Urology Journal

Purpose: Previous meta-analyses that compared the outcome of laparoendoscopic single-site adrenalectomy (LESSA) and conventional laparoscopic adrenalectomy (CLA) have not shown consistent results. The aim of this meta-analysis was to reassess current evidence regarding the efficacy and safety of LESSA versus CLA.

Materials and Methods: A literature search of PubMed, Embase, Medline, and the Cochrane Library was performed to identify eligible articles up until September 2015. Quantitative variables were calculated using the weighted mean differences (WMDs), and qualitative variables were pooled using odds ratios (ORs).

Results: Ten retrospective studies, including a total of 704 cases, were identified. Patients in the LESSA group benefitted from shorter length of hospital stay (95% confidence interval [CI]: -1.27 to -0.36, WMD: -0.81, P < .001) and better postoperative pain scores (95% CI: -1.51 to -0.99, WMD: 1.25, P < .001). There was no significant difference between the two techniques in operative time, estimated blood loss, resumption of oral intake, dose of analgesic required, perioperative complications, conversion, transfusion, or pain medications required.

Conclusions: Based on current evidence, LESSA appear to be a safe and feasible alternative to CLA with a shorter length of hospital stay and lower postoperative pain scores in certain patients. We await high-quality, double-blind randomized clinical trials with long-term follow-up to confirm and update the findings of this analysis; future studies should focus on failure of technique, cosmesis, and cost.

Purpose: To present a combining pyelolithotomy and endoscopy, an alternative approach for treating staghorn calculi in children.

Materials and Methods: We treated 1414 children (age, 10 months to 17 years) with urolithiasis between 2009 and 2013 in the Pediatric Surgery Department and in the Pediatrics and Nephrology Department, Military Institute of Medicine in Warsaw. Most patients were treated conservatively. In 162 cases, an extracorporeal shockwave lithotripsy (SWL) procedure was needed. Surgery was only used in patients who had failed SWL. We performed minimally invasive procedures, ureterolithotripsy using semi-rigid and flexible ureterorenoscopes or percutaneous nephrolithotomy (PCNL) in 126 patients.

Results: In the most serious cases of staghorn or multifocal calculi, we performed a combined operation of pyelolithotomy with endoscopic removal of concrements from all calyces of the diseased kidney. In 15 out of the 18 combination treatments (83.3%), concrements were completely removed from the kidney in a single procedure. In three cases, fine concrements (5 to 6 mm) remained after the procedure, and these were candidate for SWL. In one case, a boy aged 4 years, symptoms of infection in the urinary tract occurred 2 days after the procedure.

Conclusion: Combining pyelolithotomy with endoscopy to remove concrements clears the diseased kidney without causing parenchymal damage in one procedure. The method is safe in children, does not require blood transfusion, and helps maintain kidney function.

Purpose: To investigate the clinicopathology and magnetic resonance imaging (MRI) features of bladder paraganglioma, an extremely rare clinical entity.

Materials and Methods: Five patients with bladder paraganglioma (3 males and 2 females, 27-52 years old) were retrospectively reviewed. All cases underwent baseline MRI and contrast-enhanced scans, and three cases underwent diffusion weighted imaging (DWI) and cystoscopy. Cases were immunohistochemically examined with neuroendocrine markers (chromogranin and synaptophysin) and Ki-67, and histology was reviewed by a pathologist.

Results: Three cases exhibited painless gross hematuria, including one case with hypertension, whereas two cases were asymptomatic. One of the three patients who underwent cystoscopy was negative. The tumors were round (n = 1) or oval (n = 4) and located in the anterior wall (n = 1), posterior wall (n = 1), lateral wall (n = 2) or trigone (n = 1). All tumors were located in the submucosal or lamina propria. Four cases presented with well-circumscribed margins, whereas one case was poorly circumscribed. All tumors exhibited slight hyperintensity on T1-weighted images (T1WI) and hyperintensity with "salt and pepper" appearance on T2-weighted images (T2WI). DWI indicated strong hyperintensity, and all cases exhibited conspicuous enhancement after intravenous gadobenate dimeglumine (Gd-DTPA) injection. Pathological evaluation confirmed paraganglioma.

Conclusion: MRI plays an important role in the preoperative diagnosis of bladder paraganglioma. This rare condition has a characteristic round or oval appearance, located in the submucosal area, with slight hyperintensity on T1WI and hyperintensity with "salt and pepper" appearance on T2WI. DWI indicated strong hyperintensity and conspicuous enhancement on contrast-enhanced scans.

Purpose: The purpose of this study was to assess the impact of music on anxiety and perceived pain during transrectal ultrasound-guided prostate biopsy.

Materials and Methods: Forty consecutive men with an elevated serum prostate specific antigen (PSA) level and/ or an abnormal digital rectal examination referred for transrectal ultrasound-guided prostate biopsy were recruited and allocated to a music (n = 20) or a non-music (n = 20) group. Anxiety was assessed prior to and after biopsy and pain was assessed after biopsy in each patient using visual analog scales (VAS) in the same setting, and group anxiety scores were compared.

Results: Patients in the music group experienced less anxiety (P = .046) during the procedure, but group pain scores were not significantly different.

Conclusion: Music was found to decrease anxiety effectively during transrectal ultrasound-guided prostate biopsy.

Purpose: Polymorphisms in the genes coding for the carcinogen metabolizing enzymes may affect enzyme activities and alter the activation and detoxification rates of the carcinogens. AKR1C3 is one of the very polymorphic xenobiotic metabolizing enzymes involved in the bioactivation process. Here we aimed to investigate the association of two single nucleotide polymorphisms in AKR1C3, rs12529 (c.15C > G) and rs1937920 (12259 bp 3' of STP A > G) with urinary bladder cancer (UBC).

Materials and Methods: Two-hundred fifty UBC cases and 250 control subjects were genotyped using the Polymerase Chain Reaction and Restriction Fragment Length method. Associations of the genotypes with UBC risk and tumor characteristics were assessed using logistic regression and Fisher's exact test. The results are corrected for multiple testing.

Results: We identified strong associations between the studied AKR1C3 variants and UBC risk. The homozygous variant genotype of rs12529 was found to be inversely associated with UBC, and rs1937920 was shown to be associated with increased risk of UBC. None of the genotypes were found to be significantly associated with tumor characteristics.

Conclusion: We provided evidence that rs12529 and rs1937920 are significant in the molecular pathogenesis of UBC. However, the results presented here should be regarded as preliminary and might represent a first step of future larger studies aiming to better elucidate the role of AKR1C3 polymorphisms in the susceptibility to bladder cancer.

Purpose: To describe the acceptance and efficacy of clean intermittent catheterization (CIC) in the management of lower urinary tract (LUT) dysfunction regardless of the age of the children and their degree of urethral sensation.

Materials and Methods: We retrospectively evaluated boys managed with CIC at a pediatric teaching hospital between 1992 and 2014. Age, urethral sensation, acceptance, efficacy in terms of continence and preserving upper urinary tract and genitourinary complications were reviewed in the medical records.

Results: Sixty boys managed with CIC for LUT dysfunction due to neurological or urological disorders were identified. The median age at CIC initiation was 8.2 years (range, 1.4-18). With regard to age, CIC was well tolerated in younger boys and without genital sensation. Failure in the CIC protocol occurred within the first six months (n = 9). More boys with genital sensation were socially continent with CIC (91% versus 83%, P = .05). Vesicoureteral reflux was resolved in 69% of boys (P = .03), and hydronephrosis in 54% (P = .07).

Conclusion: CIC was effective in terms of continence and renal protection. The procedure was feasible even in boys with preserved urethral sensation. Therapeutic education by a dedicated urotherapy nurse is the key factor in ensuring long-term CIC compliance and acceptability.

Purpose: To present the results of a two-stage technique used for the treatment of proximal hypospadias with severe curvature.

Materials and Methods: The medical records of children with proximal hypospadias and severe curvature were retrospectively analyzed. A 2-stage procedure was performed in 30 children. In the first stage, the release of chordee was performed, and a well-vascularized preputial island flap was created. The vascularized island flap was brought anteriorly and sutured over the ventral surface of the glans and degloved penile shaft. The second stage was performed 6-8 months later. A neourethra was reconstructed by the tubularization of the preputial-urethral plate utilizing the principles of Duplay technique. All surgical procedures were performed between 2005 and 2011.

Results: The mean age of the patients was 4.4 years (1-17 years). The mean duration of urethral catheterization was 6 days after the first stage and 10 days following the second stage. The flaps were viable in all of the children. There was no residual chordee. Following the second stage (n = 30), complications developed in 11 children (36%), namely, a fistula in 7, a pinpoint fistula in 3, and a diverticulum formation in 1. The cosmetic outcome was satisfactory. Uroflowmetry measurements were evaluated, and only one patient had a diverticulum formation at the late follow-up.

Conclusion: Vascularized preputial island flap is an alternative to free grafts for the reconstruction of the urethra. The main advantage of this flap technique is the creation of a thick, healthy and well-vascularized urethral plate. The advantages of this technique include better aesthetic appearance, an acceptable complication rate, and a very low rate of diverticula formation.

Purpose: Comparing the effectiveness of dietary vitamin C and weight loss exercises interventions for weight loss on semen characteristics in normal obese man.

Materials and Methods: A total number of 200 men were randomly allocated into two groups based on body mass index, exercise and vitamin C groups. Also, 50 men with normal spermogram were placed in a control group. In exercise group, a 6 months intensive exercise program was designed under a coach's supervision to reduce the body weight. In vitamin C group, 1,000 mg of vitamin C were given every other day as supplement.

Results: Weight loss increased the volume of semen in participants with 25-30 (P = .02) and more than 30 body mass index (P = .001). The increased concentration of sperm per mL of semen in body mass index (BMI) 25-30 group (P = .01) and more than 30 (P = .003) BMI was significant. Improving sperm motility after two hours in participants with more than 30 (P = .01) BMI was significant. In vitamin C group, the improvement of sperm concentration in participants who had less than 25 (P = .01), between 25 and 30 (P = .01), more than 30 (P = .02) BMI was significant. Sperm motility improved in all three groups (P = .001, P = .02 and P = .003, respectively).

Conclusion: Weight loss can significantly increase semen volume, its concentration, its mobility and percentage of normal morphology. Consuming vitamin C significantly improves sperm concentration and mobility, but the semen volume and the percentage of normal morphology will not change significantly.

Purpose: Urinary tract infections (UTIs) are widespread and affect a large portion of the human population. Cranberry juices and extracts have been used for UTI prevention due to their content of bioactive proanthocyanidins (PACs), particularly of the A type (PAC-A). Controversial clinical results obtained with cranberry are often due to a lack of precise determination and authentication of the PAC-A content. This study used Oximacro® (Biosfered S.r.l., Turin, Italy), a cranberry extract with a high content of PAC-A, to prevent UTIs in female and male volunteers.

Materials and Methods: The Oximacro® PACs content was assayed using the Brunswick Laboratories 4-dimethylaminocinnamaldehyde (BL-DMAC) method, and the dimer and trimer PACs-A and PACs-B percentages were determined via high-performance liquid chromatography/electrospray ionization tandem mass spectrometry (HPLC/ESI-MS/MS). A balanced group of female (ranging from 19 to over 51 years) and male volunteers (over 51 years) was divided into two groups. The experimental group received 1 capsule containing Oximacro® (36 mg PACs-A) twice per day (morning and evening) for 7 days, and the placebo group was given the same number of capsules with no PACs.

Results: Analysis of Oximacro® revealed a high total PAC content (372.34 mg/g ±2.3) and a high percentage of PAC-A dimers and trimers (86.72% ±1.65). After 7 days of Oximacro® administration, a significant difference was found between the placebo and Oximacro® groups for both females (Mann-Whitney U-test = 875; P < .001; n = 60) and males (Mann-Whitney U-test = 24; P = .016; n = 10). When the female and male age ranges were analysed separately, the female age range 31-35 showed only slightly significant differences between the placebo and Oximacro® groups (Mann-Whitney U-test = 20.5; P = .095; n = 10), whereas all other female age ranges showed highly significant differences between the placebo and Oximacro® groups (Mann-Whitney U-test = 25; P = .008; n = 10). Furthermore, colony forming unit/mL counts from the urine cultures showed a significant difference (P < .001) between the experimental and the placebo groups (SD difference = 51688; df = 34, t = -10.27; Dunn-Sidak Adjusted P < .001, Bonferroni Adjusted P < .001).

Conclusion: Careful determination of the total PAC content using the BL-DMAC method and the authentication of PACs-A with mass spectrometry in cranberry extracts are necessary to prepare effective doses for UTI prevention. A dose of 112 mg Oximacro® containing 36 mg PACs-A was found to be effective in preventing UTIs when used twice per day for 7 days.