessions (seminar1), and the subsequent three sessions (seminar 2). We evaluated thefollowing parameters: total time, path length, angular path length,tissue damage, maximum damage and stretch damage. The subjectswere divided into junior (PGY 1,2) and senior resident groups(PGY 3,4,5). The Wilcoxon Signed-Rank test for paired sampleswas used to compare the performances of the juniors and seniorsduring seminar 1 to their performance in seminar 2 to determinewhether there was improvement over time. The Wilcoxon Rank-Sum test for independent samples was used to compare the performance of the juniors to that of the seniors for seminar 1, seminar 2 and the combination of both seminars to determine whether the more experienced senior residents performed better than the lessexperienced juniors.Results: No significant performance improvement between testingsessions could be demonstrated. Similarly, there was no significantdifference in performance between junior and senior residents.Conclusions: Construct validity could not be demonstrated for thetotal time, path length, angular path length and tissue handlingparameters of the LapSim laparoscopic surgical simulator whenexamined within the context of a urology residency program.
A rare case of metastatic lung cancer to the bladder
Authors: Karle William , Barazani Yagil , Tareen Basir
Published: October 2016

Cancer metastasis to the bladder from non-contiguous sites is veryrare. Lung metastasis to the bladder is even more uncommon, withan extensive literature search identifying only four documentedcases in the past 20 years. Of these four cases, only one wasfrom lung adenocarcinoma. In this report, we present the caseof a 66-year-old male with known lung adenocarcinoma foundto have the incidental finding of a bladder mass upon computedtomography imaging. Histochemical staining of samples from thebladder confirmed metastatic dissemination from the primary lungmalignancy.
Scrotal lymphangiomatosis: a case report
Authors: Wong Rachel , Melnyk Megan , Tang Steven S. , Nguan Chris
Published: October 2016

Lymphangiomas are benign tumours of the lymphatic system, andthere are several reported cases of scrotal lymphangioma in theliterature to date. We report a rare case of multilocular cutaneouslymphangiomatosis treated with surgical excision (total scrotectomyand reconstruction using split-thickness skin grafts withvacuum-assisted closure dressing).
Mixed epithelial and stromal tumor of the kidney (MEST) simulating
Authors: Sountoulides Petros , Koptsis Michail , Metaxa Linda , Theodosiou Alexandros , Kikidakis Dimitrios , Filintatzi Chrysa , Paschalidis Konstantinos
Published: October 2016

We present a rare and interesting case of a mixed epithelial andstromal tumour (MEST) of the kidney. The case is unique as itinvolves a male patient with no history of hormonal therapy presenting with a filling defect in the renal collecting system and positive urine cytology. The patient was diagnosed with transitional cell carcinoma of the renal pelvis and subjected to nephroureterectomy, which revealed a solid tumour arising from the lower calyces and extending into the renal pelvis and upper ureter. Pathology revealed a MEST. The patient was disease-free at the 6-month follow-up.
Leiomyosarcoma of the spermatic cord: case report and literature review
Authors: Dangle Pankaj , Basavaraj Doddametikurke R. , Bhattarai Selina , Paul Alan B. , Biyani, Chandra Shekhar
Published: October 2016

A 51-year-old man presented with a 2-year history of painless lump in the lefthemiscrotum. Scrotal examination demonstrated a 3-cm, firm-to-hard massattached to the left spermatic cord. Scrotal ultrasound scan revealed a heterogeneousmass separate from the left testis and epididymis. An orchidectomywas recommended to the patient; however, he declined surgery andunderwent excision biopsy of the lesion with preservation of the left testis.Histology suggested a leiomyosarcoma of the spermatic cord and positivemargins. Following a normal staging CT scan, the patient was referred tothe regional sarcoma clinic. He was treated with an orchidectomy. Microscopicexaminations showed fibrosis in the spermatic cord and negative margins.The patient has been followed up for 12 months with CT scans and shows nosigns of recurrence.
Prevalence and prognostic factors for erectile dysfunction in renal transplant recipients
Authors: Wong Jaime A. , Lawen Joseph , Kiberd Bryce , Alkhudair Waleed K.
Published: October 2016

Introduction: The purpose of this study was to determine the prevalence of erectiledysfunction (ED) at our institution in the postrenal transplant populationand to compare those patients who had ED with those who did not have ED, with respect to several patient characteristics.Methods: We conducted a cross-sectional study of male renal transplant recipientswho were in attendance at the transplant clinic from April 1, 2004, toMarch 31, 2006. Erectile function was evaluated using the International Indexof Erectile Function short form questionnaire. Patients were also screened fordepression using the Beck Depression Inventory. We performed a chart reviewto obtain various patient characteristics.Results: This study involved 55 patients. Their average age was 50 years oldand the mean duration of the current transplant was 7.9 years. ED was identifiedin 28 of the patients (51%). More patients with ED were over age 50 years(64% v. 26%, p = 0.004). There was a higher prevalence of diabetes mellitus(39% v. 11%, p = 0.02) in patients with ED compared with those patients withoutED. More patients with ED were depressed compared with those patientswho did not have ED (29% v. 7%, p = 0.04). These 3 factors were significantlyassociated with ED and this relationship was confirmed on multivariateanalysis.Conclusion: ED remains a common problem in the renal transplant population.The cause of ED is multifactorial, with increasing age and the presenceof diabetes mellitus and depression increasing the risk of ED.
Renal leiomyoma: Case report and literature review
Authors: Brunocilla Eugenio , Pultrone Cristian Vincenzo , Schiavina Riccardo , Vagnoni Valerio , Caprara Giacoma , Martorana Giuseppe
Published: October 2016

Renal leiomyomas are rare benign tumours of the kidney originating from muscle cells. They are usually found by an autopsy,whether the patient is asymptomatic or has symptoms (i.e., abdominal/flank pain, hematuria, palpable mass). Today the widespread use of ultrasonography and computed tomography has increased the detection of clinically asymptomatic renal leiomyomas. The differential diagnosis between leiomyomas and other malignant lesions (above all renal cell carcinoma or leiomyosarcoma) is still possible by histological examination. Radiological examinations are not sufficient for the differential diagnosis. Renal leiomyomas have no aggressive behaviour and they usually do not metastasize. The prognosis, after surgery, is excellent without recurrence. We report a case of leiomyoma in a 31-year-old man who presented hematuria and flank pain. We also review the literature and provide a summary of clinical, radiological and histological features of renal leiomyomas.
A rare case of penile cancer in situ metastasizing to lymph nodes
Authors: Kim Brian , Garcia Francisco , Touma Naji , Moussa Madeleine , Izawa Jonathan I.
Published: October 2016

Penile carcinoma in situ, or Queyrat’s erythroplasia, is a rare condition of theglans penis. This lesion has been associated with invasive squamous cell carcinoma;however, metastasis without an invasive component is extremely rare.There have only been 2 documented cases with metachronous metastases.We report a third case in which metastases were diagnosed at presentation. Thepatient was a 51-year-old man who presented with a glans penile lesion andbilateral inguinal masses later determined to be carcinoma in situ with metastasesto the inguinal and pelvic lymph nodes. He subsequently underwent a partialpenectomy and lymphadenectomy followed by adjuvant chemotherapy andradiation. This case is discussed, along with a brief review of the literature.
An analysis of preoperative delays prior to radical cystectomy forbladder cancer in Quebec
Authors: Fahmy Nader , Kassouf Wassim , Jeyaganth Suganthiny , Amin Moamen , Mahmud Salaheddin , Steinberg Jordan , Tanguay Simon , Aprikian Armen
Published: October 2016

Background: The province of Quebec has the highest incidence of urothelialtumours in Canada. Radical cystectomy remains the standard treatment for invasivebladder cancer. We have previously observed that prolonged delays betweentransurethral resection of bladder tumour (TURBT) and radical cystectomy leadto worse survival in Quebec.Objective: The aim of our study was to characterize the various periods of delaysustained by bladder cancer patients before radical cystectomy across Quebecand to determine their relation to survival.Methods: We obtained the billing records for all patients treated with radicalcystectomies for bladder cancer across Quebec from 1990 to 2002. Collectedinformation included patient age and sex; dates of family physician (FP) andspecialist visits with accompanying diagnoses; dates of cystoscopy, TURBT andCT scanning; surgeon age; surgical volume and dates of death.Results: We analyzed a total of 25 862 visits for 1633 patients. Median diagnosticdelays from FP to specialist, then to cystoscopy, then to TURBT and finallyfrom TURBT to CT were 20, 11, 4 and 14 days, respectively, over the entirestudy period. Median overall delay from FP visit to radical cystectomy was93 days. In addition, median FP to radical cystectomy delay progressivelyincreased from 1990 to 2000 from 58 to 120 days (p < 0.01). Multivariate analysesshowed that patients with an overall delay of either < 25 or > 84 dayshad a 2.1 and 1.4 times increased risk of dying, respectively (p ≤ 0.01).Conclusion: Preoperative delays have been progressively increasing over time.Overall, delays from FP to radical cystectomy of < 25 and > 84 days may translateinto worse outcomes. Poor survival in cases with < 25 days delay maybe attributed to case selection, with more advanced cases being managed muchquicker. Poor survival in cases with delays of > 84 days may be attributed todisease progression while awaiting completion of management.
Nonstented tubularized incised plate urethroplasty with Y-to-I spongioplasty in non–toilet trained children
Authors: Almodhen Fayez , Alzahrani Ahmed , Jednak Roman , Capolicchio Jean Paul , El Sherbiny Mohamed T.
Published: October 2016

Introduction: This study was designed to evaluate the supportive role of spongioplastyduring tubularized incised plate (TIP) urethroplasty repair of hypospadias.Methods: All non–toilet trained children who underwent TIP repair for primaryhypospadias by 1 surgeon over a 30-month period were included inour study. The divergent spongiosa was mobilized off the corpora cavernosaand was rotated toward the midline to wrap the neourethra. A dartos flapwas used to cover the neourethra. The neourethra was calibrated immediatelyafter surgery in all patients. A urethral stent was left in place only when difficultcalibration was encountered. Complications and cosmetic appearance weredocumented at last follow-up.Results: Thirty-two consecutive patients with a mean age of 18 (standard deviation[SD] 6) months were included in the study. The defects were distal andmid-shaft in 26 patients (81.3%) and proximal-shaft in 6 (18.8%). No intraoperativecatheterization difficulties were encountered and all repairs were nonstented.Antibiotics and anticholinergics were not required. Mean follow-up was9 (SD 6) months. Urinary extravasation developed in 1 patient (3.1%) on the secondpostoperative day. A urethral catheter was easily inserted and left indwellingfor 5 days. One patient presented 6 days postoperatively with suspected voidingdifficulty. Urethral calibration was easily performed excluding any mechanicalobstruction. There were no urinary fistulae and reoperation was not required.An excellent cosmetic appearance was achieved in all patients.Conclusion: TIP urethroplasty is a versatile operation that can be performed inalmost all cases of penile hypospadias. A nonstented technique for hypospadiasrepair simplifies postoperative care and obviates the need for antibioticsand anticholinergics. We believe that spongioplasty provides good supportto the neourethra and the hypoplastic distal urethra that may facilitate catheterizationin the immediate and early postoperative periods, if required. Futurecontrolled study is warranted to further evaluate the role of spongioplasty.
Initial experience with robotic-assisted laparoscopic radical prostatectomy in the Canadian health care system
Authors: Chin Joseph L. , Luke Patrick P. , Pautler Stephen E.
Published: October 2016

Background: Robotic-assisted laparoscopic radical prostatectomy (RALRP) has gained popularity in the United States due to claims of its superior 3-dimensional magnified vision and improved manual dexterity for surgeons that shorten the learningcurve and facilitate the transition from standard open radical prostatectomyto laparoscopic prostatectomy as a minimally invasive procedure. The Canadian health care system, however, faces unique challenges when dealing with theintroduction of new technologies. We report the initial experience with the useof the da Vinci robot for RALRP at the University of Western Ontario.Methods: We retrospectively reviewed the records of the initial 30 cases ofRALRP with a minimum of 6 months follow-up. Data included the surgical times of various operative segments from cases 1–15 and 16–30, perioperative complications,early oncology and early functional results.Results: The lack of dedicated resources initially led to sporadic and infrequentcases. Nevertheless, there was improvement in surgical proficiency with significantdifference in operative times between cases 1–15 and 16–30. Perioperativecomplications, though significant, were commensurate with reported early experiencesfrom other centres worldwide, which reflects the learning curve with RALRP.Conclusion: Initiating a new surgical program that involves significant capital andmaintenance costs, such as an RALRP program, within the Canadian healthcare system poses unique challenges for the surgical team. Nevertheless, ourinitial experience has encouraged us to proceed with the next phase of evaluationfor the urological and oncological application of the technology.
Sarcoma of the bladder with metastasis to the left ventricle
Authors: Mirza Saqeb B. , Puttasidiah Parmesh , Panesar Sukhmeet S. , French Jane A. , Jones David R. , Stock David
Published: October 2016

Genitourinary sarcomas are rare clinical entitities. Current information on thesetumours is sparse and anecdotal. Cardiac metastasis from genitourinary tumoursin general is an exceedingly rare phenomenon and has previously been reportedonly in relation to carcinomas. We report the first case of sarcoma ofthe bladder with metastasis to the heart causing sudden death.
Early versus late treatment of voiding dysfunction with pelvic neuromodulation
Authors: Hassouna Magdy M. , Elkelini Mohamed S.
Published: October 2016

Introduction: Pelvic neuromodulation is an established method of treating voidingdysfunction. Little is known about the pathophysiology associated with voiding dysfunction. Reports have suggested that a delay in treating patients with sacral neuromodulation therapy can impact the success rate of this type oftreatment in voiding dysfunction. We examined patient response to pelvic neuromodulationwhen it was applied early versus late in the postdiagnosis of voidingdysfunction.Methods: We conducted a retrospective study of 42 patients (38 women and4 men) with voiding dysfunction who underwent surgery for implant with the Interstim (Medtronic, Minneapolis, Minn.). Prior to implantation, patients wererequired to pass a percutaneous nerve evaluation (PNE) over a 1-week period. Patients were observed for 20–48 months postimplantation. All patients recorded their voiding parameters at baseline, after screening and every 6 months thereafter. Twenty patients (in the early group) underwent implant surgery withthe neurostimulator 2–4 weeks post-PNE, and 22 patients (the late group)had the device implanted 6–24 months post-PNE owing to local logisticalcircumstances.Results: In the early group, 16 of 20 patients (80%) maintained a good response.In the late group, 13 of 22 (59%) patients showed a good response. Groupswere well matched in terms of age, duration of voiding dysfunction and incidenceof comorbidity.Conclusion: Patients who were delayed more than 6 months in receiving the neurostimulatorimplant showed a worse response than did patients who had thedevice implanted soon after PNE. This indicates the possibility of disease progression,which may limit the response to sacral neuromodulation.
Testosterone deficiency syndrome and prostate cancer: illustrative annotations for a debate
Authors: Morales Alvaro , Black Angela
Published: October 2016

As illustrated in this issue of the CUAJ,1 the use of testosteronein elderly men diagnosed with testosterone deficiency syndrome(TDS), or hypogonadism, remains controversial. Perhaps the mostcontentious point refers to the effect of supplemental testosterone onprostate health. In the last few years, small studies appear to indicatethat in men treated successfully for prostate cancer and TDS, testosteronetreatment is warranted, usually successful and largely free of seriousadverse effects.2,3 To complement some of the points raised, we presenta case that typifies the situation and strengthens some of the opinionsexpressed in the Point / Counterpoint section of this issue.
Virtual cystoscopy: the evaluation of bladder lesions with computed tomographic virtual cystoscopy
Authors: Karabacak Osman Raif , Cakmakci Esin , Ozturk Ufuk , Demirel Fuat , Dilli Alper , Hekimoglu Baki , Altug Ugur
Published: October 2016

Purpose: Our objective was to assess the accuracy of computedtomographic virtual cystoscopy (CTVC) in the detection of urinarybladder lesions.Methods: Twenty-five patients were examined using CTVC. Bladderscanned using multislice CT at a slice thickness of 1 mm. The datawere transferred to a workstation for interactive navigation usingsurface rendering. Findings obtained from CTVC were comparedwith results from conventional cystoscopy and with pathologicalfindings.Results: Thirty-eight lesions were identified. The smallest was0.2 × 0.3 cm; the largest was 7 × 4.5 cm. Both CTVC and conventionalcystoscopy were used. Conventional cystoscopy detectedthe same number of lesions that were detected by CTVC. Onmorphological examination, 26 of the lesions were polypoid, 7were sessile and 5 were bladder wall-thickening. While one of thepolypoid lesions was reported as an inverted papilloma, 2 of the 5lesions that were identified as wall-thickening were malignant and3 were benign. The sensitivity of using CTVC to identify neoplasiaswas 100%; the accuracy was 89%.Conclusion: Although the definitive diagnosis of some suspectedurinary bladder tumours is only possible with conventional cystoscopyand biopsy, CTVC is a minimally invasive technique whichprovides beneficial information about urinary bladder lesions.
Renal histopathology features according to various warm ischemiatimes in porcine laparoscopic and open surgery model
Authors: Sabbagh Robert , Chawla Arun , Tisdale Britton , Kwan Kevin , Chatterjee Suman , Kwiecien Jacek M. , Kapoor Anil
Published: October 2016

Background: Thirty minutes has been considered as the thresholdfor tolerable warm ischemic time (WIT). Recent reports demonstraterecovery of renal function after longer WIT. We assessed renalhistology according to different WIT in a 2-kidney porcine model.Methods: Twelve female pigs were randomized to an open orlaparoscopic group. Each pig was further randomized within eachgroup to clamping the left renal artery for 5, 15, 30, 45, 60 or180 minutes. Preclamping left renal biopsies were performed oneach pig. The contralateral kidney in each animal was used as anindividual control. On postoperative day 14, all animals underwentbilateral nephrectomies. Preclamping left renal biopsiesand all renal specimens were evaluated by a blinded veterinarypathologist.Results: One pig died in the open group after 180 minutes ofclamping. Histopathology did not show any significant changesbetween the two groups and across clamp times from 5 to 60minutes. After 180 minutes of laparoscopic clamping, there wasevidence of diffuse necrosis.Interpretation: Sixty minutes of ischemia did not show any permanentrenal damage in both groups. Further studies are needed toverify these findings in humans. A prolonged ischemic time withoutpermanent renal damage would be helpful in partial nephrectomy.Warm ischemic time of 180 minutes exceeded the renal ischemicburden based on histological features.
Progression to metastatic disease from a small renal cell carcinoma prospectively followed with an active surveillance protocol
Authors: Wong Jaime A. , Rendon Ricardo
Published: October 2016

With the widespread use of abdominal imaging to evaluate other medical conditions, many renal tumours are being diagnosed at earlier stages. Older patients have experienced the most significant increase in the incidence of renal cellcarcinoma (RCC). This age group frequently has significant medical comorbidities. This has led to the concept of active surveillance for select patients withrenal lesions that may not affect their mortality. However, the ultimate risk ofactive surveillance is the potential for developing metastases. This case report presents the development of metastatic disease from a small, incidentally detectedand prospectively followed RCC with asymptomatic progression.
Renal sarcoma and associated malignant pulmonary embolism: a report of 2 cases
Authors: Taylor Jonathan S. , Breau Rodney H. , Cagiannos Ilias , Morash Christopher
Published: October 2016

Renal sarcoma with venous tumour thrombus is usually an aggressive malignancy that necessitates complete surgical extirpation to achieve cure. Due to the rarity of these tumours, clinicians rely on case reports to better understandand treat patients with this disease. We recently encountered 2 patientswith renal sarcoma who developed malignant pulmonary embolus. Our cases,combined with those previously published, suggest renal sarcoma tumour thrombusis at high risk for spontaneous and intraoperative embolization. This reportdetails our experience and outlines measures that may decrease the rate ofvenous tumour embolization in patients with sarcoma.
Partial cystectomy: Is it a reliable option for the treatment of bladder
Authors: Xu Yun-fei , Wang Guang-chun , Zheng Jun-hua , Peng Bo
Published: October 2016

Bladder leiomyosarcoma is a unique mesenchymal tumour,accounting for less than 0.5% of all primary bladder malignancies.Bladder leiomyosarcoma used to be treated with radical surgeryin either old or young patients, often resulting in significantimpact on the patients’s quality of life after surgery. We reporton a case of bladder leiomyosarcoma in a 31-year-old femalewho was treated with partial cystectomy. Fortunately, no tumourmetastasis or relapse was observed during the 7-year follow-upperiod and the patient now has a good quality of life. We foundthat partial cystectomy may be an acceptable option to treat bladderleiomyosarcoma in the low MSKCC (Memorial Sloan-KetteringCancer Center) stage.
A case of intraepithelial squamous cell carcinoma arising from urethral caruncle
Authors: Kaneko Gou , Nishimoto Koshiro , Ogata Kentaro , Uchida Atsushi
Published: October 2016

A 62-year-old female patient had occasional bleeding from a massin the urethral meatus. She had been conservatively treated withsteroid ointment at another hospital for 1 year, but the bleedinghad persisted. The patient was therefore referred for further treatment.A reddish mass, measuring 5 mm in diameter was noted atthe posterior lip of the urethral meatus. The mass was diagnosedto be a urethral caruncle and was removed. Microscopically, thesquamous epithelium, which covered the urethral caruncle, wasfound to be keratinized, with the proliferation of atypical cells withswollen nuclei in the entire mucosal layer. The mass was finallydiagnosed to be intraepithelial squamous cell carcinoma arisingfrom the urethral caruncle.The occurrence of intraepithelial squamous cell carcinomaarising from a urethral caruncle is extremely rare. A search of theEnglish literature revealed only 1 other case report.
Recommendations by Canadian urologists and radiation oncologists for the treatment of clinically localized prostate cancer
Authors: Pearce Andrew , Newcomb Chris , Husain Siraj
Published: October 2016

Objective: Previous work has shown that urologists and radiation oncologists prefer the treatment that they themselves deliver when treating clinically localized prostate cancer. Our objective was to determine whether Canadian radiation oncologists and urologists have similar biases in favour of the treatments that they themselves deliver for localized prostate cancer.Methods: We developed a survey to poll the beliefs that Canadian radiation oncologists and urologists held toward prostate specific antigen (PSA) screening, survival benefits of treatment, recommendations for treatment of prostate cancer and the likelihood of side effects with each therapy.Results: Urologists were more likely to recommend routine PSA screening for men up to age 70 (p < 0.001), while radiation oncologists were more likely to recommend PSA screening for men over age 80 (p < 0.04). More urologists felt that there was “definitely” a survival advantage with radical prostatectomy (RP) (60% v. 21%, p < 0.001). More radiation oncologists recommend external beam radiation therapy (EBRT) (p < 0.01) or brachytherapy (p < 0.03) to treat low-risk prostate cancer. More urologists than radiation oncologists recommend RP for intermediate-risk patients (98% v. 70%, p < 0.001).Conclusion: Most Canadian urologists and radiation oncologists recommend routine PSA screening for men aged 50 to 70. A significant preference was detected among both urologists and radiation oncologists for the treatment that they themselves deliver. While both urologists and radiation oncologists recommend prostatectomy for the treatment of low-risk localized prostate cancer, urologist sare significantly less likely to recommend EBRT. Conversely, when patients present with intermediate-risk prostate cancer, radiation oncologists were significantly less likely than urologists to recommend a prostatectomy.
Biomarkers for detection and surveillance of bladder cancer
Authors: Budman Lorne I. , Kassouf Wassim , Steinberg Jordan R.
Published: October 2016

Introduction: Bladder cancer is the fourth most common cancer in men and the ninth most common cancer in women in Canada. Early detection of tumours is essential for improved prognosis and long-term survival. The standard method for detection and surveillance is cystoscopy together with urine cytology. Cystoscopy is relatively sensitive but is expensive and invasive. Urinary cytology is a noninvasive method that has poor sensitivity but high specificity; it is relied on for the detection of carcinoma in situ. Currently, several urinary based bladder tumour biomarkers with USFDA/Health Canada approval are available commercially, but none have been widely adopted by urologists despite their offering high sensitivity and/or specificity. We present here a review of recent studies evaluating 7 commercial biomarker assays for the detection and/or surveillance of bladder cancer.Results: Sensitivity and specificity ranges, respectively, for each marker were reported as follows: BTA Stat (Polymedco), 52.5%–78.0% and 69.0%–87.1%; BTA Trak (Polymedco), 51%–100% and 73%–92.5%; cytology, 12.1%–84.6% and 78.0%–100%; hematuria dipstick, 47.0%–92.6% and 51.0%–84.0%; NMP22 Bladder Cancer Test (Matritech), 34.6%–100% and 60.0%–95.0%; NMP22 BladderChek (Matritech), 49.5%–65.0% and 40.0%–89.8%;ImmunoCyt/uCyt+ (DiagnoCure), 63.3%–84.9% and 62.0%–78.1%; ImmunoCyt/uCyt+ and cytology, 81.0%–89.3% and 61.0%–77.7%; and UroVysion (Abbott Molecular)/florescence in situ hybridization, 68.6%–100% and 65.0%–96.0%.Conclusion: We find that no currently available bladder cancer urinary marker is sensitive enough to eliminate the need for cystoscopy. In addition, cytology remains integral to the detection of occult cancer. However, owing to their relatively high sensitivities, these markers may be used to extend the period between cystoscopies in the surveillance of patients with transitional cell carcinoma. Further study is required to determine which markers, alone or in panel, would best accomplish this.
Penile fracture with bilateral corporeal rupture and complete urethral disruption: case report and literature review
Authors: Hoag Nathan A. , Hennessey Kiara , So Alan
Published: October 2016

Penile fracture is a rare injury most commonly sustained duringsexual intercourse. We report the case of a 35-year-old man whopresented with bilateral rupture of the corpora cavernosa andcomplete disruption of the urethra. A review of the literature onpenile fracture is also presented. Urgent surgical exploration wasperformed and the injuries repaired primarily. In follow-up, thepatient reported satisfactory erectile function. This case highlightsthe importance of early surgical repair and evaluation for concomitanturethral injuries in cases of penile fracture.
Carcinome épidermoïde de l’urètre masculin révélé par une rupture spontanée de l’urètre
Authors: Ghorbel Jilani , Hafsia Ghassen , Derouiche Amine , Chebil Mohamed
Published: October 2016

Le carcinome épidermoïde de l’urètre masculin est une tumeurrare, les tumeurs de l’urètre tous types confondus représentantmoins de 1 % des tumeurs de l’appareil urinaire. Le pronosticreste défavorable malgré un traitement chirurgical énergique. Laradiochimiothérapie semble être un traitement prometteur, maisson rôle doit être défini par d’autres études.Nous rapportons un cas rare de carcinome épidermoïde del’urètre bulbo-membraneux découvert à un stade localement avancéaprès observation d’une rupture urétrale transtumorale chez unhomme âgé de 70 ans. Le patient a été traité, après drainage vésical,par une irradiation externe associée à une chimiothérapie parcisplatine, et est décédé après progression de la maladie sur un an.La rupture spontanée de l’urètre transtumorale est un modede découverte exceptionnel témoignant d’une évolution localedéfavorable, ce qui rend ces tumeurs difficilement opérables.Cependant, l’espoir actuel réside dans des protocoles thérapeutiquesassociant radiothérapie et chimiothérapie.
Sunitinib therapy for metastatic renal cell carcinoma: recommendations for management of side effects
Authors: Kollmannsberger Christian , Soulieres D. , Wong R. , Scalera A. , Gaspo R. , Bjarnason G.
Published: October 2016

Sunitinib, a new vascular endothelial growth factor receptor inhibitor, has demonstrated high activity in renal cell carcinoma (RCC) and is now widelyused for patients with metastatic disease. Although generally well tolerated andassociated with a low incidence of common toxicity criteria grade 3 or 4 toxicities, sunitinib exhibits a distinct pattern of novel side effects that require monitoring and management. This article summarizes the most important side effects and proposes recommendations for their monitoring, prevention and treatment,based on the existing literature and on suggestions made by an expert groupof Canadian oncologists. Fatigue, diarrhea, anorexia, oral changes, skin toxicityand hypertension seem to be the most clinically relevant toxicities of sunitinib. Fatigue may be partly related to the development of hypothyroidismduring sunitinib therapy for which patients should be observed and, if necessary, treated. Hypertension can be treated with standard antihypertensivetherapy and rarely requires treatment discontinuation. Neutropenia and thrombocytopenia usually do not require intervention, in particular no episodes ofneutropenic fever have been reported to date. A decrease in left ventricula rejection fraction is a rare, but potentially life-threatening side effect. Becauseof its metabolism by cytochrome P450 3A4 a number of drugs can potentiallyinteract with sunitinib. Clinical response and toxicity should be carefullyobserved when sunitinib is combined with either a cytochrome P450 3A4 induceror inhibitor and doses adjusted as necessary. Knowledge about side effects, as well as the proactive assessment and consistent management of sunitinib related side effects, is critical to ensure optimal benefit from sunitinib treatment.
Vasitis: clinical and ultrasound confusion with inguinal hernia clarified by computed tomography
Authors: Eddy Kathleen , Piercy Bruce , Eddy Richard
Published: October 2016

Vasitis or inflammation of the vas deferens is a rarely describedcondition categorized by Chan & Schlegel1 as either generallyasymptomatic vasitis nodosa or the acutely painful infectious vasitis.Clinically, infectious vasitis presents with nonspecific symptomsof localized pain and swelling that can be confused with other,more common conditions such as epididymitis, orchitis, testiculartorsion, and inguinal hernia. Ultrasound with duplex Doppler scanningcan be used to exclude epididymitis, orchitis, and testiculartorsion. On the other hand, while inguinal hernia is difficult todifferentiate from vasitis using ultrasound, computed tomography(CT) is diagnostic. We describe 2 cases of vasitis with clinicaland ultrasound findings that initially were interpreted as inguinalhernias. In both patients, CT was diagnostic for vasitis showing anedematous spermatic cord and no hernia. Urine cultures in bothpatients were negative, but the symptoms resolved with antibiotictreatment.
Infravesical obstruction results as giant bladder calculi
Authors: Aydogdu Ozgu , Telli Onur , Burgu Berk , Beduk Yasar
Published: October 2016

A 48-year-old man was hospitalized with the chief complaints oflower abdominal pain, pain during micturation and pollakuria.Plain radiography showed 2 giant bladder stone shadows: one as6.0 × 5.0 cm and the other one 5.0 × 5.0 cm in size. Cystolithotomywas performed. The first stone weighed 400 g and measured6.0 × 5.0 × 6.0 cm in size, and the other stone was fragmented tosmaller particles with pneumatic lithotriptor. Although a bladderstone is not rare, this case is interesting for 2 huge bladder calculithat were completely obstructing the bladder outlet and observedseveral years following pelvic trauma. To the best of our knowledge,our patient represents one of the largest bladder stone casesreported to date.
New surgical horizons: the role of cytoreductive nephrectomy for metastatic kidney cancer
Authors: Rendon Ricardo A.
Published: October 2016

Renal cell carcinoma is the most lethal urologic malignancy. Up to 30% of patients with kidney cancer have metastatic disease and 30% of those treatedfor local or locally advanced disease will progress to metastases. Radical nephrectomy is the standard treatment for the management of nondisseminated kidney cancer, but the role of cytoreductive nephrectomy for patients with metastatic disease is controversial. In this paper, the rationale for cytoreductivenephrectomy is described and the currently available evidence for andagainst it is evaluated. The different approaches to defining prognostic factorsto select which patients will benefit from cytoreductive nephrectomy willalso be described. Finally, the role of cytoreductive nephrectomy in the eraof new targeted therapies is discussed.
Commercial renal transplantation: A risky venture? A single Canadian centre experience
Authors: Kapoor Anil , Kwan Kevin G. , Whelan J. Paul
Published: October 2016

Background: Canada, akin to other developed nations, faces thegrowing challenges of end-stage renal disease (ESRD). Even withexpanded donor criteria for renal transplantation (the treatment ofchoice for ESRD), the supply of kidneys is outpaced by the escalatingdemand. Remuneration for kidney donation is proscribedin Canada. Without an option of living-related transplantation(biological or emotional donors), patients often struggle with longwaiting lists for deceased donor transplantation. Accordingly, manypatients are now opting for more expedient avenues to obtaininga renal transplant. Through commercial organ retrieval programs,from living and deceased donors, patients are travelling outsideCanada to have the procedure performed.Methods: Between September 2001 and July 2007, 10 patients (7males, 3 females) underwent commercial renal transplantation outsideCanada. We describe the clinical outcomes of these patientsmanaged postoperatively at our single Canadian transplant centre.Results: Six living unrelated and 4 deceased donor renal transplantationswere performed on these 10 patients (mean age49.5 years). All procedures were performed in developing countriesand the postoperative complications were subsequently treatedat our centre. The mean post-transplant serum creatinine was142 mmol/L. The average follow-up time was 29.8 months (range:3 to 73 months). One patient required a transplant nephrectomysecondary to fungemia and subsequently died. One patient had afailed transplant and has currently resumed hemodialysis. Acuterejection was seen in 5 patients with 3 of these patients requiringre-initiation of hemodialysis. Only 1 patient had an uncomplicatedcourse after surgery.Discussion: Despite the kidney trade being a milieu of corruptionand commercialization, and the high risk of unconventionalcomplications, patients returning to Canada after commercial renaltransplantation are the new reality. Patients are often arriving withoutany documentation; therefore, timely, goal-directed therapy forsurgical and infectious complications is frequently delayed becauseof the time taken to establish an accurate diagnosis. Refuting theexistence of commercial renal transplantation may not be a practicalsolution; more consistent communication and documentationwith transplant teams may be more pragmatic. In the current climate,patients considering the option of overseas commercial renaltransplantation should be advised of the potential increased risks.