Urology News Feeds
Re: Magnetic Resonance Imaging Underestimation of Prostate Cancer Geometry: Use of Patient Specific Molds to Correlate Images with Whole Mount Pathology
In this article the authors suggest that magnetic resonance imaging (MRI) consistently underestimates the size and extent of prostate tumors. We agree and would like to share our ideas on this subject.
Re: Extended Duration Enoxaparin Decreases the Rate of Venous Thromboembolic Events after Radical Cystectomy Compared to Inpatient Only Subcutaneous Heparin
The authors compare the outcomes of extended prophylaxis with enoxaparin to inpatient only heparin, an increasingly common treatment strategy. Their conclusion, that enoxaparin should be administered in place of heparin, is based on convention—statistically significant p values. While most readers are generally attuned to assessing levels of evidence in an article, we want to highlight a less well-known concept, the fragility index.
Lower Urinary Tract Symptoms and Benign Prostate Hyperpasia Features among Male BRCA Mutation Carriers
To analyze lower urinary tract symptoms (LUTS) and benign prostate hyperplasia (BPH) features among male BRCA 1 and 2 carriers and an age matched control group.
A 47-year-old man presented to the urology department with visible haematuria. He was found to have a high-grade non-muscle-invasive transitional cell carcinoma of the bladder and was subsequently treated with intravesical BCG instillations. On routine surveillance CT scan following treatment he was found to have multiple rounded areas of low density in the right kidney, suspicious for renal malignancy. He underwent renal biopsy which revealed necrotising granulomatous inflammation suggestive of mycobacterial infection.
MRP-1 and BCRP Promote the Externalization of Phosphatidylserine in Oxalate-Treated Renal Epithelial Cells: Implications for Calcium Oxalate Urolithiasis
To investigate the possible involvement of multidrug resistance-associated protein 1 (MRP-1) and breast cancer resistance protein (BCRP) in the oxalate-induced redistribution of phosphatidylserine (PS) in renal epithelial cell membranes.
When the Gold Standard Proves to be Fool's Gold – Blue Light Cystoscopy in a Case of High Risk Non-Muscle Invasive Bladder Cancer
A 75-year-old male was referred for a second opinion on the management of BCG-unresponsive non-muscle invasive bladder cancer (NMIBC). He was initially diagnosed with NMIBC two years prior to his referral to our institution upon workup for painless gross hematuria. His initial biopsy demonstrated multifocal carcinoma in situ (CIS) and subsequently underwent an induction course of intravesical therapy with Bacillus Calmette-Guerin (BCG). He tolerated the therapy well and he underwent a post-BCG bladder biopsy, which unfortunately demonstrated persistent CIS.
Urinary tract infections, chronic high blood pressure and bleeding or clotting disorders may increase the risk of pregnancy-associated stroke in women with preeclampsia, a high-blood pressure...
Bipolar Plasma Enucleation of the Prostate (B-TUEP) in Benign Prostate Hypertrophy Treatment. 3-Year Results”
To numerous endoscopic techniques have been described for the treatment of benign prostate enlargement (BPE). The plasma-button enucleation of the prostate (B-TUEP) is a successful treatment option because the large surface creates a fast enucleation process, vaporization and concomitant haemostasis. The aim of this study was to evaluate the efficacy of bipolar button electrode transurethral adenoma enucleation (B-TUEP) in saline solution. The second endpoint was to determine the change of IPSS, PVR, IEFF-5, TrUS and PSA.
The authors describe the prevalence of malnutrition and its impact on urology patients with special attention to cystectomy. While ERAS (enhanced recovery after surgery) protocols have focused on optimizing postoperative care, this review reminds us that mitigating the risk of malnutrition before surgical intervention remains a potential unevaluated target to improve outcomes. With the application of neoadjuvant chemotherapy we often have a minimum of 6 weeks to prepare patients for surgery. The authors conclude that identification of malnutrition is an important first step.
Cancer is an extremely complex disease, but its definition is quite simple: the abnormal and uncontrollable growth of cells.
Low Energy Shock-Wave Therapy - a Novel Treatment Option for Erectile Dysfunction in Men with Cardiovascular Disease.
Patients with cardiovascular disease (CVD) are prone to developing erectile dysfunction (ED) due to the common risk factors and pathogenesis underlying ED and CVD. As a result, ED affects nearly 80% of male patients with CVD. The efficacy of phosphodiesterase type 5 inhibitors, vacuum erection devices or intracavernosal injection of vasodilating agents is well established in the treatment of ED; however, their use is limited. Low energy shock-wave therapy (LESWT) is a novel modality that may become a causative treatment for ED.
Our patient suffered a perineal straddle injury, resulting in right cavernosal artery pseudoaneurysm in combination with a cavernosal-urethral fistula. The urethra failed to heal after several weeks and the patient presented with severe intermittent urethral bleeding. The pseudoaneurysm was successfully treated by coil embolization, with resolution of the bleeding. The patient recovered completely, with normal erectile and voiding function. This type of injury is very rare in literature: traumatic cavernosal arterial pseudoaneurysm is known to cause high flow priapism, but in this case additional cavernosal-urethral fistula resulted in a severe urethraggia.
The management of painful mesh complications is challenging and fraught with unknowns. Although multiple studies demonstrate substantial improvements in chronic pain after mesh removal, the sequelae of mesh removals are not well-defined. In this study, we sought to develop a reliable prognosis of the risk of recurrent incontinence in continent patients considering sling excision.
Over the past two decades synthetic mid-urethral slings have become the standard treatment for stress urinary incontinence (SUI).1 However, as with all surgical procedures, slings are not without complications, and reported rates range from 10-36%.2,3 Complications, including mesh exposure, obstructed voiding, pelvic and thigh pain are often transient and may initially be treated conservatively with any combination of pelvic floor physical therapy, analgesic medication and vaginal estrogen. However, refractory cases may necessitate surgical removal of the mesh.
We would like to thank the authors of the editorial response for their comments. We do agree that computed tomography arteriography would be the most definitive study to diagnose an arteriovenous fistula. However, this comes with added and unnecessary expense and risk to patients. Most patients' overall renal function will diminish after the removal of a renal unit, and a contrast load may increase the risk of contrast-induced injury.
In 1947, the musical “Brigadoon” debuted on Broadway. The play focuses on a mysterious Scottish village that appears 1 day every 100 years. Its compelling and original storyline has led to revivals, traveling productions, and has been made for TV movies. En bloc ligation of the renal hilum and the subsequent formation of an arteriovenous fistula (AVF) is truly the Brigadoon of urologic surgery…a mystic and captivating complication that was first reported nearly 100 years ago and has since been frequently discussed, yet rarely seen.
Side-to-side refluxing non-dismembered ureterocystotomy: A novel strategy to address obstructed megaureters in children
A non-refluxing megaureter (NRMU) is a relatively common cause of antenatal hydronephrosis (ANH). Although non-operative management is favored, surgical intervention is sometimes warranted. There is controversy regarding the best approach, particularly in young children. Herein we describe our experience with a non-dismembered side-to-side refluxing ureterocystotomy (UC) as a simple option to address obstruction.
Despite a perceived knowledge of etiology UES remains an issue in patients who undergo radical cystectomy (reference 5 in article). Like enhanced recovery protocols for surgical recovery,1 it may be the sum of many small factors that will be the ultimate prevention. The authors contend that a longer ileal conduit, anastomosis to a buttonhole instead of to a slit and retroperitonalization of the ureteroenteric anastomosis may assist but like many questions of surgical technique there is no definitive trial.
The use of RARC is on the rise and we continue to learn about its long-term outcomes. This study describes a 13% UES rate among 407 patients treated with RARC who had a median followup of 17 months. Similar stricture rates have been reported from high volume centers and there is currently no evidence that RARC increases the risk of UES (references 6, 12 and 23 in article). Three technical factors increased the risk of UES in this study, including ICUD, urine leak and the shorter length of ureter excised.
Comprehensive Qualitative Assessment of Urethral Stricture Disease: Toward the Development of a Patient Centered Outcome Measure
The primary objective of this manuscript is to report what patients consider to be the most important symptoms, functions and impacts of USD. Correlation of the patient and physician perspective was performed.