ISSN: 1735-1308

Summer
Vol. 6 No. 3 (2009)

REVIEW


Palliative Treatment of Intractable Hematuria in Context of Advanced Bladder Cancer: A Systematic Review

Seyed Mohammad Ghahestani, Nasser Shakhssalim

Urology Journal, Vol. 6 No. 3 (2009), 27 August 2009 , Page 149-156
https://doi.org/10.22037/uj.v6i3.358

Introduction: In a patient with bladder urothelial cancer that is not suitable for or does not choose curative treatment, intractable hematuria is a disastrous condition. In this article, we tried to review the literature and extract a stepwise approach for palliative treatment of hematuria in these patients.

Materials and Methods: The MEDLINE was searched with the help of the Medical Subject Headings system using different combinations of terms urinary bladder neoplasm, hematuria, carboprost, cyclophosphamide, cystitis, alum, and hyperbaric oxygenation. The articles were separately reviewed by the two authors and verified by each other. Eventually, a decision tree was developed for management of gross hematuria in patients with bladder cancer.

Results: Although, there was not any reported randomized controlled trial or prospectively designed study, the available case series were rather expressive to draw out a logical approach. Formalin has a grave adverse effect profile and recommended only in special circumstances. For management of each case of gross hematuria in bladder cancer, the etiology of bleeding is the most important determinant.

Conclusion: Hematuria in the context of advanced bladder neoplasms can now be effectively treated with fewer side effects using all available modalities in a logical holistic approach. We proposed a decision tree for management of hematuria in this context. However, regarding lack of well-designed trials, a treatment method should be based on individualized scenarios and clinical experience, bringing into account the patient’s preferences.

SPECIAL FEATURE


Prostate Cancer Screening in Greece: Current Facts

Konstantinos Stamatiou, Michael Lardas, Evagelos Kostakos, Vasilios Koutsonasios, Dimitrios Lepidas

Urology Journal, Vol. 6 No. 3 (2009), 27 August 2009 , Page 157-161
https://doi.org/10.22037/uj.v6i3.360

Introduction: The purpose of the current article is to summarize the existing literature focusing on the current status of prostate cancer screening behaviour in Greece.

Materials and Methods: We identified studies published from 2000 onwards by searching the MEDLINE database of the National Library of Medicine. Initial search terms were prostate-specific antigen screening, prostate cancer screening, and Greece. Bibliographic information of the selected publications was checked for relevant publications not included in the MEDLINE search.

Results: Currently in Greece, there is no official recommendation for prostate cancer screening, and thus, its practice depends on the social and educational status of the patient and where the patient lives in Greece.

Conclusion: We conclude that patients should be thoroughly informed of the limitations of prostate cancer screening by prostate-specific antigen test, and in consultation with urological specialists, make their personal decision of whether to receive it. Therefore, a project to support shared decision-making and informed choice for men considering testing for prostate cancer should be undertaken.

PICTORIAL UROLOGY


ORIGINAL PAPER (LAPAROSCOPIC AND ROBOTIC UROLOGY)


Early Continence After Open and Laparoscopic Radical Prostatectomy With Sutureless Vesicourethral Alignment: an Alternative Technique, 8 Years' Experience

Nasser Simforoosh, Ahmad Javaherforooshzadeh, Alireza Aminsharifi, Ali Tabibi

Urology Journal, Vol. 6 No. 3 (2009), 27 August 2009 , Page 162-169
https://doi.org/10.22037/uj.v6i3.374

Introduction: We reviewed urinary outcomes after sutureless vesicourethral alignment in open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP).

Materials and Methods: Charts of 324 patients who underwent sutureless ORP (n = 188) and LRP (n = 136) were reviewed. After prostatectomy, a 22- to 24-F silicon Foley catheter was passed into the bladder via the preserved bladder neck. The Foley balloon was filled, and mild traction was applied to appose the bladder neck to the urethral stump. The Foley catheter was fixed to the patient's leg. No cystostomy was placed.

Results: The follow-up period ranged from 12 to 60 months. The mean operative time was 65 minutes in ORP and 260 minutes in LRP. Blood transfusion was significantly less frequent with LRP (9.6% versus 19.7%, P = .02). The mean postoperative catheterization durations were 12 days in ORP and 13 days in LRP. Complete continence was achieve in 293 patients (90.4%) after 3 months of follow-up (88.9% in LRP and 91.5% in ORP, P = .78). The continence rate improved to 96.3% in LRP and 95.2% in ORP at 1 year (P = .52). Bladder neck stricture rate was 13.6% (12.8% in ORP versus 14.7% in LRP, P = .87).

Conclusion: Sutureless vesicourethral alignment during ORP and LRP is a promising approach with minimum urinary extravasation, a high rate of continence, and an acceptable rate of stricture. This technique could be considered as an alternative in anatomically demanding situations.

Comparison of Open and Laparoscopic Varicocelectomies in Terms of Operative Time, Sperm Parameters, and Complications

Ali Shamsa, Leila Mohammadi, Mehran Abolbashari, Mohammad-Taghi Shakeri, Saeed Shamsa

Urology Journal, Vol. 6 No. 3 (2009), 27 August 2009 , Page 170-175
https://doi.org/10.22037/uj.v6i3.390

Introduction: Varicocele is one of the most common causes of infertility. In this study, we evaluated and compared the operative time, sperm analysis results, and complications of three different methods of open and laparoscopic varicocelectomies.

Materials and Methods: From among all bilateral varicocelectomies in our center, we randomly selected 30 of each following cases: laparoscopic varicocelectomy, open subinguinal varicocelectomy under general anesthesia, and open subinguinal varicocelectomy under local anesthesia. We compared the operative time, sperm analysis results, and complications between these three groups.

Results: The mean operative times were 30.0 ± 5.5 minutes for laparoscopies, 27.0 ± 3.5 minutes for open varicocelectomies under general anesthesia, and 38.0 ± 1.8 minutes for open varicocelectomies under local anesthesia (P = .02). Intra-operative complications occurred only in the laparoscopic group, and postoperative complications were seen in 23.3%, 20.0%, and 4.2% of the patients with laparoscopy, open surgery under general anesthesia, and open surgery under local anesthesia, respectively. Semen analysis did not show any significant changes after varicocelectomy except for a slight improvement of sperm morphology in patients who underwent open varicocelectomy under local anesthesia.

Conclusion: Subinguinal varicocelectomy under local anesthesia is better than laparoscopic method in terms of recurrence, hydrocele formation, and operative time. Subinguinal method under general anesthesia has intermediate efficacy regarding less complications than laparoscopic method and shorter operative time than the two other methods.

Transperitoneal Laparoscopic Partial Nephrectomy Using a New Technique

Akbar Nouralizadeh, Seyed Amirmohsen Ziaee, Abbas Basiri, Nasser Simforoosh, Hamidreza Abdi, Nastaran Mahmoudnejad, Amir H Kashi

Urology Journal, Vol. 6 No. 3 (2009), 27 August 2009 , Page 176-181
https://doi.org/10.22037/uj.v6i3.391

Introduction: We report our experience with a new technique for transperitoneal laparoscopic partial nephrectomy with the kidney turned upside down intraoperatively.

Materials and Methods: Laparoscopic partial nephrectomy was performed in 10 patients with upper pole lesions through a transperitoneal approach. Once complete mobilization of the kidney was achieved, it was rotated 180 degrees around the horizontal axis, so that the upper pole was positioned inferiorly. After performing partial nephrectomy, the resection bed was sutured by 2-0 polyglactin sutures and application of Hem-o-Lok clips. Then, the kidney was returned into its normal position and fixed to the abdominal wall.

Results: We performed laparoscopic partial nephrectomy on 9 patients with a contrast-enhancing upper pole kidney mass and 1 patient with a nonfunctioning upper pole. The median tumor size was 58 mm (range, 41 mm to 92 mm). The median operative time was 206 minutes (range, 114 to 262 minutes) and the mean warm ischemia time was 30 minutes (range, 22 to 35 minutes). One patient underwent surgical exploration due to bleeding 6 hours after the operation. Prolonged urine leakage (more than 7 days) was observed in 1 patient, which responded to ureteral stent insertion. Surgical margins were negative in all of the patients. Renal cell carcinoma was histologically diagnosed in patients with a kidney tumor.

Conclusion: Laparoscopic upper pole partial nephrectomy had acceptable results while the kidney was turned upside down intraoperatively, in terms of operative time and complications. This approach facilitates the procedure by achieving a better field of vision.

ORIGINAL PAPER(UROLOGICAL ONCOLOGY)


Value of Prostate-Specific Antigen and Prostate-Specific Antigen Density in Detection of Prostate Cancer in an Iranian Population of Men

Mahyar Ghafoori, Peyman Varedi, Seyed Jalil Hosseini, Mojgan Asgari, Madjid Shakiba

Urology Journal, Vol. 6 No. 3 (2009), 27 August 2009 , Page 182-188
https://doi.org/10.22037/uj.v6i3.394

Introduction: The objective of this study was to evaluate the value of serum prostate-specific antigen (PSA) and prostate-specific antigen density (PSAD) in the diagnosis of prostate cancer.

Materials and Methods: A total of 330 consecutive patients suspected of having prostate cancer due to either abnormal digital rectal examination or elevated serum PSA levels underwent transrectal ultrasonography-guided sextant biopsy of the prostate. The PSA and PSAD values were assessed based on the biopsy results.

Results: One hundred and twenty-one patients (36.7%) had prostate cancer. In this group, the mean PSA was 31.60 ± 30.85 ng/mL (range, 1.9 ng/mL to 166.0 ng/mL) and the mean PSAD was 0.83 ± 1.01 (range, 0.04 ng/mL/cm3 to 6.38 ng/mL/cm3). In those without prostate cancer the mean PSA and PSAD levels were 13.80 ± 18.72 ng/mL (range, 0.4 ng/mL to 130.0 ng/mL; P < .001) and 0.24 ± 0.32 (range of 0.01 ng/mL/cm3 to 2.29 ng/mL/cm3; P < .001). The receiver operating characteristic curve analysis revealed that the discriminating power of serum PSA for detecting prostate cancer, as estimated by the area under the curve, was 0.74 while that for PSAD was 0.81 (P < .001). For the PSA range of 3.5 ng/mL to 41 ng/mL (gray zone) the areas under the curve was 0.68 for PSA, while it was 0.78 for PSAD (P < .001).

Conclusion: The use of PSAD instead of PSA in the diagnosis of prostatic cancer improves the diagnostic accuracy.

Introduction: We determined the recurrence and progression at 1 year in patients with non-muscle-invasive urothelial carcinoma who underwent transurethral resection of bladder tumor (TURBT) and compared those with the calculated risk according to the European Organization of Research and Treatment of Cancer (EORTC).

Materials and Methods: Follow-up data of 92 patients with non-muscle-invasive bladder cancer who underwent TURBT were reviewed, and their 1st year recurrence and progression were recorded. The risk of recurrence and progression were calculated for 1 year according to the EORTC scoring system, using tumors’ stage, grade, size, and multiplicity, and the presence of carcinoma in situ and previous recurrence episodes. The outcomes were compared with the EORTC’s predictive scores.

Results: The patients were 75 men and 17 women with an age range of 31 to 91 years. Sixteen patients (17.4%) had a recurrent disease, 41 (44.6%) had a tumor larger than 3 cm in diameter, 35 (38.0%) had multiple lesions, 2 (2.2%) had carcinoma in situ, 73 (79.3%) had stage T1 lesions, and 8 (8.7%) had a high-grade disease. Recurrence was found in 34 patients (37.0%). The recurrence rates were 20.0%, 28.2%, 40.5%, and 83.3% in groups with the predicted EORTC risks of 15%, 24%, 38%, and 61%, respectively. There were 2 patients (2.2%) with progression of the diseases.

Conclusion: A significant concordance was noted between the EORTC’s calculated risk and the recurrence rate of stage Ta T1 bladder cancer at 1 year. Progression was less than that predicted, probably due to our small sample size.

ORIGINAL PAPER (KIDNEY TRANSPLANTATION)


Postnephrectomy Changes in Doppler Indexes of Remnant Kidney in Unrelated Kidney Donors

Abolfazl Bohlouli, Mohammad Kazem Tarzamni, Afshar Zomorrodi, Sedigeh Abdollahifard, Bahram Hashemi, Nariman Nezami

Urology Journal, Vol. 6 No. 3 (2009), 27 August 2009 , Page 194-198
https://doi.org/10.22037/uj.v6i3.396

Introduction: We aimed to evaluate the intralobar renal arteries indexes using the Doppler ultrasonography indexes, which have become the established method of kidney monitoring, in living unrelated kidney donors during the postnephrectomy period.

Materials and Methods: In this prospective study, we evaluated and followed up 34 living unrelated kidney donors. The Doppler ultrasonography indexes, including resistive index, pulsatility index, and peak systolic velocity, along with the grey-scale ultrasonographic indexes of cortical thickness, length, and anteroposterior diameter of the kidney were determined before nephrectomy, and then, 1 week and 3 months after nephrectomy. In addition, glomerular filtration rate were assessed simultaneously.

Results: The resistive index and pulsatility index did not change 1 week and 3 months after nephrectomy (P = .66 and P = .38, respectively). The peak systolic velocity at 1 week was significantly higher than its prenephrectomy value (P = .02). Also, the peak systolic velocity at 3 months was significantly higher than that prior to nephrectomy (P < .001). Indexes of the kidney size all increased during the follow-up period. The estimated glomerular filtration rate increased decreased 1 week after nephrectomy, but it reach to a level comparable with its preoperative values after 3 months.

Conclusion: Results of the present study showed an increased peak systolic velocity in association with unaltered resistive index and pulsatility index in the remnant kidney of donors, during the short-term follow-up. This finding indicates the increased blood flow and kidney size in the remnant kidney of donors, following nephrectomy.

ORIGINAL PAPER (ANDROLOGY)


Pattern of Compensatory Hypertrophy in Contralateral Testis After Unilateral Orchiectomy in Immature Rabbits

Kamyar Tavakkoli Tabassi, Sakineh Amoueian, Elena Saremi

Urology Journal, Vol. 6 No. 3 (2009), 27 August 2009 , Page 199-203
https://doi.org/10.22037/uj.v6i3.397

Introduction: Our aim was to evaluate effects of hemicastration in immature rabbits on the histology of the contralateral testis after puberty.

Materials and Methods: Eighteen immature male rabbits were randomly divided into two groups. The first group underwent right or left hemicastration and the second, sham operation. After their puberty, the rabbits underwent the second operation. In the former group the contralateral testis and in the latter, the right or left testis was removed and sent for pathologic examination. The two groups were compared in terms of Leydig cell count, testis volume, and seminiferous tubule count and diameter.

Results: The mature rabbits’ mean weight at the orchiectomy time, seminiferous tubule count, and seminiferous tubules diameter did not show significant differences between two groups. However, testis volumes and Leydig cell count were significantly higher in the first group with hemicastration prior to puberty. The mean testis volume was 3.24 ± 2.06 mL in the first group and 1.4689 ± 0.85701 mL in the second group (P = .03), and the mean Leydig cell count in every 5 microscopic high-power fields was 86.22 ± 54.96 and 42.00 ± 18.09, respectively (P = .04).

Conclusion: Our research demonstrated that prepubertal hemicastration in rabbits led to the compensatory hypertrophy in the contralateral testis after puberty and an increase in the number of the Leydig cells.

ORIGINAL PAPER (RECONSTRUCTIVE SURGERY)


Supracrural Rerouting as a Technique for Resolution of Posterior Urethral Disruption Defects

Seyed Jalil Hosseini, Alireza Rezaei, Mojtaba Mohammadhosseini, Iraj Rezaei, Babak Javanmard

Urology Journal, Vol. 6 No. 3 (2009), 27 August 2009 , Page 204-207
https://doi.org/10.22037/uj.v6i3.398

Introduction: Selection of an acceptable method for the treatment of posterior urethral disruption defects would be highly desirable. We determined the efficacy and success rate of some techniques including supracrural rerouting for removing of these defects among our patients.

Materials and Methods: Records of 200 consecutive men treated with anastomotic urethroplasty for traumatic posterior urethral strictures were reviewed at our teaching hospital. Prior treatment, surgical approach, and ancillary techniques required during reconstruction were evaluated.

Results: Success rate due to posterior urethral reconstruction was achieved in 78.0% of cases. Supracrural urethral rerouting was performed in 11 patients (5.5%), of whom 7 sustained recurrent stricture requiring intervention. The highest success rate of defect resolving was reported by urethral mobilization (92.4%).

Conclusion: Supracrural rerouting is not an acceptable technique and can result in postoperative complications such as recurrent stricture in most of the patients with posterior urethral disruption defects.

UNCLASSIFIED


Introduction: The objective of this study was to evaluate the correlation of suprapubic ultrasonography and transrectal ultrasonography in measurements of prostate dimension and volume.

Materials and Methods: One hundred consecutive patients with lower urinary tract symptoms were examined by suprapubic and transrectal ultrasonography modalities in a same session. Measurements of the 3 dimensions of the prostate (anteroposterior, transverse, and craniocaudal) and its volume performed by suprapubic ultrasonography were compared with the corresponding measurements by transrectal ultrasonography in order to determine the correlation of the measurements. Prostate volumes were calculated using the ellipsoid formula. Data were further analyzed in subgroups according to prostate volumes smaller or larger than 50 mL, measured by suprapubic ultrasonography.

Results: The mean prostate volume of the 100 patients, measured by suprapubic and transrectal ultrasonography were 65.9 ± 35.8 mL and 62.5 ± 32.0 mL, respectively (r = 0.94; P < .001). The craniocaudal diameters had the strongest correlation among dimension measurements (r = 0.89; P < .001). Suprapubic and transrectal ultrasonography measurements also showed significant correlations for both prostates smaller or larger than 50 mL. Eighty-five percent of the patients had both volume measurements under or above this limit.

Conclusion: There was strong correlation between suprapubic and transrectal ultrasonography measurements of the prostate sizes, including both for volume or specific dimension measurements.

POINT OF TECHNIQUE


CASE REPORT


UROLOGY IN HISTORY


Avicenna, the Iranian scientist, describes the mechanisms of normal voiding in his famous book, the Canon of Medicine. Then, he enumerates urinary symptoms. In this article, his discussion on dysuria, its causes, and its pathophysiology is compared with these concepts in modern urology. Avicenna points to some etiologic theories of interstitial cystitis and chronic prostatitis. In the Canon, we can distinguish bases of the theory of infection and mucosal theory, along with abnormalities of urine, psychological factors, and abnormalities in prostatic secretions. Avicenna also indicates some differential diagnoses of and associated disorders with interstitial cystitis. His short but rather concise discussion on oliguria and its causes is an interesting point for urologists and nephrologists.

UROLOGY FOR PEOPLE