Urology News Feeds
Bobby B. Najari, Leonard Introna, Darius A. Paduch, Improvements in Patient Reported Sexual Function after Microsurgical Varicocelectomy, Urology (2016), http://dx.doi.org/doi: 10.1016/j.urology.2016.04.044.
Portosystemic collaterals are common sequelae of portal hypertension. These often present as gastroesophageal varices. Ectopic varices can rarely be seen in duodenum, jejunum, rectum, and sites of surgical anastomoses. Bladder varices are extremely rare presenting with recurrent hematuria, with only a few reported cases. We report here management of an unusual case of hematuria managed with blood transfusion, intravenous terlipressin and endoscopic N-butyl cyanoacrylate glue injection.
A Novel Non-Invasive Ultrasound Vibro-Elastography Technique for Assessing Patients with Erectile Dysfunction and Peyronie's Disease
Erectile dysfunction (ED) is a common condition that is characterized by progressive corporal smooth muscle fibrosis. There is currently no widely accepted methods to characterize the extent and severity of penile fibrosis.
Objective: to present a novel surgical concept by using the transdouglas approach in order to perform a robotic-assisted simple prostatectomy (RASP) for high volume benign prostate hyperplasia (BPH). This transposition from oncological surgery enables to perform a better bladder neck sparing adenomectomy with good functional results.
Testicular tumours represent 1% of all malignancies in men and are the most common solid tumours occurring in males between the age of 20 and 40 with the majority being primary germ cell tumours (1,2). Metastases to the testes are rare (3), and excluding lymphoma and leukaemia, the commonest primary site is the prostate, followed by the lung (2,4,5). Patients with secondaries to the testes are most often over 50 years of age (3,6). We detail a rare case of a young man presenting with a testicular mass, proven to be metastasis from mucinous adenocarcinoma of the lung.
Longitudinal Rupture of Distal Corpus Cavernosum with Concomitant Urethral Injury: an Uncommon Result of a Common Mechanism
Fracture of the penis is a well-recognized yet relatively uncommon urologic event. Forceful, blunt trauma with lateral bending of the penis in an erect state typically results in a transverse rupture of the tunica albuginea of the corpus cavernosum. Longitudinal tears of the corpus cavernosum are by themselves considered infrequent. We present a rare case of a patient with longitudinal rupture of the distal corpus cavernosum with concomitant extension to the corpus spongiosum causing partial urethral disruption as a result of trauma during sexual intercourse.
A 14-month-old girl was evaluated for intermittent vaginal bleeding. Vaginoscopy revealed a friable tumor, and biopsy results confirmed a yolk sac tumor. AFP was elevated (1386 ng/mL) at diagnosis but quickly normalized with chemotherapy. Twelve months after diagnosis, she remains tumor-free. Although rare, malignant tumors of the vagina must be included in the differential diagnosis of prepubertal girls who present with vaginal bleeding. Primary yolk sac tumor of the vagina is seen in girls less than 3 years of age and is treated with chemotherapy with or without surgical excision.
Hermaphroditism is known as ovotesticular disorder of sex development. A 14-year-old boy was admitted with right acute scrotum. Exploration revealed tunica rupture and hematoma, with no viable tissue. After one month, he was admitted again with left hemiscrotal pain. Microscopic examination of the left gonad demonstrated foci of hemorrhagic cysts, primordial follicles, and regions of seminiferous tubules. We preserved testicular tissue and the ovarian part was extracted completely. Long-term follow-up with his hormonal profile are reported.
Treatment for benign prostate conditions, such as hyperplasia, can have many complications and an extensive recovery time. Learn more about it here.
The purpose of carcinoma staging is to aggregate patients with similar clinical outcomes. T2 substaging in the TNM system has been subject to much controversy with several changes with time.1 The 8th TNM edition has now eliminated pT2 substaging entirely (references 1 and 2 in article).
Since the adoption of the 1992 AJCC/UICC TNM prostate cancer staging system incorporating a 3-tier subgrouping for pT2 along with several subsequent revisions during the years, pT2 substaging has remained controversial due to the lack of robust evidence that it adds meaningful prognostic value (reference 13 in article). In the current study Nguyen et al evaluated the oncologic outcomes of pT2a/b vs pT2c. They confirmed that all pT2 subgroups have a similar postoperative long-term oncologic outcome, thereby providing validation for a single tier pT2 entity as used in the 2017 staging system (reference 1 in article).
This study is noteworthy as the first investigation of the therapeutic role of PPD for bladder cancer. While tuberculin is derived from Mycobacterium tuberculosis, the proteins in the PPD are conserved among most mycobacterial species, including M. bovis and environmental mycobacteria. Thus, repeat PPD placement can recall existing but waned immune responses and result in positive reactions in the absence of mycobacterial infection, which is termed the boosting phenomenon. This boosting effect is maximal if the repeat PPD test is administered between 1 and 5 weeks after the first test (reference 12 in article).
Considering the enormous investment in efforts to improve NMIBC treatment beyond 3-week maintenance BCG immunotherapy, the existence of an effective, inexpensive, safe and readily available technique such as PPD testing sounds too good to be true. Surprisingly it is not. In earlier centuries medical students were taught that the immune response after sensitization is accelerated and heightened. In my first study of BCG there was no significant inhibition of chemically induced bladder cancer without prior sensitization.
As pointed out, women who present with MUS complications generally have multiple complaints. Therefore, a single outcome measure (pain or incontinence) is clearly insufficient to capture the real clinical outcome in these multisymptomatic cases. To tackle this unusual situation in the field of female pelvic medicine and reconstructive surgery we evaluated different multidomain outcome tools and found the UDI-6, possibly supplemented by information on sexual function and urinary tract infections, is relevant and practical.
In this complicated retrospective review Shakir et al characterized presenting symptoms and outcomes in a select group of patients who elected to undergo SSR at a single center using the UDI-6 questionnaire as well as the presence or absence of recurrent UTIs, urinary incontinence and dyspareunia. The authors were attempting to address the lack of uniformity in reporting MUS complications (reference 7 in article). They found that there were many different presenting symptoms and the UDI-6 correlated with symptom improvement irrespective of presenting complaints.
To determine whether an enhance recovery protocol for radical cystectomy patient affected the length of stay or the number and type of readmissions that occurred after hospital discharge.
Preclinical Animal Studies of Intravesical Recombinant Human Proteoglycan 4 (rhPRG4) as a Novel Potential Therapy for Diseases Resulting From Increased Bladder Permeability
To test in an animal model the hypothesis that rhPRG4 (lubricin), a highly O-glycosylated mucin-like glycoprotein, may be a novel surface-active therapeutic for treating bladder permeability with co-morbid bowel permeability. Previously we showed that inducing bladder permeability in rats with dilute protamine sulfate (PS) produced colonic permeability and visceral hypersensitivity, suggesting increased bladder permeability could represent an etiologic factor in both Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) and Irritable Bowel Syndrome (IBS).
Assessment of Discomfort and Pain in Patients Undergoing Fusion-MRI-Guided Versus TRUS-Guided Prostate Biopsy
To investigate patient pain perception from receiving MRI fusion guided prostate biopsy (FBx) in addition to transrectal ultrasound guided template biopsy (TBx) versus pain from standard TBx alone.
In his 1914 novel The World Set Free, British science fiction writer H.G. Wells portrays a war of our world in which Earth's major cities are destroyed by atomic bombs.1 No serious scientist of the time believed this was possible, as evidenced by no less than the 1908 Nobel laureate in chemistry, Sir Ernest Rutherford, who as late as 1933 lectured to the effect that the energy locked within the atomic nucleus which he himself had discovered would never be available for mankind to use.2 A young Hungarian physicist travelled to London to meet Wells, and was intrigued by the author's ideas.