ISSN: 1735-1308

Vol. 11 No. 2 (2014)

REVIEW


Antibiotics Are Not Beneficial in the Management of Category III Prostatitis: A Meta-Analysis

Yongtong Zhu, Chunyan Wang, Xiang Pang, Fei Li, Wei Chen, Wanlong Tan

Urology Journal, Vol. 11 No. 2 (2014), 7 May 2014 , Page 1377-1385
https://doi.org/10.22037/uj.v11i2.1683

Purpose: To determine whether antibiotics are beneficial in the management of category III prostatitis.

Materials and Methods: The PubMed, Medline and Embase databases were searched for all published documents from January 1, 1965 to September 1, 2012 without language restriction. The randomized controlled trials that mentioned comparable groups of antibiotics treatment versus placebo or other control group for patients with category III prostatitis were included based on specific criteria. The quality of studies was assessed by the modified Jadad scale, and Revman 5.0 software was used for data syntheses and analysis.

Results: Seven studies which met the selection criteria were included in this review. All of them were high quality according to the modified Jadad scale. A random effect model was applied because of the high heterogeneity. The meta-analysis showed that summary association between category III prostatitis and antibiotics were not statistically significant.

Conclusion: Our meta-analysis reveals that antibiotics are not beneficial in the management of category III prostatitis. Therefore, we may reduce the usage of antibiotics in such a population.

ORIGINAL PAPER (ENDOUROLOGY AND STONE DISEASE)


Blind versus Fluoroscopy-guided Percutaneous Nephrolithotomy: A Randomized Clinical Trial

Hossein Karami, Mohammad Mohsen Mazloomfard, Aida Moeini, Mojtaba Mohammadhosseini, Alireza Rezaei, Behzad Lotfi

Urology Journal, Vol. 11 No. 2 (2014), 7 May 2014 , Page 1386-1391
https://doi.org/10.22037/uj.v11i2.1355

Purpose: Due to the negative impact of radiation on the patient and the surgical team during percutaneous nephrolithotomy (PCNL), we aimed to evaluate success rate and complications of blind access for PCNL using lumbar notch landmark and compare with conventional fluoroscopy- guided access.

Materials and Methods: In a clinical trial, 100 patients who were candidate for PCNL, were randomly assigned into blind group (1) and fluoroscopy-guided group (2). In group 1 the lumbar notch was used to guide percutaneous access and in group 2 fluoroscopy performed after needle insertion, Amplatz placement and at the end of surgery. If the access failed, we would repeat puncturing up to 5 times. In group 2, access was achieved using full fluoroscopy guidance. All patients underwent postoperative assessment including kidney-ureter-bladder X-ray and ultrasonography.

Results: Both mean access time and mean operation time were statically similar in group 1 and group 2 (3.3 ± 0.5 vs. 3.6 ± 0.7 min and 35.2 ± 4.6 vs. 38.9 ± 4.1 min, respectively). A successful puncture was achieved in 86% and 94% of the patients in groups 1 and 2, respectively (P = .18). Total success rate of procedure was 80% and 88% of the patients in groups 1 and 2, respectively (P = .27).

Conclusion: According to this study, it seems that blind access is a safe and effective PCNL method, and we recommend employment of this technique by skilled endourologist in urology centers especially for patient with large hydronephrotic kidney.

 

Management of Calculus Anuria Using Ureteroscopic Lithotripsy as a First Line Treatment: Its Efficacy and Safety

Slavisa Savic, Vinka Vukotic, Miodrag Lazic, Natasa Savic

Urology Journal, Vol. 11 No. 2 (2014), 7 May 2014 , Page 1392-1399
https://doi.org/10.22037/uj.v11i2.2089

Purpose: To present our experience with emergency ureteroscopic lithotripsy (URSL) for ureteral calculi associated with acute kidney injury (AKI).

Materials and Methods: We retrospectively evaluated the 61 patients consisted of 90 ureteral units (UU), who underwent URSL. The cause of anuria was bilateral calculus obstructions in 29 cases, and unilateral calculus obstruction with, absent, nephrectomized contralateral kidney in 32 cases. In the case of bilateral synchronous ureteric calculi same-session bilateral ureteroscopy (SBBU) was done. The duration of anuria varied between 12 to 72 hours. At the end of the procedure, ureteral stent was systematically left in place in all patients. Surgery was performed 6-12 hours after admission to hospital. Patients were followed at least 1 month postoperatively.

Results: The stone free rates (SFR) were determined as baseline, on the first post-operative day, and as overall on the 30 days after procedure. The greatest success was achieved in the distal localization of stones up to 10 mm (93%). Renal function returned in 51 (83.6%) patients within 7 days. In 18 (29.5%) patients [18 (20%) UU] we performed second procedure as extracorporeal shockwave lithotripsy in 16.7% and open surgery in 2.2%. In 43 (70.5%) patients URSL was a successful therapeutic approach in dealing with pain, obstruction and calculus.

Conclusion: Calculus anuria is a medical emergency that requires rapid diagnosis and prompt treatment for the purpose of decompression. URSL is the proper method of choice for selected patients and can be performed safely and has high success rates with minimal morbidity.

 

ORIGINAL PAPER (PEDIATRIC UROLOGY)


The Assessment of Thiol Status in Children with Neurogenic Bladder Caused by Meningomyelocele

Agata Korzeniecka-Kozerska, Bo?ena Okurowska Zawada, Bo?ena Okurowska Zawada, Joanna Michaluk Skutnik, Joanna Michaluk Skutnik, Anna Wasilewska, Anna Wasilewska

Urology Journal, Vol. 11 No. 2 (2014), 7 May 2014 , Page 1400-1405
https://doi.org/10.22037/uj.v11i2.1824

Purpose: Oxidative stress can cause tissue damage in many diseases. Oxidative status depends on the balance between total oxygen radical absorbance capacity and antioxidants. Neurogenic bladder (NB) is a special state where oxidative status can influence urinary tract function. We decided to measure antioxidant (thiol) status in patients with NB and assess the effect of NB on the urinary antioxidant status and to correlate it with urodynamic findings.

Materials and Methods: The investigation was conducted on two groups. The first group, constituted of 41 children with NB. The second group, consisted of 20 healthy children with no abnormality in urinary and nervous systems. The antioxidant status was assessed based on the enzyme-linked immunosorbent assay of thiols.

Results: The median value of urinary protein thiol level was significantly lower in NB patients than in reference group [median 48 (0.0-633.33) and 221.55 (0.17-1293] μmoL/g protein, respectively (P < .01). We found out the statistically significant differences in urinary thiol level between patients with and without overactivity (P = .017) and between catheterized and noncatheterized patients (P = .048).

Conclusion: This study demonstrates that antioxidant status in patients with NB decreased and the level of thiol status depends on the grade of bladder overactivity. Oxidative stress may be involved in the pathophysiology of bladder dysfunction related to neurogenic damage.

Circumcision in Bleeding Disorders: Improvement of Our Cost Effective Method with Diathermic Knife

Muhammet Ihsan Karaman, Bülent Zulfikar, Metin Ishak Özturk, Orhan Koca, Mehmet Akyüz, Fikret Bezgal

Urology Journal, Vol. 11 No. 2 (2014), 7 May 2014 , Page 1406-1410
https://doi.org/10.22037/uj.v11i2.1771

Purpose: Circumcision is a very common surgical procedure that has been performed for thousands of years. In this paper, we report the long-term results of circumcision performed by using diathermic knife on patients with bleeding diathesis and the amount of blood factors used.

Materials and Methods: A total of 147 patients with bleeding diathesis circumcised under local anesthesia by using diathermic knife between 1996 and 2010 were recruited into this study. Age of the patients, type of the bleeding diathesis and the treatment protocols were recorded. Postsurgical infection and bleeding rates of 2 different factor replacement protocols were recorded.

Results: Mean age of the patients was 11.5 years (range, 1.5-37 years). In the group of protocol 1 applied patients, 3 patients (4%) had bleeding and one patient had infection whereas in group of protocol 2, 4 patients (5.4%) had bleeding. The bleeding cases were taken under control after the factor replacement and elastic bandage.

Conclusion: Whenever it is necessary for an individual to be circumcised for any reason whatsoever, we think that circumcision can be performed in the patients with bleeding diathesis with lower costs and complication rates by using diathermic knife and the protocol that we used.

Purpose: We investigated whether children getting ready for circumcision under local anesthesia had any additional genital region abnormalities not detected before the circumcision.

Materials and Methods: We performed circumcision under local anesthesia for children with normal physical examination findings, and together with corrective surgery for those with other genital anomalies among the children aged 6 years old and over presenting at the pediatric surgery department of our hospital during the school break.

Results: Circumcision was planned under local anesthesia in a total of 1,695 cases aged between 6 and 17 years during the June to September 2010 and 2011 periods. We found an external genital anomaly in the pre-circumcision physical examination in 58 patients (3.4%), with a mean age of 7.87 ± 1.49 years. These patients were operated on with corrective surgery while 1,637 children underwent circumcision under local anesthesia. The most common anomaly was inguinal hernia seen in 14 (24.1%), followed by hypospadias in 11 (18.9%), hydrocele in 9 (15.9%) and undescended testis in 8 (13.8%).

Conclusion: In countries where circumcision is traditional, an intervention room within the hospital to perform circumcision under local anesthesia can enable many children to be circumcised under hospital conditions and previously undetected genital abnormalities to be found with a pre-circumcision genital region examination.

 

ORIGINAL PAPER(UROLOGICAL ONCOLOGY)


Can Non-Urological Doctors Play a Role in Early Prostate Cancer Detection?

Cenk Murat Yazici, Cagri Dogan

Urology Journal, Vol. 11 No. 2 (2014), 7 May 2014 , Page 1429-1434
https://doi.org/10.22037/uj.v11i2.1574

Abstract

Purpose: To evaluate the awareness of non-urological doctors for their role in evaluating prostate cancer (Pca) in scientific manner which may be a possible probability for late diagnosis of Pca.

Materials and Methods: A total of 936 non-urological specialists working in 1 university and 4 education and research hospital who were able to evaluate male patients over 50 years of age were included to the survey. A face to face questionnaire had been administered to all participants.

Results: A total of 92 (9.8%) participants were evaluating prostate-specific antigen (PSA) level to all their elderly male patients while 404 (43.2%) participants had never made this evaluation. Among the participants who were evaluating PSA, none was performing an informed decision making consult and even they did not have any idea about the meaning of this strategy. About the criteria for urological consultation, 56 (6%) reported that they consult all their elderly male patients, whereas 880 (94%) answered that they perform consultation if their patients has sought help for any urological symptom.

Conclusion: Urologists must remind the non-urological specialists that their approaches to Pca evaluation may change mortality rates of this disease and give them proper information about the scientific evaluation of Pca. This may help us to decrease the mortality rates of Pca.

Abstract

Purpose: We sought to develop prognostic models to predict disease recurrence and cancerspecific mortality in patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU).

Materials and Methods: Data on 253 patients treated with RNU between 1995 and 2008 at a single high-volume tertiary referral center were analyzed. Statistically and clinically significant patient and tumor characteristics were identified in a univariate analysis and incorporated into a multivariable Cox regression model. The model was compared to the 2010 American Joint Committee on Cancer (AJCC) staging classification using the concordance index (c-index), corrected for statistical optimism using bootstrap methods.

Results: Five-year recurrence-free survival (RFS) and cancer-specific survival (CSS) rates were 73% [95% confidence interval (CI): 66-79%)] and 78% (95% CI: 71-84%), respectively. On multivariate analysis, higher preoperative glomerular filtration rate (GFR) was associated with better CSS [hazard ratio (HR) per 1 mL/min/m2 increase in GFR for CSS: 0.74; P = .002)], while higher pathologic stage (HR for pT2: 2.99 and for ≥ pT3: 7.34; P < .001) and lymph node involvement (HR: 3.75; P < .001) were associated with worse CSS; results were similar for RFS. The ability of the final models, which included preoperative GFR, lymph node status, pathologic grade, and stage, to predict RFS and CSS (c-index 0.82 and 0.83, respectively) was similar to that of the 2010 AJCC staging classification (c-index 0.80 and 0.81, respectively).

Conclusion: Given the data-dependent selection of variables in this single institution cohort, it is unlikely that the marginal improvement found with these prediction models would importantly impact clinical decision-making or improve patient care. The 2010 AJCC staging classification alone is very accurate and should continue to guide follow-up after RNU.

 

Abstract

Purpose: To evaluate individually tailored open nephron-sparing surgical techniques for urothelial carcinoma of the pyelocalyceal system (UCPCS).

Materials and Methods: Four patients underwent nephron-sparing surgery for UCPCS including, open partial resection of the pyelon with peritoneal reconstruction, partial nephrectomy, open partial resection of the pyelon with kidney autotransplantation, combined open resection and calicoscopic laser coagulation.

Results: Recurrence-free survival was 24 months without any impairment of kidney function in all patients.

Conclusion: Open nephron-sparing surgery for UCPCS should be taken into consideration for selected cases.

 

ORIGINAL PAPER (LAPAROSCOPIC AND ROBOTIC UROLOGY)


Abstract

Purpose: A major concern when performing laparoscopic partial nephrectomy (LPN) is potential postoperative renal dysfunction. The objective of this study was to compare the effects of LPN with selective renal parenchymal clamping (SRPC) (LPNSRPC) and LPN using microwave tissue coagulation (MTC) (LPNMTC) on postoperative renal function.

Materials and Methods: This study included 12 patients (5 men and 7 women) who underwent LPNSRPC (n = 6) or LPNMTC (n = 6) for exophytic tumors. Renal scanning with technetium- 99m diethylenetriaminepentaacetic acid (Tc-99m DTPA) was performed preoperatively and postoperatively at 1 month in all patients.

Results: The mean tumor size, surgical duration, and intraoperative blood loss were similar in both groups. In the LPNMTC group, although not significant, the mean postoperative glomerular filtration rate (GFR) values in the affected kidneys were decreased compared to the preoperative values. When evaluating the affected renal function by split function (SF), the mean postoperative SF in the affected kidneys was significantly decreased compared to the preoperative value. In the LPNSRPC group, the mean postoperative GFR and SF in the affected kidneys were not significantly changed compared with the preoperative values.

Conclusion: Our preliminary experience demonstrates that LPNSRPC facilitates maximal nephron-sparing surgery without collateral thermal damage causing renal impairment.

Comparison of Laparoscopic and Open Ureterolithotomy in Impacted and Very Large Ureteral Stones

Goksel Bayar, Orhan Tanriverdi, Mehmet Taskiran, Umut Sariogullari, Hüseyin Acinikli, Elshad Abdullayev, Kaya Horasanli, Cengiz Miroglu

Urology Journal, Vol. 11 No. 2 (2014), 7 May 2014 , Page 1423-1428
https://doi.org/10.22037/uj.v11i2.1946

Abstract

Purpose: To compare the efficacy of laparoscopic and open ureterolithotomy in patients withureteral stones.

Materials and Methods: Patients who had undergone open or laparoscopic ureterolithotomy between 2001 and 2013 in our clinic were enrolled in the study.Ureterolithotomy was performed due to the following reasons: failure to position the patient for ureteroscopy,unreachable stone with ureteroscopy also use of balloon dilatation, high stone volume, and the need for removal of kidney stones at the same session.. The patients' demographic data, the volume of the stones, the duration of the operation and the hospital stay, the amount of analgesics administered after the operation, and the need for another procedure were compared.

Results: Of study subjects 32 patients had undergone open and 20 patients had undergone laparoscopic ureterolithotomy. When the two groups were compared, there was no statistically significant difference with regard to the mean age (44.5-44 years), the body mass index (26-24.7 kg/m²), the stone volume (420-580 mm³), the duration of operation (122-123 min), the need for anotherprocedure and complications. The mean amount of analgesics administered after the operation (3.6 and 1.81 doses, P = .02) and the mean hospital stay (6.1 and 2.9 days, P = .01) were significantly lower in the laparoscopic ureterolithotomy group.

Conclusion: Laparoscopic ureterolithotomy is a good alternative with less need for analgesia and a shorter hospital stay when compared with open ureterolithotomy.

ORIGINAL PAPER (KIDNEY TRANSPLANTATION)


Short-term Survival in Renal Transplantation from Brain-Death Donors: Focusing on Recipients with Diabetes Background

Manoochehr Nakhjavani, Fatemeh Ghaemi, Hamid Ravaghi, Mohammad Aghighi, Farahnaz Ghaemi

Urology Journal, Vol. 11 No. 2 (2014), 7 May 2014 , Page 1474-1477
https://doi.org/10.22037/uj.v11i2.1757

Abstract

 

Purpose: Our aim was to evaluate short term survival rates in renal transplant recipients from deceased donors, while focusing on recipients with diabetes mellitus background.

Materials and Methods: This is a longitudinal follow-up study based on national registry of recipients in Ministry of Health and Medical Education in Iran from 2010-11. Five hundred fifty-five recipients, 226 (40.8%) females and 328 (59.2%) males, were included in the study. Mean (± SD) age of the recipients was 39 ± 14 years. Of donors 18.4% were females and 81.6% were males. Age of the donors was 33 ± 14 years. All allograft recipients from deceased donors enrolled in the study. Short-term graft survival (1 year) was determined. Data regarding age, gender, background disease and cold ischemic time of recipients and donors were collected from the organ procurement units.

Results: Allografts were functioning in 499 (90.1%) of recipients after one year. Of recipients 38 (6.9%) died and rejection of transplanted kidney occurred in 17 (3.1%) cases. So, in 55 (9.9%) cases, allografts were not functioning. There were significant relationships between short term graft survival of donors' gender, age of recipients, cold ischemic time and level of clearance of creatinine of recipients.

Conclusion: In addition to cold ischemic time, graft survival can be affected by recipients' age. There are some other considerations and implications regarding the short term graft survival in renal transplantation from cadaver donors which are discussed in this paper.

 

ORIGINAL PAPER (FEMALE UROLOGY)


Impact of Urinary Incontinence on Quality of Life among Residents Living in Turkey

Muhammet Guzelsoy, Hakan Demirci, Soner Coban, Buket Belkiz Güngör, Emin Ustunyurt, Serhat Isildak

Urology Journal, Vol. 11 No. 2 (2014), 7 May 2014 , Page 1447-1451
https://doi.org/10.22037/uj.v11i2.2167

Abstract

Purpose:To assess the impact of urinary incontinence on the quality of life in Turkish population.

Materials and Methods: This was a cross-sectional study performed on 530 participants admitted to Sevket Yilmaz Research Hospital in Turkey. Quality of life (QoL) was assessed using Incontinence Impact Questionnaire (IIQ-7). Frequency and severity of urinary incontinence (UI) were diagnosed by answers to the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) instrument. The relationship between several demographic data and QoL was examined.

Results: The mean age of the attendees was 55.36 ± 10.62 years (range 40-91). A total of 109 (44%) women and 46 (16%) men suffered involuntary urine leakage. QoL changes for all domains showed significant deteriorations. Frequency and severity of UI were negatively associated with the QoL scores.

Conclusion: Our results have shown that, UI considerably worsens QoL. Challenge with UI should be priority of any project aiming to promote the quality of life.

 

ORIGINAL PAPER (ANDROLOGY)


Percutaneous No-Scalpel Vasectomy via One Puncture in China

Liping Li, Jialiang Shao, Xiang Wang

Urology Journal, Vol. 11 No. 2 (2014), 7 May 2014 , Page 1452-1456
https://doi.org/10.22037/uj.v11i2.2053

Abstract

 

Purpose: To evaluate the efficacy and postoperative morbidity of percutaneous no-scalpel vasectomy (NSV) via one puncture in China.

Materials and Methods: A total of 150 men visiting outpatient clinic of the surgery department of urology, Huashan Hospital and its Baoshan branch of Fudan University, opted for percutaneous NSV with local anesthesia. The clinical data of 150 who underwent modified NSV (MNSV) were retrospectively compared with those of 120 patients who underwent standard NSV (SNSV). The results and follow-up were recorded.

Results: The reviewed average operative time was 9.8 min (range 8 to 20 min). Average incisional length was 5 mm (range 4 to 8 mm). Patients reported complete recovery in an average of 8.5 days (range 4 to 14 days). The complication rates were extremely low with this modified technique. Only one case of late healed incision was observed (0.67%).

Conclusion: Percutaneous NSV via one puncture was proved to be a painless and effective form of permanent contraception with an extremely low complication rate.

Comparison of Different Autogenous Graft Materials for Reconstruction of Large Segment Vas Deferens Defect: Experimental Study in Rat

Serdar Nasir, Sedat Soyupek, Selman Altuntas, Ersay Konas, Emir Charles Roach, Alper Ozorak, Sema Bircan

Urology Journal, Vol. 11 No. 2 (2014), 7 May 2014 , Page 1457-1464
https://doi.org/10.22037/uj.v11i2.1712

Abstract

Purpose: Vasectomy is one of the most common urological operations performed, and provides permanent contraception. Many vasectomized men ultimately seek vasectomy reversalbecause of unforeseen changes in lifestyle. Vasovasostomy has varying rates of success. Inthis study, we utilize vas deferens (VD), artery, and vein grafts to reconstruct 30% and 50%defects of the total vas deferens length.

Materials and Methods: Forty two male Wistar rats were divided into three groups as VDgraft, carotid artery and external jugular vein transplantations. Each group was equally dividedinto 2 different subgroups according to the length of transplant material as 1.0 cm (n = 7) and1.5 cm (n = 7). To evaluate whether these materials may be used for long segment vas deferensreconstruction, the patency rate, partial or total graft occlusion, and histologic examination ofall specimens were examined.

Results: No patency was found in any of the grafts and many of them suffered destructivechanges in anatomic structure. Sperm granulomas were determined around the testicular sideanastomosis due to accumulated semen fluid which was in our belief, a result of aperistalticzone caused by the grafts.

Conclusion: When the poor results obtained in our study are put into perspective, vasoepididymostomyis the only treatment method to date for reconstruction of large segment vasdeferens defects.

Vitrification of Neat Semen Alters Sperm Parameters and DNA Integrity

Mohammad Ali Khalili, Maryam Adib, Iman Halvaei, Ali Nabi

Urology Journal, Vol. 11 No. 2 (2014), 7 May 2014 , Page 1465-1470
https://doi.org/10.22037/uj.v11i2.1986

Abstract

Purpose: Our aim was to evaluate the effect of neat semen vitrification on human sperm vital parameters and DNA integrity in men with normal and abnormal sperm parameters.

Materials and Methods: Semen samples were 17 normozoospermic samples and 17 specimens with abnormal sperm parameters. Semen analysis was performed according to World Health Organization (WHO) criteria. Then, the smear was provided from each sample and fixed for terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. Vitrification of neat semen was done by plunging cryoloops directly into liquid nitrogen and preserved for 7 days. The samples were warmed and re-evaluated for sperm parameters as well as DNA integrity. Besides, the correlation between sperm parameters and DNA fragmentation was assessed pre- and post vitrification.

Results: Cryopreserved spermatozoa showed significant decrease in sperm motility, viability and normal morphology after thawing in both normal and abnormal semen. Also, the rate of sperm DNA fragmentation was significantly higher after vitrification compared to fresh samples in normal (24.76 ± 5.03 and 16.41 ± 4.53, P = .002) and abnormal (34.29 ± 10.02 and 23.5 ± 8.31, P < .0001), respectively. There was negative correlation between sperm motility and sperm DNA integrity in both groups after vitrification.

Conclusion: Vitrification of neat ejaculates has negative impact on sperm parameters as well as DNA integrity, particularly among abnormal semen subjects. It is, therefore, recommend to process semen samples and vitrify the sperm pellets.

 

CASE REPORT


Cavernous Hemangioma of the Female Urethra: A Rare Case Report

Sakir Ongun, Serdar Çelik, Guven Aslan, Kutsal Yorukoglu, Adil Esen

Urology Journal, Vol. 11 No. 2 (2014), 7 May 2014 , Page 1521-1523
https://doi.org/10.22037/uj.v11i2.1847

Genitourinary hemangiomas are rare entities that can affect any portion of the urinary system. The urethra is rarely involved, and most reported cases have occurred in the male urethra. To our knowledge few cases of hemangioma occurring in the female urethra have been reported. We report a cavernous hemangioma of the urethra in a female patient.

Ampullary Tumor Caused by Metastatic Renal Cell Carcinoma and Literature Review

wang haidong, Wang Jianwei, Li Guizhong, Liu Ning, He Feng, Man Libo

Urology Journal, Vol. 11 No. 2 (2014), 7 May 2014 , Page 1504-1507
https://doi.org/10.22037/uj.v11i2.1628

We present a case of a 50-year-old man with a metastasis to the ampulla of vater thatled to the discovery of renal cell carcinomas.The man was referred to us because of jaundice.Computed tomography (CT) scan of the abdomen showed irregular masses in the right kidney. Magnetic resonance imaging (MRI) revealed dilatation of the bile duct. The patient underwentright nephrectomy and pancreatoduodenectomy. Postoperative histopathologic examination revealedclear cell carcinoma in both the renal and ampullary lesions. After a 5-year follow-up ,the patient was alive with no evidence of recurrent disease.

BRIEF COMMUNICATION


Abstract

Purpose: Tyrosine kinase inhibitors (TKI) play a pivotal role in the modern treatment of patients with metastatic renal cell carcinoma (mRCC). Depending on the course and the response, the targeted therapy may last for years. Thus the question arises, if a successful treatment leading to a complete response or at least a stable disease after a partial remission, may be discontinued.

Materials and Methods: Here we present 3 patients with mRCC treated with sunitinib for at least one year, resulting in a partial response, followed by a stable disease for several years. In these patients, the treatment was interrupted for different medical reasons.

Results: After a period of 20, 33 and 34 months, respectively, the metastases of the renal cell cancer showed no signs of progression, neither clinically nor in computed tomography scans, but the side effects of TKI or the medical problem leading to treatment interruption resolved in all patients within a few weeks.

Conclusion: The discontinuation of the treatment for mRCC with TKI seems to be possible, even in those patients with a partial response only, but no complete remission has been achieved before.

PICTORIAL UROLOGY


EDITORIAL


UNCLASSIFIED


Changes in Bacterial Species and Antibiotic Sensitivity in Intensive Care Unit: Acquired Urinary Tract Infection during 10 Years Interval (2001-2011 )

byung il Yoon, Hyo Sin Kim, Sung Dae Kim, Kang Jun Cho, Sun Wook Kim, U-Syn Ha, Yong-Hyun Cho, Dong Wan Sohn

Urology Journal, Vol. 11 No. 2 (2014), 7 May 2014 , Page 1478-1484
https://doi.org/10.22037/uj.v11i2.1629

Abstract

Purpose: Patients in the intensive care unit (ICU) are usually at greater risk for acquiring urinary tract infections (UTIs). Few studies have focused on UTIs specifically acquired within the ICU. We studied the change in bacterial species causing UTIs in ICU admitted patients in 2001 and 2011.

Materials and Methods: We reviewed the medical records of a total of 2,890 ICU patients who had undergone urine culture in 2001 and 2011 at the Yeouido and Bucheon St. Mary's hospitals. Changes in causative organisms and their antibiotic sensitivity between the years 2001 and 2011 were analyzed.

Results: Escherichia coli (E. coli) was the most common organism in ICU-acquired UTIs in 2001 and 2011 in our study. The pathogens that significantly increased in 2011 compared to 2001 were Pseudomonas, and Klebsiella species (P < .05). In 2011gram-negative organisms showed relatively higher sensitivities to amikacin, imipenem, and tazocin (72.0%, 77.5% and 76.1%, respectively), whereas they showed relatively lower sensitivities to third-generation cephalosporins and ciprofloxacin (55.2% and 45.0%, respectively). In 2011gram-positive organisms showed high sensitivities to teicoplanin and vancomycin (91.1% and 87.9%, respectively), whereas they showed low sensitivities to ampicillin and ciprofloxacin (24.1% and 25.5%, respectively). The antibiotic resistance rate of Pseudomonas species was nearly doubles that of E. coli.

Conclusion: Infections caused by Pseudomonas and Klebsiella species were found to have increased significantly in 2011. Pseudomonas species had a significantly lower susceptibility to antibiotic sensitivity than other identified organisms.

 

Adrenal Ganglioneuromas: Experience from a Retrospective Study in a Chinese Population

Liping Li, Jialiang Shao, Jianjun Gu, Xiang Wang, Lianxi Qu

Urology Journal, Vol. 11 No. 2 (2014), 7 May 2014 , Page 1485-1490
https://doi.org/10.22037/uj.v11i2.1753

Abstract

Purpose: Ganglioneuromas (GNs) are benign neoplasms of combined neural crest, schwannian,and connective tissue origin, occurring rarely in the adrenal glands. The present study isto share our experience regarding diagnostic and therapeutic management of these tumors.

 

Materials and Methods: Adrenal GNs of 15 patients were found incidentally with ultrasonographyand were evaluated subsequently with computed tomography (CT) scan. Clinical dataas well as follow-up data were collected retrospectively. All the patients received operativeresection.

 

Results: The mean age of the patients was 38.4 years (range, 25-52 years; male to female ratio,2:1). Of study subjects 11 patients had unilateral GN on the right side, and the remaining4 on the left side. All but 1 patient were asymptomatic. No hormonal secretion was apparent.Mean size of the tumors in CT scan was 6.27 cm (range, 2.5-14 cm), while 10 were largerthan 5 cm. Eight patients underwent open adrenalectomy and the remaining 7 underwentlaparoscopic anterior adrenalectomy. Histologically, all 15 neoplasms were completely differentiated,mature GN. We had no mortality or significant morbidity. Mean duration of hospitalization was 5.5 days (range, 3-7 days). There was no recurrence, during a mean followupof 5.4 years (range, 1-10 years).

 

Conclusion: Pre-operative diagnosis of adrenal GNs remains difficult merely according tophysical examination. Therefore, we recommend complete operative resection once malignancycannot be excluded by pre-operative analyses. Laparoscopic adrenalectomy is a reasonableoption, at least for tumors ≤ 5 cm.

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