bluuebunny/crossref_metadata_2025 huggingface dataset:
How do asymptomatic toilet-trained children void following
Authors: Eassa Waleed , Brzezinski Alex , Jednak Roman , El-Sherbiny Mohamed
Published: October 2016

Purpose: To evaluate the functional outcome in the form of urinary flow rates in asymptomatic children following uncomplicated tubularized incised plate urethroplasty (TIPU) hypospadias repair.Methods: We reviewed the records of children who underwentTIPU at our institution between April 1997 and September 2007and included only asymptomatic toilet-trained children who hadan uncomplicated postoperative course and had undergone uroflometry not less than 1 year postoperatively. Unfavourable voiding parameters were either a plateau curve, a peak flow below the 5th percentile range in nomogram or a post-void residual (PVR) more than 20% of the total functional capacity of the bladder. Uroflowmetry findings were analyzed against variables, including the surgeon, the severity of hypospadias, the presence of a hypoplastic urethra, the use of double layer closure, the performance of a spongioplasty and the use of a stent. Serial uroflowmetries when available, were compared with respect to the initial flow study.Results: In total, 59 patients were eligible for the study. The mean age at surgery was 2.4 years. Hypospadias was distal penile in 50 (85%) and mid and proximal penile in 9 (15%). Mean follow-up was 3.3±2 (1-9.5) years. The uroflow curve was bell-shaped in 18 (30%), interrupted in 8 (14%), slightly flattened in 27 (46%) and plateau in 6 (10%). Flow rate nomograms revealed that 40 (68%) were above the 20th percentile, 10 (17%) were below the 5th percentile and 9 (15%) were between these ranges. PVR was >20% of the pre-void volume in 9 children (15%). No patient demonstrated all three unfavourable parameters together. The groups of childrenwith unfavourable functional voiding parameters were compared to the children with favourable parameters specifically with respect to the possible predictors of outcome. Follow-up uroflometry in 17 patients showed improvement in the flow curve, flow rate and PVR with significant improvement of maximum urinary flow rate (Qmax) and PVR values.Conclusions: Asymptomatic, urodynamic abnormalities wereobserved in our study following uncomplicated TIPU repair. These abnormalities were not related to the variation of the technique among surgeons. Spontaneous improvement has been noted on serial flow studies.
Impact of academic affiliation on radical cystectomy outcomes in
Authors: Bianchi Marco , Trinh Quoc-Dien , Sun Maxine , Meskawi Malek , Schmitges Jan , Shariat Shahrokh F. , Briganti Alberto , Tian Zhe , Jeldres Claudio , Sukumar Shyam , Peabody James O. , Graefen Markus , Perrotte Paul , Menon Mani , Montorsi Francesco , Karakiewicz Pierre I.
Published: October 2016

Background: The objective of this study was to examine the rates of blood transfusions, prolonged length of stay, intraoperative and postoperative complications, as well as in-hospital mortality, stratified according to institutional academic status in patients undergoing radical cystectomy (RC).Methods: Within the Health Care Utilization Project NationwideInpatient Sample (NIS), we focused on patients in whom RC was performed between 1998 and 2007. Multivariable logistic regression analyses were fitted to predict the likelihood of blood transfusions, prolonged length of stay, intraoperative and postoperative complications, and in-hospital mortality. Covariates included age, race, gender, Charlson Comorbidity Index (CCI), hospital region, insurance status, annual hospital caseload (AHC), year of surgery and urinary diversion.Results: Overall, 12 262 patients underwent RC. Of those, 7892(64.4%) were from academic institutions. Patients treated at academic institutions were younger and healthier at baseline (all p < 0.001). RCs performed at academic institutions were associated with fewer postoperative complications (28.8% vs. 32.9%, p < 0.001), shorter length of stay (54.0% vs. 56.2%, p = 0.02) and lower in-hospital mortality rates (2.1 vs. 3.0%, p = 0.002). In multivariable analyses, patients who underwent RC at an academic hospital were 12% less likely to succumb to postoperative complications (odds ratio=0.88, p = 0.003).Interpretation: Even after adjusting for AHC, RCs performed atacademic institutions are associated with better postoperative outcomes than RCs performed at non-academic institutions. From a public health prospective, performing RCs at academic institutions may help reduce costs associated with the management of complicationsand prolonged length of stay.
Technique de York-Mason dans le traitement des fistules
Authors: Nouri Anass , El Yacoubi Souhail , Daoudi Anas , Karmouni Tarek , El Kahder Khaled , Koutani Abdellatif , Attya Ahmed Ibn , Hachimi Mohamed
Published: October 2016

Les fistules urétro-prostato-rectales ou prostato-rectales sontrares, et le plus souvent secondaires à une interventionchirurgicale. L’emplacement profond de ces fistules expliquela difficulté de l’accès chirurgical et, par conséquent,la multiplicité des voies d’abord décrites pour les traiter. Lavoie trans-ano-sphinctérienne décrite par York-Mason offreun bon accès et n’expose à aucune complication quand sesrègles sont respectées.Dans notre étude, nous présenterons 3 cas opérés entre1996 et 2009 par la voie transanorectale et trans-sphinctériennede York-Mason, en comparant cette voie avec lesautres décrites; nous préciserons ses avantages et ses indications.
Renal angiomyoadenomatous tumour: Imaging features
Authors: Sahni V. Anik , Hirsch Michelle S. , Silverman Stuart G.
Published: October 2016

Renal angiomyoadenomatous tumour is a rare, recently describedneoplasm with a distinctive histological appearance. Althoughreported in the pathology literature, to our knowledge, no priorreports have described its imaging appearance. We describe thecomputed tomography and magnetic resonance imaging featuresof an incidentally detected renal angiomyoadenomatous tumourthat appeared as a well-marginated, solid T2-hypointense enhancing mass, in a 50-year-old woman. It is indistinguishable from a variety of benign and malignant renal neoplasms.
Adult intrarenal neuroblastoma presenting as renal cell carcinoma
Authors: Bayrak Omer , Seckiner Ilker , Erturhan Sakip , Aydin Abdullah , Yagci Faruk
Published: October 2016

Neuroblastoma is known to arise from cells of the neuralcrest that form the adrenal medulla and sympathetic ganglia.Tumours may occur anywhere along the sympatheticchain within neck, thorax, retroperitoneum, pelvis or in theadrenal gland. Seventy-five percent arise in the retroperitoneum, 50% in the adrenal, and 25% in the paravertebral ganglia.1 The variety of locations in which these tumours can arise and the spectrum of their differentiation result in a wide range of clinical presentations and behaviours. These tumours can undergo spontaneous regression, differentiate to benign neoplasm or exhibit extremely malignant behaviour. Neuroblastoma has a variable prognosis and is very rarely reported in adults. There are only 3 cases in the English literature on kidney neuroblastoma. We present a case of neuroblastoma in a woman who had an intrarenal mass.
Intrathecal clonidine added to small-dose bupivacaine prolongs
Authors: Gecaj-Gashi Agreta , Terziqi Hasime , Pervorfi Tune , Kryeziu Arben
Published: October 2016

Introduction: The aim of this prospective, double-blinded studywas to investigate the effects of clonidine in co-administrationwith bupivacaine during spinal anesthesia, regarding the onset and regression of motor and sensory block, postoperative analgesia and possible side effects.Methods: We randomly selected 66 male patients (age 35 to 70), from the American Society of Anesthesiologists (ASA) class I-II; these patients were scheduled for transurethral surgical procedures. These patients were randomly allocated into two groups of 33 patients each: group B (bupivacaine) only received 0.5% isobaric bupivacaine 7.5 mg intrathecally and group BC (bupivacaine + clonidine) received bupivacaine 7.5 mg and clonidine 25 μg intrathecally. We performed the spinal anesthesia at a level of L3-L4 with a 25-gauge needle. We assessed the sensory block with a pinprick,the motor block using the Bromage scale, analgesia with thevisual analog scale and sedation with the modified Wilson scale.We also recorded the hemodynamic and respiratory parameters.Results: The groups were demographically similar. The mean time of achievement of moto block (Bromage 3) and sensory block at level T9 was significantly shorter in the BC group compared with B group (p = 0.002, p = 0.000, respeectively). The motor block regression time was not significantly different between the two groups (p = 0.237). The postoperative analgesia requirement was significantly longer in group BC compared with group B (p = 0.000). No neurological deficit, sedation or other significant adverse effects were recorded.Conclusion: The intrathecal application of clonidine in combination with bupivacaine improves the duration and quality of spinal anesthesia; it also provides longer duration of postoperative analgesia, without significant side effects.
Variations between two 24-hour urine collections in patients
Authors: Nayan Madhur , Elkoushy Mohamed A. , Andonian Sero
Published: October 2016

Introduction: The current Canadian Urological Association (CUA)guideline recommends two 24-hour urine collections in the metabolic evaluation for patients with urolithiasis. The aim of the present study was to compare two consecutive 24-hour urine collections in patients with a history of urolithiasis presenting to a tertiary stone clinic.Methods: We retrospectively reviewed 188 patients who had two24-hour collections upon presentation between January 2010 and December 2010. Samples were collected on consecutive days and examined for the following 11 urinary parameters: volume, creatinine, sodium, calcium, uric acid, citrate, oxalate, potassium, phosphorous, magnesium and urea nitrogen. For each parameter, the absolute value of the difference between the two samples rather than the direct difference was compared with zero. Similarly, the percent difference between samples was calculated for each parameter.Results: The means of the absolute differences between the twosamples were significantly different for all 11 urinary parameters(p < 0.0001). The percent differences for all urinary parametersranged from 20.5% to 34.2%. Furthermore, 17.1% to 47.6% ofpatients had a change from a value within normal limits to anabnormal value, or vice-versa. Significance was maintained when patients with incomplete or over-collections were excluded.Conclusions: Significant variations among the two 24-hour urinecollections were observed in all of the 11 urinary parameters analyzed. This variation may change clinical decision-making in up to 47.6% of patients if only a single 24-hour urine collection is obtained. The present study supports the CUA guideline of performing two 24-hour urine collections.
The autologous fascia pubovaginal sling for complicated female
Authors: Welk Blayne K. , Herschorn Sender
Published: October 2016

Introduction: The purpose of this study is to review our contemporary experience with autologous fascia pubovaginal slings (AF-PVS) in the era of the midurethral sling.Methods: A retrospective review was completed to identify allpatients who underwent an AF-PVS between 2002 and 2009. Across-sectional questionnaire was used to assess postoperative urinary- specific quality of life (consisting of the Urogenital Distress Inventory [UDI-6] and the Incontinence Impact Questionnaires [IIQ-7]).Results: We identified 33 patients. They had failed a median oftwo previous incontinence treatments. Of these patients, 16 (48%) had failed a previous midurethral sling, and of these half had experienced a significant mesh erosion necessitating mesh removal. Preoperative median incontinence pad usage was 5/day. After a median follow-up of 16 months from the time of AF-PVS, the median pad usage had decreased to 1/day (p = 0.003). A third of the patients had postoperative urgency, and only 1 patient continues to use intermittent catheterization. The median IIQ-7 score was 19/100, and the median UDI-6 score was 44/100. Overall quality of life was mixed-to-delighted in 62% of patients.Conclusions: The AF-PVS has reasonable outcomes in a diversepopulation of patients, despite failure of other treatment modalities.
Clinicopathological characteristics and treatment outcomes of adult
Authors: Keskin Serkan , Basaran Mert , Kilicaslan Isin , Tunc Murat , Bavbek Sevil
Published: October 2016

Introduction: We report our experience with 8 consecutive adults treated for paratesticular rhabdomyosarcoma (RMS) at a single institution between 2000 and 2010.Methods: After primary surgical excision, 7 patients were classified into group I according to the Intergroup Rhabdomyosarcoma Study Group (IRSG) Postsurgical Grouping Classification, and 1 patient into group IIB. Retroperitoneal node dissection was not a required staging procedure. Adjuvant chemotherapy was administered to 7 of the 8 patients. No additional radiotherapy was administered.Results: The median age at diagnosis was 24 years (range: 18-60). Embryonal histology was the most common (75%) subtype. During follow-up, 3 patients experienced local relapse and 5 distant relapse. The median progression-free and overall survival times were 17.0 ± 9.9 months (range: 5-31) and 27.3 ± 1.3 months (range: 16-58), respectively.Conclusion: Paratesticular RMS is an uncommon malignancy inadults. We confirm that patients with localized paratesticular RMS may have different prognoses. Retroperitoneal lymphadenectomy can be avoided as a treatment for paratesticular RMS after radical inguinal orchiectomy.
Robotic partial cystectomy for lymphangioma of the urinary bladder
Authors: Seyam Raouf , Alzaharani Hassan M. , Alkhudair Waleed K. , Anas Mohammed , Al-Otaibi Mohammed F.
Published: October 2016

Lymphangioma of the urinary bladder is a very rare tumour inadulthood. Robotic partial cystectomy is evolving for treatmentof a limited number of bladder tumours. We describe a case ofan adult woman with a bladder dome lymphangioma for whichrobotic partial cystectomy was carried out.
Vertebral osteomyelitis following transrectal ultrasound-guided
Authors: Rajgopal Raghav , Wang Yuding , Faber Kenneth J. , Izawa Jonathan I.
Published: October 2016

Transrectal ultrasound-guided needle biopsy of the prostate (TRUS)is a well-tolerated and standardized procedure for the diagnosisof prostate cancer. Complications associated with TRUS requiringemergency room visits or hospital admissions are relatively low andinclude complications, such as a 1% risk of urinary retention andless than 1% chance of bacterial sepsis. Vertebral osteomyelitis isa rare complication of TRUS; there are 3 reported cases. Vertebralosteomyelitis has an insidious onset and usually resolves followingmedical intervention. We present an extremely rare case ofvertebral osteomyelitis following TRUS, its clinical outcome andmanagement.
Urachal-sigmoid fistula associated with diverticular disease
Authors: Rapoport Daniel , Ross Alison , Goshko Vic , McAuley Iain
Published: October 2016

Background: Urachal anomalies rarely present in adulthood. We report thesecond known case of urachal-sigmoid fistula associated with diverticulardisease.Method: We performed a case report and literature review. We searchedMEDLINE and PubMed using the search words “urachus,” “urachal fistula,”“sigmoid colon” and “diverticulosis.”Results: Our literature review revealed 1 previous report of urachal-sigmoidfistula associated with diverticular disease. We reviewed other publications withrespect to pathophysiology, diagnosis and management of urachal disease.Conclusion: Urachal disease that presents in an adult is usually the result of somecomplication of a urachal anomaly. Various modes of imaging may help confirmthe diagnosis, although CT sinography has been recommended and waskey in the present case. Management includes eradication of infection and, usually,surgical intervention.
Malignant spinal cord compression secondary to testicular seminoma at the time of initial presentation and at relapse while on surveillance
Authors: Yee Don , Gabos Zsolt , North Scott , Moore Ronald B.
Published: October 2016

We report cases of 2 pure seminoma patients who developed metastatic spinalcord compressions. One patient was diagnosed at age 33 years with stage 1seminoma and, after undergoing an orchidectomy, chose to be followed ona surveillance protocol. He was lost to follow-up and presented again 22months later with back pain, leg weakness and sensory loss when his diseaserecurred as a spinal cord compression. He was treated with urgent surgicaldecompression and subsequent standard chemotherapy. More than 2years posttreatment, he is disease-free with normal neurologic function inhis lower extremities. The second patient presented at age 44 years withback pain and rapid loss of leg strength and sensation. Investigations revealeda malignant cord compression with lymphatic and vertebral body metastases.On physical examination, the patient was found to have a 6-cm lefttesticular mass. He was treated with emergency radiotherapy to the regionof his cord compression followed by a left inguinal orchidectomy. Pathologyconfirmed a pure classic seminoma. Postoperatively, he received standardchemotherapy and eventually regained neurologic function in his legs. Althoughit is rare for malignant spinal cord compression to occur in seminoma patients—either as the initial presentation of disease or as a site of disease recurrencein stage 1 patients on surveillance—it is crucial to consider seminoma as apossible etiology in young men diagnosed with malignant spinal cord compressionbecause timely contemporary treatments for seminoma will cure mostof these patients and offer them excellent functional recovery.
Health advocacy training in urology: a Canadian survey on
Authors: Leveridge Michael , Beiko Darren , Wilson James W.L. , Siemens Robert
Published: October 2016

Introduction: Health advocacy is a well-defined core competency recognizedby medical education and regulatory bodies. Advocacy is stressed as a criticalcomponent of a physician’s function within his or her community andalso of performance evaluation during residency training. We sought to assessurology residents’ perceptions and attitudes toward health advocacy in residencytraining and practice.Methods: We administered an anonymous, cross-sectional, self-report questionnaireto all final-year urology residents in Canadian training programs. The surveywas closed-ended and employed a 5-point Likert scale. It was designedto assess familiarity with the concept of health advocacy and with its applicationand importance to training and practice. We used descriptive and correlativestatistics to analyze the responses, such as the availability of formaltraining and resident participation in activities involving health advocacy.Results: There was a 93% response rate among the chief residents. Most residentswere well aware of the role of the health advocate in urology, and a majority(68%) believed it is important in residency training and in the urologist’s rolein practice. This is in stark contrast to acknowledged participation and formaltraining in health advocacy. A minority (7%–25%) agreed that formal trainingor mentorship in health advocacy was available at their institution, and only21%–39% felt that they had used its principles in the clinic or community. Only4%–7% of residents surveyed were aware of or had participated in local urologicalhealth advocacy groups.Conclusion: Despite knowledge about and acceptance of the importance ofthe health advocate role, there is a perceived lack of formal training and a dearthof participation during urological residency training.
Long-term renal function and continence status in patients with
Authors: Braga Luis H.P. , Lorenzo Armando J. , Dave Sumit , Del-Valle Maria H. , Khoury Antoine E. , Pippi-Salle Joao L.
Published: October 2016

Introduction: Urinary continence after cloacal repair is difficult to achieveand renal outcome in patients with cloacal malformations has been scarcelyreported. As a result, we reviewed our experience with cloacal malformationsto determine the status of continence and the long-term renal function in thesechildren.Methods: A retrospective chart review from 1990 to 2003 identified 12 patientswith cloacal malformation (1 posterior, 4 complex and 7 classical) who underwentsurgical reconstruction. The confluence was defined as high (commonchannel ≥ 3 cm) and low (< 3 cm) by cystovaginoscopy. Renal ultrasound,voiding cystouretrogram, renal scan and sacral radiograph were performedin all children. Most patients underwent 1-stage abdominoperineal pull-through,applying the principle of total urogenital sinus mobilization. We collected dataregarding hydronephrosis, vesicoureteral reflux and split differential renal function.Renal outcome was evaluated based on glomerular filtration rate and ageadjustedserum creatinine values (μmol/L). Urinary continence was definedas a dry interval > 4 hours.Results: Patients’ mean age at surgery was 20 months (range 7–29 mo). Ofthe 12 children who underwent cloacal repair, 7 (58.3%) had a common channel≥ 3cm. Renal anomalies were identified in 3 of 12 (25%) girls: there were 2 solitary kidneys and 1 pelvic kidney. Lumbar–sacral radiography demonstrated bony abnormalities in 11 of the 12 (91.6%) cases: hemivertebra in 3 cases, sacral agenesis in 4 cases, hypoplastic sacrum in 3 cases and bifid sacrum in 1 case. Total urogenital sinus mobilization through an abdominoperineal approach in a single stage was performed in 8 girls. Follow-up ranged from 4 to 14 years (mean 8.5 yr). Eight (66.6%) children had dry intervals > 4 hours, 5 (62.5%) of them were on clean intermittent catheterization through aMitrofanoff channel and 1 (12.5%) was through the urethra. The remaining 2 (25%) patients were voiding spontaneously. Three (33.3%) patients were totally incontinent, and 1 (8.3%) patient was awaiting reconstruction. The mean measured glomerular filtration rate was 93.5 mL/min/1.73m2 (range 34–152 mL/min/1.73m2). Four (57.1%) of 7 patients who had a common channel ≥ 3 cm ended up needing augmentation cystoplasty, compared with none of the patients with a common channel < 3 cm (57.1% v. 0%, p = 0.038).Conclusion: Urinary continence can be achieved in most patients with cloacalmalformation at the expense of major reconstructive surgery and despite thepresence of associated urological abnormalities. However, these childrenharbour an important risk for renal impairment later in life and should be closelymonitored.
Surgeon-controlled robotic partial nephrectomy for a rare renal epithelioid angiomyolipoma using near-infrared fluorescence imaging using indocyanine green dye: A case report and literature review
Authors: Patel Timil H. , Sirintrapun S. Joseph , Hemal Ashok K.
Published: October 2016

Renal epithelioid angiomyolipoma (E-AML) is a rare variant of angiomyolipoma (AML). It is a mesenchymal tumour believed to originate from the perivascular epithelioid cell (PEC). Unlike conventional AML which are benign, E-AML has a rare aggressive behaviour. Conventional AML is typically triphasic containing adipose tissue, smooth muscle and dystrophic vessels in variable proportions, while E-AML are generally composed of plump spindled and polygonal-shaped “epithelioid cells” showing clear or eosinophilic cytoplasm and occasional pleomorphic multinucleated giant cells. E-AML can be misdiagnosed as renal cell carcinoma (RCC) when these “epithelioid cells” show clearing. Only a small number of cases of E-AML have been reported with the standard treatment being radical or partial nephrectomy. We report the first case report of a surgeon-controlled robotic partial nephrectomy using a near infrared fluorescence imaging using indocyanine green dye on a 25-year-old woman with a T1B (6.6 cm) right renal mass. The final pathology revealed the diagnosis of E-AML. There was no recurrence and metastases after the 6-month follow-up.
Long-term urological follow-up of multicystic dysplastic kidneys: Is it still indicated in 2007?
Authors: Psooy Karen
Published: October 2016

Objective: To determine whether the current indications for the long-term urologicalfollow-up of children with multicystic dysplastic kidneys (MCDKs) are supported by the literature.Methods: The membership of the Pediatric Urologists of Canada was surveyedto determine if long-term urological follow-up was being performed, and if so, for what indications. A literature search using PubMed, EMBASE and aConference Papers Index was performed to determine whether the indicationslisted were supported by the literature.Results: A response rate of 72% was achieved for the survey, with most respondentsfollowing children with MCDK long-term. The main indications for long term follow-up were the increased risk of Wilms’ tumour (54%) and hypertension(32%), observation of the contralateral kidney (43%) and involutionof the MCDK (36%). The literature search did not support long-term urological follow-up for any of these indications, provided unilateral MCDK was anisolated genitourinary abnormality. Although it is rare, a primary care physician could monitor for hypertension.Conclusion: Long-term urological follow-up of children with “simple MCDK”is not supported by the literature, provided the diagnosis has been confirmedwith a follow-up renal ultrasound at 12–24 months. Blood pressure monitoringby a primary care physician is recommended.
Rhabdomyolysis following renal autotransplantation
Authors: Weber Bryce , Todd Gerald , Moore Ronald B.
Published: October 2016

A 26-year-old male body builder diagnosed with renal artery stenosis and middleaortic syndrome underwent an autotransplantation with bench reconstructionand end-to-end anastomosis using the hypogastric artery. Shortly afterthe procedure, the patient developed rhabdomyolysis and renal insufficiency,possibly related to his increased muscle mass, potentially greater susceptibilityto hypertrophic skeletal muscle cells or his unique vascular condition. Wereview the risk factors, diagnosis, management and outcome of a case ofrhabdomyolysis in a male patient who underwent autotransplantation for renalvascular hypertension.
Subcapsular hepatic hematoma with right hepatic vein thrombosis: a complication of shock wave lithotripsy
Authors: Gordetsky Jennifer , Hislop Sean , Orloff Mark , Butler Melanie , Erturk Erdal
Published: October 2016

Extracorporeal shock wave lithotripsy (ESWL) is a well-established, safe andeffective therapeutic modality for surgical treatment of urolithiasis. Hematomais a rare complication of ESWL and, when it occurs, typically involves thekidney. We report the case of a 71-year-old woman who developed severe,persistent abdominal pain after ESWL for a 9-mm stone at the ureteropelvicjunction. Post-treatment CT scan demonstrated a 13 × 6–cm subcapsular hepatichematoma. A follow-up CT scan showed expansion of the hematoma and developmentof hepatic vein thrombosis. This finding, along with persistent abdominalpain and rising liver transaminases, led to surgical intervention. The patient’ssymptoms resolved and liver function returned to baseline following liver decompression.
High resolution analysis of wait times and factors affecting surgical expediency
Authors: Cole Eric , Hopman Wilma , Kawakami Jun
Published: October 2016

Objectives: Wait times in Canada are increasingly being monitoredas an indicator of quality health care delivery. We created a higherresolution picture of the wait experienced by urological surgerypatients beginning with the initial referral. In doing so, we hopedto (a) identify potential bottlenecks and common delays at ourcentre, and (b) identify predictors of wait time.Methods: The charts of 322 patients undergoing surgery fromNovember 2007 to March 2008 were reviewed and specific dates,patient factors and delays were recorded. The data were used todetail the patient’s wait and to determine the patient factors whichwere predictive of wait time.Results: The mean time from decision to operate to the day ofoperation was 75.87 days for all patients. This number accountsfor 53% of the wait time, while the time from referral to decision tooperate is 47%. Predictors of a decreased wait time include cancercases, younger age, urgency score, repeat patients and female genderin multivariate analysis. Delays were experienced by 16.8% ofpatients; most common delays were operating room cancellations/time constraints, patients requiring further optimization and delaysin referral (4.7%, 3.4% and 3.1%, respectively).Conclusions: The waiting process is complex; the actual waitingtime that a patient must endure is much longer than the wait timestraditionally recorded and reported by hospitals. As strategies areimplemented to decrease wait times, it will become increasinglyimportant to monitor the entire wait time from referral to operationand to ensure that changes are being made that truly decreasewait times and not simply shift where and when the patient waits.
Development and validation of a virtual reality transrectal ultrasound guided prostatic biopsy simulator
Authors: Chalasani Venu , Cool Derek W. , Sherebrin Shi , Fenster Aaron , Chin Joseph , Izawa Jonathan I.
Published: October 2016

Objective: We present the design, reliability, face, content andconstruct validity testing of a virtual reality simulator for transrectalultrasound (TRUS), which allows doctors-in-training to performmultiple different biopsy schemes.Methods: This biopsy system design uses a regular “end-firing”TRUS probe. Movements of the probe are tracked with a micromagneticsensor to dynamically slice through a phantom patient’s3D prostate volume to provide real-time continuous TRUS views.3D TRUS scans during prostate biopsy clinics were recorded.Intrinsic reliability was assessed by comparing the left side of theprostate to the right side of the prostate for each biopsy. A contentand face validity questionnaire was administered to 26 doctors toassess the simulator. Construct validity was assessed by comparingnotes from experts and novices with regards to the time taken andthe accuracy of each biopsy.Results: Imaging data from 50 patients were integrated into thesimulator. The completed VR TRUS simulator uses real patientimages, and is able to provide simulation for 50 cases, with ahaptic interface that uses a standard TRUS probe and biopsy needle.Intrinsic reliability was successfully demonstrated by comparingresults from the left and right sides of the prostate. Face andcontent validity respondents noted the realism of the simulator,and its appropriateness as a teaching model. The simulator wasable to distinguish between experts and novices during constructvalidity testing.Conclusions: A virtual reality TRUS simulator has successfully beencreated. It has promising face, content and construct validity results.
Associations between radiographic characteristics and change in renal function following partial nephrectomy using 24-hour creatinine clearance
Authors: Breau Rodney H. , Clark Aaron T.D. , Morash Chris , Fergusson Dean , Cagiannos Ilias
Published: October 2016

Background: Radiographic characteristics may be associated withthe degree of renal function preservation following partial nephrectomy.The purpose of this study was to determine the impact ofpreoperative radiographic variables on change in renal functionusing 24-hour urine creatinine clearance (uCrCl).Methods: Patients with partial nephrectomy performed fromNovember 2003 to 2008 were enrolled in the study. Serum creatinineand 24-hour urine was collected preoperatively and at3, 6 and 12 months postoperatively. Computed tomography ormagnetic resonance imaging was used to determine tumour size,tumour location and renal volume.Results: Of the 36 patients, median age was 62 (range 30-78) and21 (58%) were male. The mean tumour diameter was 2.8±1.4 cm.Twenty-two (61%) tumours were located at the renal pole and11 (31%) were endophytic. Overall, mean preoperative uCrClwas 88.8±34.2 mL/min and mean postoperative uCrCl was82.8±33.6 mL/min (6.8%; p < 0.01). On multivariable analysis,no single characteristic was associated with a clinically prohibitivedecrease in renal function (-9.4% if endophitic, p = 0.06; -0.57%per cm diameter, p = 0.73; and -6.9% if located at the renal pole,p = 0.15). The total renal volume was also not significantly associatedwith renal function change (-1.1% per 100 cc, p = 0.86).Interpretation: Preoperative radiographic characteristics seem tobe associated with small changes in renal function following partialnephrectomy. These data support renal functional benefits of partialnephrectomy regardless of tumour size and location.
Bartholin’s gland abscess in a neonate: a case report
Authors: El Kady Sherif , Al Zahrani Ahmed , Jednak Roman , El Sherbiny Mohamed
Published: October 2016

Bartholin’s gland abscesses are extremely rare in prepubertal girls. A literature search revealed that only 3 cases have been reported in infancy and that 1 case has been reported in a neonate. We report the second case of a Bartholin’s gland abscess in a female neonate.
Extracapsular versus intracapsular allograft nephrectomy: impact on allosensitization and surgical outcomes
Authors: Touma Naji J. , Sener Alp , Caumartin Yves , Warren Jeff , Nguan Christopher Y. , Luke Patrick P.W.
Published: October 2016

Introduction: Our objective was to compare the impact of extracapsular(ECAN) versus intracapsular allograft nephrectomy (ICAN)on allosensitization and surgical outcomes.Methods: Between 1990 and 2004, 96 allograft nephrectomieswere performed at our institution. Of these, 29 procedures wereperformed within 1 month of the transplant and were thereforeomitted from analysis. Overall, the results of 44 ECAN and 23ICAN were reviewed.Results: The mean operative times were 110.9 versus 130.4 minfor ICAN versus ECAN (p = 0.02) and the estimated blood losswas 226 mL for ICAN versus 483 mL for ECAN (p = 0.004).Intraoperative and postoperative complications were low usingeither technique and differences were not statistically significant.Overall, the preoperative to postoperative change in the percentageof panel reactive antibody was +2.1% for ICAN versus +1.2% forECAN (NS) at 3 to 12 months postoperatively, respectively (NS).The percentage of patients relisted was 33.3% versus 54.3% (NS),and the percentage of patients re-transplanted once relisted wasalso very similar: 63.2% for ECAN versus 66.7% for ICAN (NS),after a mean follow-up of 4.5 and 8.4 years, respectively.Conclusions: ICAN can be performed with shorter operative timesand less blood loss versus the extracapsular approach. As well, thisoperative approach does not appear to affect allosensitization andthe ability to re-transplant patients.
Shock wave lithotripsy in patients requiring anticoagulation or antiplatelet agents
Authors: Alsaikhan Bader , Andonian Sero
Published: October 2016

Extracorporeal shockwave lithotripsy (SWL) remains the only trulyminimally invasive procedure for the treatment of upper tract nephrolithiasis.Recently, there has been a recent rise in the patientson antiplatelet agents. Therefore, the aim of the present study isto review the literature available regarding SWL in these high-riskpatients requiring anti-coagulation therapy. Alternative therapiesto SWL are also presented.
Lower abdominal mass in a 16-year old adolescent: an unusual presentation of posterior urethral valves
Authors: Kanaroglou Niki , Braga Luis HP , Massaro Peter , Lau Keith , DeMaria Jorge
Published: October 2016

Posterior urethral valves (PUV) are now commonly suspected onantenatal ultrasound, but can present with a broad spectrum ofseverity postnatally. Rarely, the diagnosis is missed until adolescenceor adulthood when the patient usually presents with lowerurinary tract symptoms. We describe an even rarer case of PUV inan adolescent who first presented with renal failure and a palpablelower abdominal mass due to urinary retention. We review theliterature on presentation, natural history and outcomes of bothearly and late presenting PUV cases.
Tumeur myofibroblastique inflammatoire de la vessie
Authors: Jomaa Wafa , Ziadi Sonia , Trimeche Mounir , Hammedi Faten , Ben Sorba Nabil , Mokni Moncef , Korbi Sadok
Published: October 2016

La tumeur myofibroblastique inflammatoire est une lésion classéepar l’OMS parmi les néoplasies intermédiaires. Elle peut siégerdans différents organes : les poumons, le pancréas, le mésentèreet l’utérus. La localisation vésicale est rare.Nous rapportons le cas d’un jeune homme de 38 ans qui aconsulté pour hématurie. L’échographie a révélé la présence d’unestructure tissulaire intravésicale de 3 cm de grand axe. L’examenanatomopathologique et l’étude immunohistochimique ont concluà une tumeur myofibroblastique inflammatoire de la vessie. À partirde cette observation, nous présentons les diagnostics différentiels etles particularités anatomopathologiques de cette localisation rare.
Patients with microscopic and gross hematuria: practice and referral patterns among primary care physicians in a universal health care system
Authors: Yafi Faysal A. , Aprikian Armen G. , Tanguay Simon , Kassouf Wassim
Published: October 2016

Background: Hematuria is one of the most common findings onurinalysis in patients encountered by primary care physicians. Inmany instances it can also be the first presentation of a serious urologicalproblem. As such, we sought to evaluate current practicesadopted by primary care physicians in the workup and screeningof hematuria.Methods: Questionnaires were mailed to all registered primary carephysicians across Quebec. Questions covered each physician’spersonal approach to men and postmenopausal women with painlessgross hematuria or with asymptomatic microscopic hematuria,as well as screening techniques, general knowledge with regardsto urine collection and sampling, and referral patterns.Results: Of the surveys mailed, 599 were returned. Annual routinescreening urinalysis on all adult male and female patients wasperformed by 47% of respondents, regardless of age or risk factors.Of all the respondents, 95% stated microscopic hematuria wasassociated with bladder cancer. However, in an older male withpainless gross hematuria, only 64% of respondents recommendedfurther evaluation by urology. On the other hand, in a postmenopausalwoman with 2 consecutive events of significant microscopichematuria, only 48.6% recommended referral to urology. Findingswere not associated with the gender of the respondent, experienceor geographic location of practice (urban vs. rural).Interpretation: There seems to be reluctance amongst primary carephysicians to refer patients with gross or significant microscopichematuria to urology for further investigation. A higher level ofsuspicion and further education should be implemented to detectserious conditions and to offer earlier intervention when possible.
Vardenafil demonstrates first-dose success and reliability of penetration and maintenance of erection in men with erectile dysfunction — RELY-II
Authors: Valiquette Luc , Montorsi Francesco , Auerbach Stephen
Published: October 2016

Objective: Vardenafil has been shown to be efficacious in patients with erectile dysfunction (ED). We evaluated first-dose and repeat-dose response to vardenafil 20 mg.Methods: This randomized, placebo-controlled study consisted of a 4-week, treatment-free run-in phase; a 1-week, open-label challenge phase; and a 12-week, double-blind treatment phase. Primary efficacy was assessed in terms of reliability of insertion based on dose as measured by the Sexual Encounter Profile question 2 (SEP2). We assessed safety by evaluating adverse events (AEs).Results: Baseline patient characteristics in the 2 treatment groups were similar. The most common comorbidities were hypertension (41%), dyslipidemia (28%) and diabetes mellitus (24%). Of the 573 patients receiving the 20-mg vardenafil challenge dose, 464 (81%) achieved first-time successful penetration (SEP2), and 401 (70%) reported successful erection maintenance (SEP3). Patients receiving vardenafil 20 mg had statistically (p < 0.001) and clinically superior SEP2 rates (85%) through weeks 0–12, compared with patients receiving placebo (45%). The increase in reliability of insertion was seen within the first 4 weeks of treatment. Vardenafil therapy was statistically (p < 0.001) and clinically superior to placebo for all secondary efficacy end points as well. Most AEs associated with vardenafil were mild to moderate, with headache, flushing and nasal congestion most frequently reported.Conclusion: Vardenafil 20 mg had a high first-dose success rate for both SEP2 (81%) and SEP3 (70%); this was maintained through to the study end point (85% for SEP2 and 78% for SEP3). These findings were achieved in men with frequentlyassociated comorbidities including hypertension, dyslipidemia and diabetes.
Life before and after residents: subjective reports on quality of life from urologists since inception of a new residency program
Authors: Roberts Gregory , Whelan Paul , Kapoor Anil
Published: October 2016

Background: It is difficult to determine the effect of a residencyprogram on the life of staff urologists. The objective of this studywas to obtain subjective reports from urologists who have practicedbefore and after the implementation of a training program on howit affects their careers in 5 spheres: education, job-stress, free time,financial life and subjective quality of life.Methods: We asked urologists from McMaster University to completea questionnaire to quantify how their current experienceshave changed compared to the pre-residency program era on abalanced 7-point scale (4 = neutral).Results: The response rate was 100% (9/9). Eight of the 9 urologists(89%) reported they would implement the program againif they could rewind the clock. Eight of 9 reported their overallcareer-related quality of life improved, with an average rating of5.1 on the 7-point scale. The quality of continuing education wasthe most positive ranking at 5.4 followed by job stress at 5.2. Theoutcomes measured below 4 (neutral) were earning potential at3.8 and ability to engage in pastimes at 3.4. Earning potential wasclustered tightly around neutral, with 7 of the 9 respondents reportingno change. The largest standard deviation, corresponding tothe most disagreement, was in their ability to engage in pastimes.Conclusion: Even with a mild decrease in earning potential andincreased job stress, McMaster urologists feel their quality of lifeand continuing education have improved since the program’simplementation; these urologists are almost uniformly happy theystarted a residency teaching program at their centre.
Long-term efficacy and tolerability of pentosan polysulphate sodium in the treatment of bladder pain syndrome
Authors: Al-Zahrani Ali A. , Gajewski Jerzy B.
Published: October 2016

Objective: The primary objective of this study is to report on thelong-term efficacy and tolerability of pentosan polysulphate sodium(PPS) in patients with bladder pain syndrome (BPS). The secondaryobjective is to find the predictors of the long-term outcome.Methods: This is a single institution, retrospective study. The studyperiod was from 1994 to 2008. All patients fulfilled the clinicalcriteria of BPS, as suggested by European Society for the Study ofInterstitial Cystitis. We included only patients with de novo BPSdiagnosis and no previous PPS or other treatment. The efficacyof PPS was measured with the global response assessment scale(GRA). Patients were stratified into 2 groups based on the durationof the treatment. Group 1 took the drug for less than 12 months.Group 2 took the drug for more than 12 months.Results: There were 271 patients eligible for the study. Most of thepatients were female (90%), with the mean age at presentation of45.5 years. The average duration of symptoms was 28.5 months.The mean follow-up was 22 months (range 3-130). Out of all thepatients, 147 patients (54.2%) reported over 50% improvementusing the GRA. The reported efficacy was higher in Group 2 (60%).Ninety-three patients (34.3%) decided to stop taking the medicationfor various reasons. The most common reasons to stop themedication were poor outcome (16.6% of patients) and side effects(11.1% of patients). Poor outcome was associated with nocturia,smoking and detrusor overactivity. Good outcome was associatedwith longer PPS intake (>12 months) and severe cystoscopic findingsof glomerulation.Conclusion: Pentosan polysulphate sodium is an effective oraltherapy to control the symptoms of BPS with good long-term efficacyand tolerability.
Nephrectomy in patients with Caroli’s and ADPKD may be associatedwith increased morbidity
Authors: Aguilar Martin , Meterissian Sarkis , Levesque Sebastien , Andonian Sero
Published: October 2016

Autosomal dominant polycystic kidney disease (ADPKD), characterizedby multiple bilateral renal cysts, is the most commoninherited disorder of the kidney and an important cause of endstagerenal disease (ESRD). Caroli’s disease is a much less frequentcondition with ectasia of the intrahepatic biliary system. A clearassociation between autosomal recessive and Caroli’s disease hasbeen described, but only 4 cases of ADPKD and Caroli’s diseasehave been reported with 2 postoperative mortalities. The aim of thiscase is to increase the awareness of intra-operative and postoperativecomplications. A 66 year-old male was diagnosed with ADPKDand Caroli’s disease with hepatosplenomegaly and 4 episodes ofascending cholangitis. After 3 years of hemodialysis for ESRD, hereceived a cadaveric renal allograft. Subsequently, he developedparoxysmal atrial fibrillation. Upon anticoagulation, he developedmultiple episodes of gross hematuria from the left native kidney.After the anticoagulation therapy was discontinued, he underwentbilateral nephrectomies of his native kidneys. Intra-operatively, asplenic laceration could not be managed conservatively. Therefore,splenectomy was performed. In addition, he developed ascendingcholangitis post-operatively that was treated with antibiotics. Hewas discharged on postoperative day 18. Genetic testing revealedthat the patient is heterozygote for a large deletion in PKD1 gene,which encompasses all tested exons (exons 1-44).
Subclavian vein thrombosis: an unusual presentation of renal cell carcinoma
Authors: Hameed Ammar , Pahuja Ajay , Thwaini Ali , Nambirajan Thiagarajan
Published: October 2016

Subclavian vein thrombosis is an uncommon clinical conditionwhich is often associated with venous catheterization or secondaryto excessive effort. We present a 54-year-old female with subclavianvein thrombosis as a first presentation of renal cell carcinoma.Although this is an unusual presentation, malignancy should beconsidered in the differential diagnosis. Hypercoagulability as partof a paraneoplastic syndrome was considered a possible etiology.In patients with otherwise unexplained subclavian vein thrombosis,full systemic examination and radiological evaluation of the abdomen,retroperitoneum and pelvis should be pursued. A review ofthe literature relevant to this unusual case is provided.
The therapeutic ratio is preserved for radiotherapy or cisplatin treatment in BRCA2-mutated prostate cancers
Authors: Vesprini Danny , Narod Steven A. , Trachtenberg John , Crook Juanita , Jalali Farid , Preiner John , Sridhar Srikala , Bristow Robert G.
Published: October 2016

Prostate cancers in patients with a mutation in BRCA2 have earlierdisease onset and an aggressive course, often necessitatingthe use of systemic therapy. However, these tumours are DNArepair-defective and could respond favourably to Parp inhibitors orDNA-damaging agents, depending on the therapeutic ratio (ratio oftumour response to normal tissue toxicity). We describe 3 patientstreated with precision radiotherapy or cisplatin who respondedfavourably to both agents, yet did not suffer undue toxicity. Wereview the concept of treating such patients with agents that areselectively toxic to repair-deficient tumours.