Dear Colleagues,

The close of the year is approaching and this is a time both to summarize what has been achieved during 2011 and to look forward. With this December issue of UroToday International Journal, we have completed another successful year for the journal, with the publication of many interesting articles, covering the whole field of urology. Thanks are due to our authors, reviewers, and readers—with your continued contributions we can look forward to a productive 2012 with confidence. Since we foster free manuscript submission, peer review, and publication for all of our authors, we anticipate an ever-growing breadth of the latest findings that we look forward to sharing with our readers in the year ahead.

Among the many interesting contributions, Saito et al. present information from phase II placebo-controlled clinical trials on mirabegron, a novel selective β3-adrenoceptor agonist, still in development for the treatment of OAB. Mirabegron represents a welcome addition to antimuscarinic drugs for the treatment of OAB, showing a good efficacy and a side effect profile different from those of the antimuscarinics.

Gittelman et al. compare the impact of degarelix and leuprolide on the quality of life for male cancer patients. They not only present the similarities between the two drugs, but the significant benefits of degarelix in patients with metastases.

Khalil et al. discuss scrotal scintigraphy and quantitative imaging, demonstrating the beneficial approach for patients with acute scrotal pain, and the emergence of quantitative imaging as an accurate diagnostic tool.

A bladder-preserving treatment, Bacillus Calmette-Guérin (BCG) therapy has confirmed value in reducing tumor recurrence, but when does it fail? Kamel and associates define BCG failure based on their summary of major urological guidelines and standards.

Although there is much interest in urinary incontinence, in Spain, studies are lacking. Martinez-Agulló et al. present a study of urinary incontinence, overactive bladder, and enuresis of the Spanish population in order to shed some light on the affected population.

A study by Shelbaia et al. outlines the successful management of ureteric calculi using Stone Cone, assessing its efficacy and safety during pneumatic lithotripsy.

Essam et al. validate improved Snodgrass repair results using a double-layer vascularized dartos flap. Coupled with Snodgrass, a urethral dartos flap reduces fistula complication, and provides excellent urine flow and esthetic results.

Sallami et al. outline the benefits of uteroscopic lithotripsy with local anesthesia, which provides a more rapid procedure that neither increases the risk of complication nor compromises the procedure results.

We also present a series of case reports that include topics such as bladder melanosis, acute scrotum, and sub-urethral diverticulum.

It has been an exciting and worthwhile year, and we are confident that where UIJ flourishes, advances are sure to follow. Thank you for your continued support.

Kind Regards,

Karl-Erik Andersson

 ABSTRACT

Aim of the work: To assess the efficacy and safety of Stone Cone during ureteroscopic pneumatic lithotripsy of proximal ureteric calculi.

Setting and design: From June 2009 to June 2010, 119 patients were included and underwent ureteroscopic management of proximal ureteric calculi with the help of Stone Cone and pneumatic disintegration.

Material and method: Our patients were divided into 2 groups. Ureteroscopic management of proximal ureteric calculi with pneumatic lithotripsy was done in group 1, and ureteroscopic management of upper ureteric stones with the help of Stone Cone and pneumatic lithotripsy was done in group 2.

Results: Patients were divided into 2 groups. Group 1 included 62 patients that underwent standard ureteroscopic pneumatic lithotripsy without Stone Cone. Group 2 included 57 patients that underwent pneumatic lithotripsy using Stone Cone as ureteral occlusion during ureteroscopy. The success rate was 87% in group 1 and 94.7% in group 2. The complication rate ranged from 3.5 to 8%. There were 4 cases of haematuria (6.4%) and one case of ureteral perforation (1.6%) in group 1. In group 2, 2 cases (3.5%) of haematuria occurred. Operative time was highly significant in group 2 and not in group 1; it was 20 to 35 minutes in group 2 versus 30 to 50 minutes in group 1.

Conclusion: Stone Cone is an instrument used during ureteroscopi lithotripsy of proximal ureteric calculi. It can be considered a very effective instrument in blocking the upward migration of ureteric calculi, enabling its safe removal.

Ahmed Shelbaia, Sherif Abd ELRahman, Ali Hussein

Submitted June 15, 2011 - Accepted for Publication Sept 12, 2011

KEYWORDS: Proximal ureteric calculi; Stone Cone; Pneumatic lithotripsy; Ureteroscopy

CORRESPONDENCE: Ahmed Shelbaia, Urology Department, Cairo University Hospital, Borg El Atbaa, Faisal Street, Cairo, Egypt (ahmedshelbaia2007@hotmail)

CITATION: Urotoday Int J. 2011 Dec;4(6):art68. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.01 

ABSTRACT

Renal arteriovenous malformation (rAVM) is a rare benign cause of hematuria. We present a case of a 40-year-old female with hematuria and renal colic secondary to a rAVM, as well as a review of the literature. rAVM has a female-to-male ratio of 3 to 1 and can be categorized as either congenital or acquired. Congenital rAVM constitutes 25 to 30% of all rAVM. Acquired rAVM could be categorised as iatrogenic, traumatic, inflammatory, and malignant. The diagnostic and therapeutic option of choice is renal angiography and embolisation. rAVM embolisation allows the maximal preservation of nephrons. Post-rAVM embolisation, 40 to 61% of patients are at risk of post-embolisation syndrome. Total or partial nephrectomy is reserved for recalcitrant rAVMs. Additionally, it is the treatment of choice in centers without angiography.

Yeng Kwang Tay, Dan Spernat, Patrick J Page, Caroline Dowling

Submitted: August 11, 2011 - Accepted for Publication: September 23, 2011

KEYWORDS: Renal arteriovenous malformation; Renal AVM; Hematuria; Ureteric obstruction

CORRESPONDENCE: Yeng Kwang Tay, MD, Department of Urology, Monash Medical Centre, East Bentleigh, 3165, Victoria, Australia. ()

CITATION: UroToday Int J. 2011 Dec;4(6):art 79. http://dx.doi.org/10.3834/uij. 1944-5784.2011.12.12

ABSTRACT

Bladder melanosis is a very rare clinical entity that has reportedly been associated with a wide variety of urinary symptoms. Reports also exist of an association with bladder malignancy. We describe a case with a 58-year-old man under urological investigation following 2 urinary tract infections. Several flat, blackened areas within the bladder were observed at cystoscopy, which histology revealed was due to increased melanin deposits within bladder urothelial cells; i.e., melanosis. This finding is of uncertain significance, and regular cystoscopic follow-up was thought to be prudent. At 3 months, appearances were unchanged; however, at 6 months, the bladder’s appearance was entirely normal with resolved changes of melanosis.

KEYWORDS: Bladder melanosis; Melanosis vesica

CORRESPONDENCE: Sara Lightowlers, MB, BChir, West Suffolk Hospital, Bury St. Edmunds, Suffolk, United Kingdom, IP33 2QZ ().

CITATION: UroToday Int J. 2011 Dec;4(6):art 73. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.06

ABSTRACT

Introduction: Despite the growing interest on urinary incontinence (UI), nocturnal enuresis (NE), and overactive bladder (OAB), in Spain, there are no epidemiologic studies on the prevalence of these health problems in the different affected groups of the general population. The objective of the present study was to observe the prevalence of the signs and symptoms of UI, OAB, and NE in specific groups of the general population.

Methods: This is an epidemiologic, observational, multicenter, and national study. Data were collected by means of personal interviews in 5 representative areas from Spain and in 4 groups of the population: 1) workingwomen (25 to 64 years old), 2) workingmen (50 to 64 years old), 3) children attending primary school (6 to 11 years old), and 4) elderly, institutionalized subjects (over 65 years old) with no mental impairment. The Interview included 2 parts: 1) sociodemographic variables and clinical history, and 2) data about OAB and UI symptoms. The interview addressing children included sociodemographic variables and questions about liquid intake and urine control.

Results: The percentage of interview answers in the different groups varied between 79.7% and 98%. The prevalence of isolated OAB and UI in workingwomen (N = 3090) was 2.69% and 4.01%, respectively; in men (N = 1071) prevalence was 3.55% and 0.56%; in the elderly (N = 996) prevalence was 9.14% and 15.16%. In total, 9.94% (95% confidence interval [CI] = 8.9 to 11.04) of the women under study suffer 1 or both health problems. This percentage was 5.14% (95% CI = 3.89 to 6.63) in men and 53.71% (95% CI = 50.56 to 56.85) in the elderly. The prevalence of nocturnal enuresis in children (N = 1279) was 7.82% (95% CI = 6.62 to 9.17).

Conclusions: The prevalence of OAB and/or UI in Spain is nearly 10% of women between 25 and 64 years old, is around 5% in men between 50 and 64 years old, and it is over 50% in persons over 65 years. The prevalence of nocturnal enuresis in children between 6 and 11 years is around 8%.

Eduardo Martínez-Agulló, Luis Gómez-Pérez, Miguel Ramírez-Backhaus, Pablo Rebollo, Maite Pérez, José Chaves, The EPICC Cooperative Study Group

Submitted July 16, 2011 - Accepted for Publication September 2, 2011

KEYWORDS: Epidemiology; Overactive bladder; Urinary incontinence; General population; Prevalence

CORRESPONDENCE: Pablo Rebollo, MD, BAP Health Outcomes Research, Azcárraga, 33010 Oviedo, Spain ().

CITATION: Urotoday Int J. 2011 Dec;4(6):art78. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.11

ABSTRACT

Purpose: To evaluate the importance of using a double-layer vascularized dartos flap for preventing fistula in Snodgrass hypospadias repair.

Patients and Methods: This study was carried out in the departments of plastic surgery and urology at Al-Azhar University hospitals. The study included 40 patients with primary hypospadias, aged 2 to 22 years (mean age 8.6), and operated from September 2008 to August 2010. Of the 40 patients, 32 had distal hypospadias and 8 had mid-shaft hypospadias. The standard technique of tubularized incised plate (TIP) urethroplasty (Snodgrass procedure) was done with additional double-layer dartos fascia flap coverage. The mean follow-up period was 4.5 months (range 3 to 12 months).

Results: Successful repair of the 40 cases was achieved. Urine flow results were excellent with a normal-looking, slit-like meatus. Two patients (5%) had meatal stenosis at the early postoperative period, which was corrected by urethral dilatation of the external meatus at an interval of up to 2 months, whereas urethrocutaneous fistula developed in 1 patient (2.5%).

Conclusion: A urethral covering dartos flap transposed ventrally with Snodgrass procedure showed a reduced incidence of fistula complication in our hands after hypospadias repair.

Taman Essam, Ismail Hassan, Salah Elwagdy

Submitted: July 7, 2011

Accepted for Publication: September 2, 2011

KEYWORDS: Hypospadias; Snodgrass procedure; Double-layer vascularized dartos flap

CORRESPONDENCE: Salah Elwagdy, MD, Department of Uro-radiology, Azhar University, Cairo, Egypt ().

CITATION: UroToday Int J. 2011 Dec;4(6):art 69. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.02

ABSTRACT

  

ABSTRACT

Objective: We evaluated the feasibility and effectiveness of ureteroscopic lithotripsy for ureteral stones under local anesthesia without any sedation.

Methods: Prospectively, ureteroscopic lithotripsy under local anesthesia was performed in 100 patients (45 males and 55 females). A rigid endoscope (8.5 to 11.5 Fr) was used in all cases. Local anesthesia consists of lidocaine jelly in the bladder associated with a penile nerve block in males only, and without any intravenous analgesia. Ureteroscopy was done for stone fragmentation with a double-J catheter insertion in 13 patients. We compared the pain perception during ureteroscopy to that of cystoscopy performed during the same procedure, using a visual-analogue pain scale recorded by the patient.

Results: The overall success rate was 82%. The success rates of the upper, mid, and lower ureteral calculi were 71.4%, 72.7%, and 89%, respectively. The success rate was 100% in calculi less than 10 mm, and 80.3% in those more than 10 mm. Postoperatively, 1 patient developed pyelonephritis. We didn’t report any cases of ureteral perforation. The mean pain scale score was lower during the ureteroscopy (3.61 [2.2 to 8.5]) than in cystoscopy (4.52 [1.5 to 8] [p <0.001]). Almost all patients tolerated pain well during the procedure. The procedure was interrupted in only 5 patients and was performed later under spinal anesthesia. Postoperative pain was also tolerable in most patients, and only 8 patients required additional analgesics after the procedure.

Conclusion: Our findings suggest that most of the patients could tolerate the pain during a rigid ureteroscopic lithotripsy under local anesthesia. This procedure does not increase the risk of complications or compromises the results of treatment. Thus, it may be recommended in carefully selected and informed patients and performed with experienced hands.

Ahmed Shelbaia, Sherif Abd ELRahman, Ali Hussein

Submitted June 15, 2011 - Accepted for Publication Sept 12, 2011

KEYWORDS: Ureteroscopy; Local anesthesia; Stone; Lithotripsy; Pain

CORRESPONDENCE: Satâa Sallami, Department of Urology, La Rabta Hospital, University of Tunis, El Manar, Tunis, Tunisia ().

CITATION: UroToday Int J. 2011 Dec;4(6):art 77. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.10

ABSTRACT

Penile strangulation caused by rings is a rare but challenging problem that a surgeon may come across. Such ringed objects may be placed by perverted men with underlying psychiatric disturbances, or for erotic and autoerotic stimulation and masturbation. Misbelief that a ring application increases and prolongs an erection may also be the cause for such activity. Incarceration of such objects causes distal oedema, ischemia, and at times, gangrene. These injuries have been divided into 5 grades, with surgery being used for advanced grades (grade IV and V). We came across 1 such case with incarceration of a metallic ball-bearing ring around the penis, which we retrieved while preserving the vascularity as well as all of the vital penile tissues, including skin.

Pramod K Sharma, Mukesh K Vijay, Ranjit K Das, Punit Tiwari, Amit Goel, Anup K Kundu Department of Urology, Institute of Post-Graduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata (West Bengal), India

Submitted June 28, 2011 - Accepted for Publication July 25, 2011

KEYWORDS: Penile strangulation injury; Metallic ring; Retrieval

CORRESPONDENCE: Pramod Kumar Sharma, Junior Doctor’s Hostel, IPGME&R and SSKM Hospital, AJC Bose Road, Kolkata (WB), India, 700020 ().

CITATION: UroToday Int J. 2011 Dec;4(6):art 75. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.08

 

ABSTRACT

Bladder cancer (BC) is the fifth most commonly diagnosed cancer in the nation. Radical cystectomy (RC) is the most effective treatment for locally advanced bladder cancer and is a formidable operation. The perioperative mortality in high-volume centers ranges from 0.7 to 5.6%. Thus, when faced with this diagnosis, there is a desire to pursue a bladder-preserving strategy and avoid RC. One treatment for HG Ta/T1, and carcinoma in situ (CIS) is intravesical bacillus Calmette-Guérin (BCG) therapy. Many studies have confirmed its value in reducing tumor recurrence following transurethral resection of bladder tumors (TURBT). After reviewing the various guidelines, we summarize our recommendations for defining BCG failure.

Mohamed H Kamel, Sarabeth L Bailey, John T Moore, Samy M Heshmat, Nabil K Bissada

Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas

Submitted: September 9, 2011 - Accepted for Publication: November 9, 2011

KEYWORDS: Bladder; Cancer; BCG; Guidelines

CORRESPONDENCE: Mohamed H Kamel, MD, Assistant Professor, Urologic Oncologist, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, Arkansas, 72205 ().

CITATION: UroToday Int J. 2011 Dec;4(6):art 82. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.15