The Canadian Journal of Urology (Can J Urol)

Publications in this journal

• Article: Primary testicular leiomyosarcoma.

  Yakup Bostanci, Ender Ozden, Ekrem Akdeniz, Amir Kazzazi, Bedri Kandemir, Yarkin Kamil Yakupoglu, Bob Djavan
  [show abstract] [hide abstract]
  ABSTRACT: Primary testicular leiomyosarcoma is an extremely rare tumor, and, to the best of our knowledge, only 20 cases in adults have been reported in the literature to date. Herein, we present a case of a 68-year-old man who complained of left scrotal swelling for 2 months. Radiological examination revealed a left testicular tumor with no metastases to other organs. A left inguinal orchiectomy was carried out and histopathologic examination revealed an intratesticular leiomyosarcoma. The patient was treated successfully by orchiectomy and received no adjuvant therapy. During follow up until 12 months after surgery, there has been no recurrence or metastases of the disease.
  The Canadian Journal of Urology 04/2013; 20(2):6730-3.
• Article: The cost-effectiveness of blue light cystoscopy in bladder cancer detection: United States projections based on clinical data showing 4.5 years of follow up after a single hexaminolevulinate hydrochloride instillation.

  Susan S Garfield, Meghan B Gavaghan, Shannon O Armstrong, J Stephen Jones
  [show abstract] [hide abstract]
  ABSTRACT: Several studies, including the recently published phase III study by Stenzl and colleagues have demonstrated that hexaminolevulinate hydrochloride, when used with blue light fluorescence cystoscopy, improves detection of non-muscle invasive bladder tumors compared to white light cystoscopy and transurethral resection of bladder tumors (TURB) alone. The objective of this study was to conduct a detailed assessment of the cost-effectiveness of using hexaminolevulinate hydrochloride with blue light cystoscopy as an adjunct to white light versus white light cystoscopy alone at time of initial TURB in the United States. A probabilistic decision tree model, using TreeAge Pro 2011 software, was developed using base case scenario cost and utility estimates. Incorporation of hexaminolevulinate hydrochloride into diagnostic cystoscopy results in lower costs over 5 years ($25,921) as compared to those patients who initially receive white light cystoscopy ($30,581). Those patients who initially receive hexaminolevulinate hydrochloride blue light TURB also experience a lower overall cancer burden. Hexaminolevulinate hydrochloride may be cost effective when used at first TURB for patients with suspected new or recurrent non-muscle invasive bladder cancer.
  The Canadian Journal of Urology 04/2013; 20(2):6682-9.
• Article: Computed tomography based renal parenchyma volume measurements prior to renal tumor surgery are predictive of postoperative renal function.

  Brian Kunzel, William Small, Michael Goodman, John Pattaras, Viraj Master, Kenneth Ogan
  [show abstract] [hide abstract]
  ABSTRACT: To determine whether preoperative computed tomography (CT) based renal parenchymal volume (RPV) measurements would be predictive of postoperative chronic kidney disease (CKD). From 2005 to 2010, 189 patients with preoperative CT imaging performed at Emory University Hospital underwent renal tumor surgery. Preoperative and postoperative renal function was determined by estimating glomerular filtration rate (GFR) using standard Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) equations. Preoperative CT measured RPV was calculated to determine association of predicted preserved renal parenchyma with postoperative renal function and the development of CKD (GFR < 60 mL/min/1.73 m2). For the entire cohort, radical nephrectomy (RN), lower preoperative GFR, and volume of kidney without tumor were associated with the development of CKD (p = < 0.05). If the non-tumor bearing kidney constituted ≥ 50% of the total bilateral preoperative RPV, then risks of developing CKD were decreased. In patients treated with partial nephrectomy (PN) or ablation, total bilateral preoperative RPV measurements predicted postoperative renal function (CKD ≥ 3 versus CKD < 3) to a significant degree (p < 0.001). Preoperative CT based RPV measurements are independently associated with the development of CKD in patients undergoing renal tumor surgery. This provides urologists with another tool in the assessment of patients with renal tumors.
  The Canadian Journal of Urology 04/2013; 20(2):6714-20.
• Article: Metanephric adenofibroma.

  Robert M Turner Ii, Jeffrey J Tomaszewski, Janelle A Fox, Csaba Galambos, Glenn M Cannon
  [show abstract] [hide abstract]
  ABSTRACT: A 10-year-old boy underwent a computed tomography (CT) scan for left flank pain following a fall. Imaging demonstrated a 5 cm left upper pole renal mass. Partial nephrectomy revealed metanephric adenofibroma, a benign stromal-epithelial tumor thought to represent a hyperdifferentiated, mature form of Wilms' tumor. We briefly discuss the histopathology and management of this rare tumor.
  The Canadian Journal of Urology 04/2013; 20(2):6737-8.
• Article: Retroperitoneoscopic single-site renal pedicle lymphatic disconnection for the treatment of serious filarial chyluria.

  Wenli Zhuo, Jinqian Chai, Tingzhao Xu, Weizhen Wu, Shunliang Yang, Jianming Tan
  [show abstract] [hide abstract]
  ABSTRACT: To report our preliminary techniques and experience with retroperitoneoscopic single-site renal pedicle lymphatic disconnection (RPSS-RPLD) in five patients with serious filarial chyluria. Between May 2010 and July 2011, five patients with serious filarial chyluria underwent RPSS-RPLD. In the patients, a 3 cm single incision was made between the 12th subcostal margin and posterior axillary line, and a homemade single multichannel port using a surgical glove and three conventional trocars was placed into retroperitoneal space. The lymphatic disconnection was similar to traditional open surgery. All the operations were successfully completed without conversion to open surgery. The mean operative time was 116 (102-145) minutes. The mean blood loss was estimated to be 98 (60-190) mL. Chyluria disappeared in all patients after surgery and did not recur during the follow up period (3-14, mean 7.6 months). RPSS-RPLD is safe and feasible, with favorable short term outcomes and aesthetic effect.
  The Canadian Journal of Urology 04/2013; 20(2):6726-9.
• Article: Long term follow up of bovine dermis pubovaginal slings.

  Joshua P Holstead, B Jill Williams, Alex Gomelsky
  [show abstract] [hide abstract]
  ABSTRACT: Women at "high risk" for sling failure (advanced age, failed previous anti-incontinence surgery, intrinsic sphincter deficiency, and absence of urethral hypermobility) underwent acellular bovine dermis slings. We evaluate long term outcomes and complications with this material. We retrospectively identified 41 women who completed 36 month postoperative follow up. Preoperative evaluation included pelvic exam, SEAPI classification, and validated quality of life (QoL) questionnaires. Stress urinary incontinence (SUI) cure equaled SEAPI (S) subset = 0 and negative cough-stress test. Perioperative data was abstracted from the hospital and office chart. The SUI cure rate was 80.5%. Most SUI recurrences occurred within the first 12 months of follow up. Perioperative complications and rates of reoperation for recurrent SUI were low. There was a postoperative improvement in mean SEAPI scores and significant improvement in all QoL indices over preoperative baseline values. At long term follow up, bovine dermis continues to be a durable biologic option for a population at "high risk" for surgical failure after sling surgery. SUI-specific clinical outcomes remain stable, while rates of complications continue to be low. Improvement in QoL indices persists with long term follow up.
  The Canadian Journal of Urology 04/2013; 20(2):6721-5.
• Article: Explosive growth of a renal tumor during active surveillance.

  Matthew A Uhlman, Scott C Pate, James A Brown
  [show abstract] [hide abstract]
  ABSTRACT: The incidence of small renal masses (≤ 4 cm) has increased over the past three decades. Partial nephrectomy remains the standard for treatment of such lesions, but increased attention is being given to patients who may benefit from active surveillance, given the low risk of metastatic spread and traditionally slow growth rates. Patients with significant comorbidities and the elderly are often considered optimal candidates for surveillance. We present an 86-year-old female undergoing active surveillance for a 1.4 cm lesion that grew in diameter approximately 0.5 cm per year over 3 years, followed by explosive growth to 7 cm in diameter with a retrohepatic inferior vena cava (IVC) thrombus over the subsequent 13 months.
  The Canadian Journal of Urology 04/2013; 20(2):6739-41.
• Article: Actos, slings, finasteride, and the vaccine compensation solution.

  Leonard G Gomella
  The Canadian Journal of Urology 04/2013; 20(2):6668.
• Article: Legends in urology.

  Imre Romics
  The Canadian Journal of Urology 04/2013; 20(2):6669-71.
• Article: Primary synovial sarcoma of the kidney with unusual follow up findings.

  Ricardo Pereira E Silva, Tito Leitão, Lurdes Correia, Francisco Martins, José Palma Dos Reis, Tomé Lopes
  [show abstract] [hide abstract]
  ABSTRACT: We present a case report of a 17-year-old patient with a large renal mass that was detected on a computed tomography scan during investigation for secondary hypertension. Radical nephrectomy was performed and the morphologic and immunocytochemical findings were compatible with a diagnosis of monophasic synovial sarcoma of the kidney. A cytogenetic search for t(X;18) translocation was performed, which was negative. The patient underwent an ifosfamide-based chemotherapy regimen. During follow up, a positron emission tomography scan showed increased 18F-fluorodeoxyglucose metabolism at the right femur. Although cancer cells were expected in the biopsy specimen, only fibrous dysplasia of the bone was found. The patient was disease free at his 29 month follow up check up.
  The Canadian Journal of Urology 04/2013; 20(2):6734-6.
• Article: Perineural invasion and TRUS findings are complementary in predicting prostate cancer biology.

  Carlos H Martinez, Andrew K Williams, Joseph L Chin, Larry Stitt, Jonathan I Izawa
  [show abstract] [hide abstract]
  ABSTRACT: Clinical variables with more accuracy to predict biologically insignificant prostate cancer are needed. We evaluated the combination of transrectal ultrasound-guided biopsy of the prostate (TRUSBx) pathologic and radiologic findings in their ability to predict the biologic potential of each prostate cancer. A total of 1043 consecutive patients who underwent TRUSBx were reviewed. Using pathologic criteria, patients with prostate cancer (n = 529) and those treated with radical prostatectomy (RP) (n = 147) were grouped as: "insignificant" (Gleason score ≤ 6, prostate-specific antigen (PSA) density ≤ 0.15 ng/ml, tumor in ≤ 50% of any single core, and < 33% positive cores) and "significant" prostate cancer. TRUSBx imaging and pathology results were compared with the RP specimen to identify factors predictive of "insignificant" prostate cancer. TRUSBx pathology results demonstrated perineural invasion in 36.4% of "significant" versus 5.4% of "insignificant" prostate cancers (p < 0.01) and pathologic invasion of periprostatic tissue in 7% of significant versus 0% of insignificant prostate cancers (p < 0.01). TRUS findings concerning for neoplasia were associated with significant tumors (p < 0.01). Multivariable analysis demonstrated perineural invasion in the biopsy specimen (p = 0.03), PSA density (p = 0.02) and maximum tumor volume of any core (p = 0.02) were independently predictive of a significant prostate cancer. TRUS findings concerning for measurable tumor and perineural invasion in TRUSBx specimens appear to be complementary to Epstein's pathologic criteria and should be considered to aid in the determination whether a prostate cancer is organ-confined and more likely to be biologically insignificant.
  The Canadian Journal of Urology 04/2013; 20(2):6696-701.
• Article: Marital status and prostate cancer outcomes.

  Mark D Tyson, Paul E Andrews, David A Etzioni, Robert G Ferrigni, Mitchell R Humphreys, Scott K Swanson, Erik K Castle
  [show abstract] [hide abstract]
  ABSTRACT: To evaluate the influence of marriage on the survival outcomes of men diagnosed with prostate cancer. We examined 115,922 prostate cancer cases reported to the Surveillance, Epidemiology, and End Results (SEER) database between 1988 and 2003. Multivariate Cox regression techniques were used to study the relationship of marital status and prostate cancer-specific and overall mortality. Married men comprised 78% of the cohort (n = 91,490) while unmarried men (single, divorced, widowed, and separated) comprised 22% of the cohort (n = 24,432). Married men were younger (66.4 versus 67.8 years, p < 0.0001), more likely to be white (85% versus 76%, p < 0.0001), presented with lower tumor grades (68% are well or moderately differentiated versus 62%, p < 0.0001) and at earlier clinical stages (41% AJCC stage I/II versus 37%, p < 0.0001). Multivariate analysis revealed that unmarried men had a 40% increase in the relative risk of prostate cancer-specific mortality (HR 1.40; CI 1.35-1.44; p < 0.0001), and a 51% increase in overall mortality (HR 1.51; CI 1.48-1.54; p < 0.0001), even when controlling for age, AJCC stage, tumor grade, race and median household income. Furthermore, the 5 year disease-specific survival rates for married men was 89.1% compared to 80.5% for unmarried men (p < 0.0001). Marital status is an independent predictor of prostate cancer-specific mortality and overall mortality in men with prostate cancer. Unmarried men have a higher risk of prostate cancer-specific mortality compared to married men of similar age, race, stage, and tumor grade.
  The Canadian Journal of Urology 04/2013; 20(2):6702-6.
• Article: Focal ablation of prostate cancer: four roles for magnetic resonance imaging guidance.

  Graham Sommer, Donna Bouley, Harcharan Gill, Bruce Daniel, Kim Butts Pauly, Chris Diederich
  [show abstract] [hide abstract]
  ABSTRACT: There is currently a great deal of interest in the possible use of focal therapies for prostate cancer, since such treatments offer the prospect for control or cure of the primary disease with minimal side effects. Many forms of thermal therapy have been proposed for focal ablation of prostate cancer, including laser, high intensity ultrasound and cryotherapy. This review will demonstrate the important roles that magnetic resonance imaging (MRI) guidance can offer to such focal ablation, focusing on the use of high intensity ultrasonic applicators as an example of one promising technique. Transurethral and interstitial high intensity ultrasonic applicators, designed specifically for ablation of prostate tissue were tested extensively in vivo in a canine model. The roles of MRI in positioning the devices, monitoring prostate ablation, and depicting ablated tissue were assessed using appropriate MRI sequences. MRI guidance provides a very effective tool for the positioning of ablative devices in the prostate, and thermal monitoring successfully predicted ablation of prostate tissue when a threshold of 52ºC was achieved. Contrast enhanced MRI accurately depicted the distribution of ablated prostate tissue, which is resorbed at 30 days. Guidance of thermal therapies for focal ablation of prostate cancer will likely prove critically dependent on MRI functioning in four separate roles. Our studies indicate that in three roles: device positioning; thermal monitoring of prostate ablation; and depiction of ablated prostate tissue, MR techniques are highly accurate and likely to be of great benefit in focal prostate cancer ablation. A fourth critical role, identification of cancer within the gland for targeting of thermal therapy, is more problematic at present, but will likely become practical with further technological advances.
  The Canadian Journal of Urology 04/2013; 20(2):6672-81.
• Article: Percutaneous renal biopsy may aid management of small renal masses on active surveillance.

  Jay D Raman
  The Canadian Journal of Urology 04/2013; 20(2):6742.
• Article: Neoadjuvant chemotherapy in the treatment of muscle invasive bladder cancer with mixed histology.

  James Lin, Michael Whalen, Dara Holder, Gregory Hruby, G Joel Decastro, James McKiernan
  [show abstract] [hide abstract]
  ABSTRACT: We examined the effects of neoadjuvant chemotherapy (NC) in the treatment of muscle invasive urothelial carcinoma of the bladder in those with mixed histology (MH) versus those with pure urothelial carcinoma (UC). Between 2000-2012, 195 patients were identified with clinical stage T2-T4, N0-Nx, M0-Mx UCB who had either NC (+/- radical cystectomy) (n = 63) or radical cystectomy (RC) alone (n = 132). Tumors were classified as either pure UC or MH. Endpoints included downstaging to pT0 and overall survival. Multivariable Cox regression and the Kaplan-Meier method were used to estimate the effects of histological type and treatment given on overall mortality. The rate of downstaging to pT0 was higher in NC treated patients with both MH (p = 0.048) and pure UC (p < 0.0001), as compared to those in each group who did not receive NC. NC was not a significant predictor of overall survival for MH patients in a Cox multivariate model (p = 0.54). However, among all patients treated with NC, MH was found to be a predictor of poorer survival compared to UC (p = 0.02). Prior evidence on the benefits of NC for patients with MH is mixed, but our data suggests that there is improvement in rate of pT0 on final pathology in those treated with NC, regardless of histology. Although patients with MH fare worse than those with pure UC in the setting of NC, given the significantly higher rate of pT0 at final pathology, strong consideration should be given to use of NC in the treatment of MH muscle invasive bladder cancer patients.
  The Canadian Journal of Urology 04/2013; 20(2):6690-5.
• Article: Combined partial cystectomy and cesarean delivery in a pregnant female with bladder pheochromocytoma.

  Ryan S Hsi, Christopher J Welty, Mathew D Sorensen, Aashiyana F Koreishi, Hunter Wessells
  [show abstract] [hide abstract]
  ABSTRACT: We report the first known case of concurrent partial cystectomy and cesarean delivery in a pregnant female with bladder pheochromocytoma. A 28-year-old G4P2 female presented at 28 weeks gestation with labile blood pressures requiring three antihypertensive medications. Urinary catecholamines were elevated, and a subsequent MRI showed a 2.6 cm x 3.2 cm bladder wall mass. She underwent combined cesarian section and partial cystectomy at 37 weeks. Fluid resuscitation and vasopressors were required in the immediate postoperative period. While bladder pheochromocytoma with pregnancy is a rare occurrence, concurrent delivery and removal of the bladder tumor can be performed safely.
  The Canadian Journal of Urology 02/2013; 20(1):6646-8.
• Article: Lactobacillus for preventing recurrent urinary tract infections in women: meta-analysis.

  Peter M Grin, Paulina M Kowalewska, Waleed Alhazzan, Alison E Fox-Robichaud
  [show abstract] [hide abstract]
  ABSTRACT: Urinary tract infections (UTIs) are the most common infections affecting women, and often recur. Lactobacillus probiotics could potentially replace low dose, long term antibiotics as a safer prophylactic for recurrent UTI (rUTI). This systematic review and meta-analysis was performed to compile the results of existing randomized clinical trials (RCTs) to determine the efficacy of probiotic Lactobacillus species in preventing rUTI. MEDLINE and EMBASE were searched from inception to July 2012 for RCTs using a Lactobacillus prophylactic against rUTI in premenopausal adult women. A random-effects model meta-analysis was performed using a pooled risk ratio, comparing incidence of rUTI in patients receiving Lactobacillus to control. Data from 294 patients across five studies were included. There was no statistically significant difference in the risk for rUTI in patients receiving Lactobacillus versus controls, as indicated by the pooled risk ratio of 0.85 (95% confidence interval of 0.58-1.25, p = 0.41). A sensitivity analysis was performed, excluding studies using ineffective strains and studies testing for safety. Data from 127 patients in two studies were included. A statistically significant decrease in rUTI was found in patients given Lactobacillus, denoted by the pooled risk ratio of 0.51 (95% confidence interval 0.26-0.99, p = 0.05) with no statistical heterogeneity (I2 = 0%). Probiotic strains of Lactobacillus are safe and effective in preventing rUTI in adult women. However, more RCTs are required before a definitive recommendation can be made since the patient population contributing data to this meta-analysis was small.
  The Canadian Journal of Urology 02/2013; 20(1):6607-14.
• Article: Epithelioid PEComa (epithelioid angiomyolipoma) of the kidney: a rare tumor subtype for patients presenting with an enhancing renal mass.

  Adam B Shrewsberry, Gabriel L Sica, Adeboye O Osunkoya, Daniel J Canter
  [show abstract] [hide abstract]
  ABSTRACT: Epithelioid angiomyolipomas, or perivascular epithelioid cell tumors (epithelioid PEComas) of the kidney, are histologically related to renal angiomyolipomas (AMLs). However, in contrast to typical AMLs, this rare tumor can exhibit an aggressive clinical course with approximately 50% of reported cases demonstrating disease progression. In this report, we present a case of a 24-year-old female with a history of stone disease who was incidentally found to have a 9.0 cm right renal mass that was difficult to characterize radiographically preoperatively. The patient underwent a right radical nephrectomy, and pathology revealed a renal epithelioid PEComa.
  The Canadian Journal of Urology 02/2013; 20(1):6643-5.
• Article: COMMENTARY - Biomarkers to improve PSA-cancer screening.

  Kevin C Zorn, Mounsif Azizi
  The Canadian Journal of Urology 02/2013; 20(1):6625.