Dear Colleagues,

We at UroToday International Journal have seen the course of another year come and go, and with it, many changes have transpired. We have seen updates to our website that have increased your ability to view our articles, submit to our journal, and have an all-around joyful experience.

As always, with the New Year, we hope to increase our readership and global community so to better provide articles of importance, as well as interest. And, with our new archiving opportunities with Portico, we know the information offered through UIJ is here to stay.

In this issue, a review from Leao and team discusses the relationship between urinary tract symptoms and renal damage, bearing in mind the epidemiology and pathophysiology of benign prostatic hyperplasia (BPH) and potential associations. They emphasize that renal damage secondary to BPH is a preventable disease.

Three studies came to us from Satáa et al.: In one, they conducted a study to evaluate the correlation between Gleason scores obtained on prostate biopsies and radical prostatectomy. They determine that the accuracy of Gleason scores determined by transrectal needle biopsy in patients with prostate cancer seems unreliable.

In the second, they examined the various modalities employed in the diagnosis and treatment of patients with Crohn disease complicated by fistulae, and they discovered that treatment, based on resection of the diseased bowel and extirpation of the fistula, could be accomplished with minimal morbidity and mortality.

In the third, they report experiences and results of balloon antegrade dilatations for benign ureteroenteric anastomotic strictures after total cystectomy and urinary diversion by ileal conduit, concluding that it is a minimally invasive and effective treatment option.

Singh et al. present their experience performing percutaneous nephrolithotomy in solitary kidneys, and they assess the postoperative complications and importance of nadir serum creatinine as a marker of long-term renal function. They find that nadir serum creatinine remains the most important predictor of long-term renal function.

We also present a series of case studies on several topics, including migratory intrauterine contraceptive devices, the use of guide wires, and horseshoe kidney malignancies, among others.

We are always grateful to our loyal readership and our ever-increasing list of authors who have contributed to UIJ after all these years. Without your dedication, we would not be where we are today. Thank you for your support. 

Warm regards, 

Karl-Erik Andersson

ABSTRACT

Horseshoe kidney is the most common fusion anomaly. Patients with horseshoe kidney typically present with symptoms related to infection, stone formation, and hydronephrosis. Rarely, patients may present with malignancy of horseshoe kidney, and most of them arise from isthmus. We are presenting a case series of 2 cases of renal cell carcinoma arising from horseshoe kidney.

Navin Ram, Bharat Behera, Sudheer Rathi, Sameer Trivedi, Uday Shankar Dwivedi

Submitted September 6, 2012 - Accepted for Publication November 8, 2012

KEYWORDS: Clear-cell carcinoma, fusion anomaly, horseshoe kidney, papillary-cell carcinoma, renal cell carcinoma

CORRESPONDENCE: Sameer Trivedi, Associate Professor Mch, DNB, Department of Urology, Institute of Medical Sciences, Banaras Hindu University,  Varanasi, Uttar Pradesh, India, 221005 ()

CITATION: UroToday Int J. 2012 December;5(6):art 70. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.15

ABSTRACT

Congenital scrotal disorders, including penoscrotal transposition, bifid scrotum, ectopic scrotum, and accessory scrotum are unusual anomalies. We present a case of ectopic scrotum with renal agenesis.

Atul Khandelwal, Mahendra Singh, Rajesh Tiwari, Vijoy Kumar, Sanjay Kumar Gupta, Rohit Upadhyay

Submitted October 11, 2012 - Accepted for Publication November 8, 2012

KEYWORDS: Ectopic, scrotum, suprainguinal

CORRESPONDENCE: Atul Khandelwal, MBBS, MS, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India ()

CITATION: UroToday Int J. 2012 December;5(6):art 68. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.13

ABSTRACT

Background: Ganglioneuromas are rare benign tumors arising from the autonomic nervous system, and they are composed of well-differentiated Schwann and ganglion cells.

Case Report: An 11-year-old girl presented with colicky right loin pain that had occurred on and off for the past 1 year. On evaluation, she was found to have a retroperitoneal mass of 6 cm x 4 cm just below the right renal hilum. Her laboratory parameters were normal. The mass was hormonally silent. Surgery was performed and the mass was resected completely. The mass was closely opposed to the inferior vena cava with tributaries to it. Fibrous attachments were also noted on the spine, which were freed. Her histopathology and immunohistochemistry confirmed the mass to be a ganglioneuroma. Her neuron-specific enolase marker was positive. She was symptom free at 3 months post surgery, and her imaging was normal.

Conclusion: Ganglioneuromas have an excellent prognosis. This case is presented for its rarity and unique presentation as right colicky pain.

Paul Vincent, Udaya Kumar

Submitted October 2, 2012 - Accepted for Publication November 8, 2012

KEYWORDS: Ganglioneuroma, retroperitoneal mass, retroperitoneal ganglioneuroma, ureteric colic

CORRESPONDENCE: Paul Vincent, MBBS, DNB (General Surgery), DNB (Urology), MIMS Hospital, Kottakkal, Kottakkal, Kerala, India

CITATION: UroToday Int J. 2012 December;5(6):art 71. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.16

 

ABSTRACT

The widespread use of imaging diagnostic tools has led to the detection of a greatly increased number of incidental renal tumors. Many of these tumors are benign and can be treated with nephron sparing surgery or radical nephrectomy. However, the clinical and even imagiological aspects of these histopathologically benign tumors are too scarce and nonpathognomonic, making their diagnosis rather difficult. Metanephric adenoma (MA) of the kidney, a rare and benign neoplasm, is an example of an entity usually difficult to distinguish from malignant neoplasms. We report one clinical case and review of this clinical entity emphasizing the need for better and more accurate diagnostic means for benign renal masses.

R. R. Leão, B. J. Pereira, R. Borges, V. Grenha, H. Coelho

Submitted August 13, 2012 - Accepted for Publication October 25, 2012

KEYWORDS: Echinococcus, cystic hydatid disease, retroperitoneum, secondary hypertension

CORRESPONDENCE: Ricardo Romão Nazário Leão, Department of Urology and Renal Transplantation, University Hospital Center EPE General Hospital, Quinta dos Vales, Sao Martinho do Bispo, 3041 Coimbra, Portugal ()

CITATION:UroToday Int J. 2012 December;5(6):art 67. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.12

ABSTRACT

Spontaneous migration of foreign bodies into the bladder is rare. Patients present late with urinary symptoms. Here we report two such cases of delayed tranvesical migration: a large bullet and an intrauterine device (Copper-T), with their successful retrieval by endoscope and a minimally invasive procedure.

Tapas Kumar Majhi, Supriya Basu, Anowar Ali Mallick, Dilip Kumar Pal

Submitted October 11, 2012 - Accepted for Publication November 8, 2012

KEYWORDS: Foreign bodies, intravesical, migration, IUD

CORRESPONDENCE: Dilip Kumar Pal, Vinayak Garden, Flat No. A/3D 41B, Simla Road, Kolkata, 700006, India ()

CITATION: UroToday Int J. 2012 December;5(6):art 69. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.14

ABSTRACT

The guide wire is a very useful medical device that helps make the cannulation of blood vessels or hollow structures safer. However, guide wires themselves can be a source of complication, such as with perforation and bleeding. Kinking of the guide wire is another complication that is less described. We postulate the sequence of events that precede kinking and discuss the ways to avoid them.

 A 60-year-old man underwent optical urethrotomy for a bulbar urethral stricture. A guide wire was passed into an existing suprapubic catheter (SPC) track to facilitate the passage of a flexible cystoscope. This was performed to examine the proximal extent of the urethral stricture. At the end of the procedure, there was unexpected resistance when withdrawing the guide wire from the bladder. Cystoscopic examination via the SPC track eased the guide wire out eventually. It was found that a kink in the guide wire had prevented its smooth retrieval. The cause of this complication was likely due to looping of the guide wire within the bladder. The loop then resulted in the guide wire getting kinked. In order to prevent kinking, one must avoid looping. Looping occurs when an excessive length of guide wire is forced into a confined space. Therefore, it is important to stop advancing the guide wire when resistance is felt. Another method to avert this problem is to first estimate the length of guide wire that would pass into the space without it curling back. Then pass the guide wire only up to the point where it is deemed adequate. By practicing such precautions, the chances of running into a complication, such as guide wire kinking, can be reduced significantly.

Guan Hee Tan, Hemanth Kumar Ramasamy, Kah Ann Git

Submitted July 26, 2012 - Accepted for Publication August 10, 2012

KEYWORDS: guide wire, complications, endourology

CORRESPONDENCE: Guan Hee Tan, MBBS, MRCS, MS, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia ()

CITATION: UroToday Int J. 2012 December;5(6):art 65. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.10

ABSTRACT

Hydatid disease is caused by the parasite Echinococcus granulosus. Humans are accidental intermediate hosts, and the parasite commonly affects the liver and the lungs. Primary retroperitoneal hydatid disease is extremely rare. We present a rare case of a primary retroperitoneal hydatid cyst with secondary hypertension treated through surgical means.

Bhavatej Enganti, Nookinaidu Chitekela, Anil Kumar Nallabothula, Vijaya Lakshmi, Srinivasan Subramanian

Submitted September 10, 2012 - Accepted for Publication October 25, 2012

KEYWORDS: Echinococcus, cystic hydatid disease, retroperitoneum, secondary hypertension

CORRESPONDENCE: Bhavatej Enganti, Department of Urology, Sri Venkateshwara Institute of Medical Sciences, Tirupati, 517507, India ()

CITATION: UroToday Int J. 2012 December;5(6):art 64. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.09

ABSTRACT

Intrauterine contraceptive devices (IUCD) have been widely accepted contraceptive methods among women for many years due to their efficacy, longevity, reversibility, and safety. There is a possibility of uterine perforation and migration, but an intravesical perforation is extremely rare. Only a few case reports depicting incrustation of such foreign bodies in the bladder, mostly incomplete and fixed to the perforated wall, are available in the literature. We are here reporting a T-shaped floating stone in the bladder in a female due to complete incrustation of a migrated IUCD in the bladder, which she had received seven years before presentation.

Vinod Priyadarshi, Mahendra Singh, Vijoy Kumar, Rajesh Tiwari, Sanjay Kumar Gupta, Nidhi Sehgal

Submitted May 4, 2012 - Accepted for Publication August 30, 2012

KEYWORDS: Intrauterine, contraceptive, bladder, stone, incrustation

CORRESPONDENCE: Vinod Priyadarshi, MBBS, MS, Senior Resident, Indira Gandhi Institute of Medical Sciences, Patna, Bihar India ()

CITATION: UroToday Int J. 2012 December;5(6):art 62. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.07

ABSTRACT

Seminal vesicle cysts combined with ipsilateral renal agenesis are a rare urological anomaly. We present a 24-year-old single man who suffered from difficulty urinating and irritative voiding symptoms for 4 years. The symptoms worsened in the last 6 months. A physical examination revealed right cryptorchidism with a pelvic mass. Digital rectal examination revealed a palpable large soft mass behind the prostate.

Diagnostic imaging (ultrasound, IV urography, computed tomography scan, and magnetic resonance imaging) showed a right seminal vesicle cyst. The ipsilateral kidney and ureter were absent. Open surgery cystectomy was performed, improving urinary symptoms.

Sallami Satáa, Sami Ben Rhouma, Haifa Nfoussi, Hanene Trabelsi, Nidhameddine Kchir, Ali Horchani

Submitted August 8, 2012 - Accepted for Publication September 7, 2012

KEYWORDS: Renal agenesis, seminal vesicle cyst, cryptorchidism

CORRESPONDENCE: Sallami Satáa, MD, La Rabta Hospital-University, Tunis, Tunis, Tunisia ()

CITATION: UroToday Int J. 2012 December;5(6):art 61. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.06

ABSTRACT

Granulosa cell tumors (GCT) of the ovary are rare tumors that represent 2% of all ovarian tumors. However, cases involving the retroperitoneum are exceedingly rare. We describe a case of primary retroperitoneal granulosa cell tumor, which, to our knowledge, has been previously reported in few cases.

A 64-year-old female presented with large intra-abdominal mass and vague abdominal pain. She had a history of hysterectomy and bilateral salpingo-oopherectomy 22 years ago for large uterine leiomyoma. She underwent exploratory laparotomy that revealed a retroperitoneal mass measuring 11 cm x 13 cm in size, with multiple cyst formation and areas of necrosis and hemorrhage. The gross, histologic, and inhibin-positive immunostaining findings of the retroperitoneal mass were characteristic of adult-type GCT. Excluding any previous history of primary ovarian GCT with this patient, a de-novo retroperitoneal diagnosis was carried out.

Submitted May 7, 2012 - Accepted for Publication August 22, 2012

KEYWORDS: Granulosa cell tumors, retroperitoneum, inhibin

CORRESPONDENCE: Yousef Al-Shraideh, MD, King Fahad Medical City, Riyadh, Riyadh, Saudi Arabia

CITATION: UroToday Int J. 2012 December;5(6):art 61. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.11

LETTER TO THE EDITOR

Dear Editor,

After percutaneous nephrolithotomy (PCNL), a nephrostomy tube has been routinely placed to ensure hemostasis, provide drainage, and maintain access to the collecting system. This causes pain after surgery and persistent urine leaks after its removal. Recently, efforts have been expended to either reduce the size of the nephrostomy tube or eliminate it altogether. Hence, tubeless percutaneous nephrolithotomy is now increasingly advocated for the treatment of uncomplicated, large kidney stones [1,2,3]. After surgery, closure of the skin without sealing the nephrostomy tract postoperatively risks bleeding and urinary extravasation [4]. Hemostatic agents have therefore been advocated to seal the PCNL tract. Herein we describe a method to facilitate the accurate application of a Floseal Matrix from the renal parenchyma to skin, and we report the outcomes of tubeless PCNL.

Pradeep Durai, Fiona Wu Mei Wen, David Terrence Consigliere, Ho Yee Tiong

Submitted October 16, 2012 - Accepted for Publication October 25, 2012

KEYWORDS: Tubeless percutaneous nephrolithotomy, PCNL, Floseal, Floseal Matrix

CORRESPONDENCE: Ho Yee Tiong, MRCS (London), MMed (Surgery), FAMS (Urology), Consultant, Department of Urology, National University Hospital, Singapore ()

CITATION: UroToday Int J. 2012 December;5(6):art 63. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.08

ABSTRACT

Background: The management of ureterointestinal stricture in patients who have undergone urinary diversion can be challenging. Endourological techniques have been increasingly used in recent years for such strictures.

Objectives: We report our experience and evaluate our results on balloon antegrade dilatations for benign ureteroenteric anastomotic strictures after total cystectomy and urinary diversion by ileal conduit.

Patients and Methods: Between December 1990 and May 2009, 8 balloon dilatations were performed on 7 patients with a mean age of 56.6 years (range: 50 to 72) to treat ureterointestinal strictures. Strictures were dilated percutaneously via the antegrade approach under fluoroscopic control. A ureteral multi-hole catheter was left for 6 to 8 weeks. Success was defined as radiological resolution of obstruction and the ability to recover normal activity in the absence of flank pain, infection, or the need for ureteral stents or nephrostomy tubes.

Results: The development of strictures occurred a mean of 4.5 months after urinary diversion. Eight renal units were treated (5 left, 3 right), including 1 bilateral procedure. There were 6 complete and 2 partial strictures. The operative time did not exceed 45 minutes. No major complications were encountered during or after these procedures. The overall success rate was 43%. Three patients required open reimplantation. Six of 7 patients showed satisfactory outcomes and 1 patient was lost to follow-up.

Conclusions: Percutaneous balloon dilatation of benign ureteroenteric anastomotic strictures, after radical cystectomy and urinal diversion by ileal conduit, is a minimally invasive and effective treatment option providing durable results. Based on these results, we believe that the procedure should be considered as a first-line treatment, as surgical reimplantation is reserved for failure. The selection of patients with the most favorable prognostic factors leads to excellent results.

Sallami Satáa, Olfa Zrayer, Habiba Mizouni, Sami Ben Rhouma, Mohamed Hmidi, Mourad Gargaouri, Maher Chtourou

Submitted June 18, 2012 - Accepted for Publication July 23, 2012

KEYWORDS: Urinary diversion, ileal conduit, ureteroenteric anastomosis, percutaneous dilatation, surgical anastomosis

CORRESPONDENCE: Sallami Satáa, MD, La Rabta Hospital-University, Tunis, Tunis, Tunisia ()

CITATION: UroToday Int J. 2012 December;5(6):art 59. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.04

ABSTRACT

Aim: To present our experience of performing percutaneous nephrolithotomy (PNL) in solitary kidneys with or without renal failure, and assessing the postoperative complications and importance of nadir serum creatinine as marker of long-term renal function.

Materials and Methods: In a retrospective study, the records of 28 patients with solitary functioning kidney (N = 12) or congenital solitary kidney (N = 16) underwent PNL between January 2004 to July 2012 were analyzed. Mild renal failure (creatinine: 1.6 to 3.0 mg %) was present in 4 patients and moderate renal failure (creatinine: 3.1 to 6.0 mg %) was present in 8 patients. Internal ureteral stenting was performed in renal failure cases, except in 4 patients who required percutaneous nephrostomy and had moderate renal failure with infected hydronephrosis. Diabetes mellitus and/or hypertension were present in 9 patients. Complete stone clearance was achieved in all except 2 cases, which had clinically significant residue (CSR) of 8 mm. Both these required shock-wave lithotripsy (SWL) and they were stone free at 4 weeks. The patients were followed up with serum creatinine and a renal ultrasound.

Results: Gross hematuria requiring blood transfusion was observed in 4 patients. All these patients initially presented with moderate renal failure, infected hydronephrosis, diabetes mellitus, and hypertension. The median follow-up was 42.5 months. The nadir serum creatinine followed internal stenting or nephrostomy if it remained above the baseline; it failed to touch the normal level following PNL.

Conclusion: PNL in solitary functioning or congenitally solitary kidneys is a safe and effective procedure. The bleeding is the commonest complication, and it can be managed conservatively. The nadir serum creatinine remains the most important predictor of long-term renal function.

Vishwajeet Singh, Rahul Janak Sinha, Manoj Kumar, Dheeraj Kumar Gupta, Deeapak Nagathan, Arvind Gupta

Submitted August 2, 2012 - Accepted for Publication October 3, 2012

 KEYWORDS: Percutaneous nephrolithotomy, solitary kidney, predictor of renal function

CORRESPONDENCE: Vishwajeet Singh, MS, MCh (Urology), Chhatrapati Shahuji Maharaj Medical University (Formerly KGMC), Lucknow, Uttar Pradesh, India ()

CITATION: UroToday Int J. 2012 December;5(6):art 60. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.05

ABSTRACT

Background: Crohn disease is a chronic inflammatory disease of the bowel that may affect the urinary system.

Objective: The authors review their experience, evaluating the incidence, and examining the various modalities employed in the diagnosis and treatment of patients with Crohn disease complicated by fistulae.

Methods: Of 541 patients with confirmed Crohn disease treated and followed in the Department of Gastroenterology in La Rabta University-Hospital in Tunisia between 1995 and 2010, 7 patients (1.3%) were found to have enterovesical fistulae.

Results: A fistula was diagnosed preoperatively in 6 patients. Six patients underwent resection of the diseased intestinal segment with bladder repair, and a temporary stoma in 1 case.

Conclusion: Enterovesical fistulae complicating Crohn disease is often clinically suspected preoperatively. Treatment, based on resection of the diseased bowel and extirpation of the fistula, can be accomplished with minimal morbidity and mortality.

Sallami Satáa, Nadia Ben Mustapha, Houda Boussorra, Meriam Serghini, Lamia Kallel, Jalel Boubaker, Monia Fekih, Azza Filali

Submitted June 14, 2012 - Accepted for Publication July 31, 2012

KEYWORDS: Enterovesical fistula, Crohn disease, bladder, inflammation

CORRESPONDENCE: Sallami Satáa, MD, La Rabta Hospital-University, Tunis, Tunis, Tunisia ()

CITATION: UroToday Int J. 2012 December;5(6):art 58. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.03

ABSTRACT

Summary: The Gleason score obtained on prostatic biopsies is a key parameter in the management of localized prostate cancer.

Objectives: We conducted this study to evaluate the correlation between Gleason scores (GS) obtained on prostate biopsies and radical prostatectomy to establish the accuracy of biopsy grading in the prediction of final grades.

Materials and Methods: Forty patients with localized prostate cancer diagnosed between 2000 and 2010, and treated with radical prostatectomy, were included in this study. All patients underwent transrectal needle biopsies (TRNB) with at least 12 cores. Gleason scores on biopsies and radical prostatectomy specimens were determined and the concordance between the 2 scores was then evaluated. Histological grading using the conventional Gleason grading system (3 groups) and the modified Gleason grading system (5 groups) was also performed. The correlation between grades obtained on biopsies and radical prostatectomy specimens was also evaluated.

Results: The mean age of patients was 61.1 years, with a mean PSA value of 10 ng/ml. In 32.5% of cases, the biopsy’s Gleason score correlated with the one obtained on radical prostatectomy. Using the conventional Gleason grading system, the correlation highly improved, with 62.5% of patients remaining in the same group after radical prostatectomy. However, using modified Gleason grading, the correlation was slightly improved and estimated at 37%.

Conclusion: In this study we have noticed that the accuracy of Gleason scores determined by transrectal needle biopsy in patients with prostate cancer seems unreliable. The classification of patients into 3 distinct groups (well, moderately, and poorly differentiated tumors) increases the concordance between the biopsy GS and the definitive GS, but the modified Gleason grading system seems to be more precise and better reflects the Gleason score.

Sallami Satáa, Ines Chelly, Amira Ben Salem, Hanen Chorfi, Haifa Nfoussi, Nidhameddine Kchir

Submitted June 11, 2012 - Accepted for Publication July 9, 2012

KEYWORDS: Prostate carcinoma, prostate biopsy, radical prostatectomy, pathology, Gleason score

CORRESPONDENCE: Sallami Satáa, MD, La Rabta Hospital-University, Tunis, Tunis, Tunisia ()

CITATION: UroToday Int J. 2012 December;5(6):art 57. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.02

ABSTRACT

Objectives: This article’s purpose is to review and discuss the relationship between urinary tract symptoms (LUTS) and renal damage, bearing in mind the epidemiology and pathophysiology of benign prostatic hyperplasia (BPH) and potential association.

Methods: Concerning the increasing number of elderly patients in urology clinics and the incidence of LUTS, the relationship between renal damage and LUTS should be an important issue. The authors searched literature in PubMed in order to correctly identify the pathophysiology and clinical correlation connecting these 2 entities.

Results: BPH is a common disease in adult men and its incidence is age related. Clinical BHP usually refers to the palpable enlargement of the prostate, which can be detected by physical or imaging examination, or by the presence of urinary symptoms loosely defined as LUTS. Despite the many possible causes of obstructive kidney disease, in studies of elderly patients with acute renal failure, the most common cause among all patients was BPH. Considering the high prevalence of BPH in older men with chronic kidney disease (CKD) it is invaluable to take into consideration the relationship between these 2 clinical entities.

Conclusion: Clinical and scientific findings show a worrisome and undiagnosed number of silent urinary obstruction symptoms that can lead to renal damage. This paper emphasizes that renal damage secondary to BPH, clinically manifested by lower urinary tract symptoms, is a preventable disease and must be under the care of physicians.

Ricardo Leao, Bruno Pereira, Hugo Coelho

Submitted August 6, 2012 - Accepted for Publication September 12, 2012

KEYWORDS: Benign prostate hyperplasia (BPH), chronic kidney disease (CKD), lower tract urinary symptoms (LUTS), renal disease

CORRESPONDENCE: Ricardo Leao, MD, Department of Urology and Renal Transplantation, University Hospital Center, Quinta dos Vales, Sao Martinho do Bispo, Coimbra, Portugal ()

CITATION: UroToday Int J. 2012 December;5(6):art 56. http://dx.doi.org/10.3834/uij.1944-5784.2012.12.01