International braz j urol: official journal of the Brazilian Society of Urology

Publisher: Sociedade Brasileira de Urologia

Description

Publication of the Sociedade Brasileira de Urologia. Mission is to publish original papers of scientific value in the field of Urology. Former Title: Brazilian Journal of Urology.

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  • Website
    International Braz J Urol website
  • Other titles
    International braz j urol (Online), International Brazilian journal of urology
  • ISSN
    1677-6119
  • OCLC
    53866074
  • Material type
    Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To describe a novel technique of repairing the VVF using the transperitoneal- transvaginal approach. Materials and Methods: From June 2011 to October 2013, four patients with symptoms of urine leakage in the vagina underwent robotic repair of VVF with the transperitoneal- transvaginal approach. Cystoscopy revealed the fistula opening on the bladder. A ureteral stent was placed through the fistulous tract. After trocar placement, the omental flap was prepared and mobilized robotically. The vagina was identified and incised. The fistulous tract was excised. Cystorrhaphy was performed in two layers in an interrupted fashion. The vaginal opening was closed with running stitches. The omentum was interposed and anchored between the bladder and vagina. Finally, the ureteral catheters were removed in case they have been placed, and an 18 Fr urethral catheter was removed on the 14th postoperative day. Results: The mean age was 46 years (range: 41 to 52 years). The mean fistula diameter was 1.5 cm (range 0.3 to 2 cm). The mean operative time was 117.5 min (range: 100 to 150 min). The estimated blood loss was 100 mL (range: 50 to 150 mL). The mean hospital stay was 1.75 days (range: 1 to 3 days). The mean Foley catheter duration was 15.75 days (range: 10 to 25 days). There was no evidence of recurrence in any of the cases. Conclusions: The robot-assisted laparoscopic transperitoneal transvaginal approach for VVF is a feasible procedure when the fistula tract is identified by first intentionally opening the vagina, thereby minimizing the bladder incision and with low morbidity.
    International braz j urol: official journal of the Brazilian Society of Urology 12/2014; 40(6):810.
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    ABSTRACT: Introduction: To determine the parameters affecting the outcome of ureteroneocystostomy (UNC) procedure for vesicoureteral reflux (VUR). Materials and Methods: Data of 398 patients who underwent UNC procedure from 2001 to 2012 were analyzed retrospectively. Different UNC techniques were used according to laterality of reflux and ureteral orifice configuration. Effects of several parameters on outcome were examined. Disappearance of reflux on control VCUG or absence of any kind of UTI/symptoms in patients without control VCUG was considered as clinical improvement. Results: Mean age at operation was 59.2 ± 39.8 months and follow-up was 25.6 ± 23.3 months. Grade of VUR was 1-2, 3 and 4-5 in 17, 79, 302 patients, respectively. Male to female ratio was 163/235. UNC was performed bilaterally in 235 patients and intravesical approach was used in 373 patients. The frequency of voiding dysfunction, scar on preoperative DMSA, breakthrough infection and previous surgery was 28.4%, 70.7%, 49.3% and 22.4%, respectively. Twelve patients (8.9%) with postoperative contralateral reflux were excluded from the analysis. Overall clinical improvement rate for UNC was 92%. Gender, age at diagnosis and operation, laterality and grade of reflux, mode of presentation, breakthrough infections (BTI) under antibiotic prophylaxis, presence of voiding dysfunction and renal scar, and operation technique did not affect the surgical outcome. However, the clinical improvement rate was lower in patients with a history of previous endoscopic intervention (83.9% vs. 94%). Postoperative UTI rate was 27.2% and factors affecting the occurrence of postoperative UTI were previous failed endoscopic injection on univariate analysis and gender, preoperative BTI, postoperative VUR state, voiding dysfunction on multivariate analysis. Surgery related complication rate was 2% (8/398). These were all low grade complications (blood transfusion in 1, hematoma under incision in 3 and prolonged hospitalization secondary to UTI in 4 patients). In long term, 12 patients are under nephrologic follow-up because of hypertension in 5, increased serum creatinine in 5, proteinuria in 1 and hematuria in 1 patient and all these patients had preoperative scarred kidneys. Conclusions: Despite its invasive nature, UNC has a very high success rate with a negligible percent of complications. In our cohort, the only factor that negatively affected the clinical improvement rate was the history of previous antireflux interventions where the predictive factors for postoperative UTI were previous failed endoscopic injection, female gender, preoperative BTI, persistent VUR and voiding dysfunction.
    International braz j urol: official journal of the Brazilian Society of Urology 12/2014;
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    ABSTRACT: Purpose: Despite the routine use of helical CT in diagnosis of renal colic, there are recent concerns regarding the radiation exposure, overuse and costs. We attempted in this retrospective study to evaluate the accuracy of ultrasound (gray-scale and color Doppler with twinkling), KUB and urinalysis in diagnosis of renal colic due to ureteral calculi presented in Emergency Room. Materials and Methods: A total of 939 consecutive cases of renal colic presented to ER have been managed and evaluated by ureteral ultrasound, KUB and urinalysis for the presence of ureteral stones. Non-confirmatory cases were subjected to Helical CT examination. Results: Renal and ureteral ultrasound (gray-scale) alone detected ureteral calculi in 615 cases (65.4%) and after utilizing Color Doppler Ultrasound with twinkling the diagnosis was made with confidence in 935 cases (99.6%) but 4 (0.4%). KUB showed radiopaque stones in 503 (53.6%) patients and no stones were detected in 436 (46.4%). Microhematuria presented in 835 (88.9%) cases while absent in 102 (10.9%). There were 190 (20.3%), 77 (8.2%) and 671 (71.5%) patients with upper, middle and lower ureteral stones respectively. The simultaneous positive findings in US and KUB with microhematuria were found only in 453 (48.2%) cases. Conclusions: The use of Color Doppler ultrasound with twinkling increased the detection rate of ureteral stones in acute renal colic patients presented to ER with less radiation exposure. Ultrasound examination as a single modality is superior to KUB and urinalysis in initial diagnosis of renal colic.
    International braz j urol: official journal of the Brazilian Society of Urology 12/2014;
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    ABSTRACT: Semen analysis is the corner-stone of infertility evaluation as it provides information on the functional status of the seminiferous tubules, epididymis and accessory sex glands. The methods on how the human semen should be evaluated are provided by the World Health Organization, which periodically releases manuals that include specific protocols and reference standards. In 2010, the WHO published new criteria for human semen characteristics that were markedly lower than those previously reported. In this review initially it is discussed the limitations of semen analysis as a surrogate measure of a man's ability to father a pregnancy. Secondly, it is analyzed methodology issues that could explain why the newly released reference values were different from those earlier reported. Thirdly, it is speculated on the likely effects of the 2010 WHO criteria in the management of male infertility. Due to the several inherent limitations of semen analysis as a surrogate marker of male infertility, physicians should exercise caution when interpreting results. A template for semen analysis reports that incorporates the distribution of the semen characteristics of recent fathers in centiles rather than solely the minimum thresholds could aid clinicians to better understand how a given patient results compare with the reference population. Importantly, a male infertility evaluation must go far beyond a simple semen analysis, as it has to be complemented with a proper physical examination, a comprehensive history taking, and relevant endocrine, genetic, and other investigations.
    International braz j urol: official journal of the Brazilian Society of Urology 12/2014;
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    ABSTRACT: To evaluate in an animal model the feasibility of a novel concept of hand-assisted surgery consisting of inserting two hands into the abdomen instead of one. The chosen procedure was retroperitoneal lymph node dissection (L-RPLND) that was performed in five pigs. A Pfannestiel and a transverse epigastric incisions were made through which both hands were introduced. The scope was inserted through the umbilicus. The colon was moved medially and the dissection was performed as in open surgery using short conventional surgical instruments. The surgery was fulfilled easily and safely in quite a similar way as in open surgery. Two-handed laparoscopy may be indicated in cases that still today require an open approach as apparently makes the operation easier and significantly shortens the surgery time. However, new opinions and trials are required.
    International braz j urol: official journal of the Brazilian Society of Urology 09/2014; 40(5):697-701.
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    ABSTRACT: To determine whether there are differences in pressure and flow measurements between conventional cystometry (CONV) and ambulatory urodynamic monitoring (AMB) in women with overactive bladder syndrome and urinary incontinence. Retrospective study which included female subjects who underwent both CONV (with saline filling medium) and AMB, separated by less than 24 months, not using medication active on the lower urinary tract and without history of prior pelvic surgery. Both tests were carried out in compliance with the International Continence Society standards. The paired Student's t test was used to compare continuous variables. Bland-Altman statistics were used to assess the agreement of each variable between both studies. Thirty women with a median (range) age of 50 (14 - 73) years met the inclusion criteria. AMB was carried out at a mean (SD) of 11 (6) months after CONV. Measurements of pves and pabd at the end of filling, and Qmax were significantly higher from AMB recordings. There were no differences in pdet at the end of filling, pdetQmax or pdetmax during voiding, nor significant difference in Vvoid. We provide previously undocumented comparative voiding data between CONV and AMB for patients who most commonly require both investigations. Our findings show higher values of Qmax but similar values of pdetQmax measured by AMB which may partly reflect an overall lower catheter caliber, physiological filling but perhaps also more 'normal' voiding conditions.
    International braz j urol: official journal of the Brazilian Society of Urology 09/2014; 40(5):666-675.
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    ABSTRACT: To analyze surgical methods and evaluate treatment efficacy and safety for managing adrenal cystic lesions. All patients presenting with adrenal lesions of the West China Hospital were reviewed retrospectively from January 2003 to April 2013 and 47 were diagnosed as adrenal cysts. Basic information, clinical history, physical examination, laboratory investigations, abdominal ultrasound and enhanced computed tomography were detailed noted. Cysts with different surgical management were analyzed and surgery option,operative time, postoperative complications and after-surgery hospital stay were all noted. The final diagnosis was judged by histopathology. Patients were followed from 3 month to 10 years. All the 47 patients with a mean age of 43.8 years were managed by surgical intervention. Compared laparoscopic technology with open technology, the laparoscopic has the advantage of a shorter operation time, shorter hospital stay after surgery and enhanced cosmesis. The histopathologic result was: 23 (50%) were endothelial cysts and 16 (35%) were pseudocysts. One patient had evidence to recurrence at the followed-up stage. Adrenal cysts are rare and with the development of imaging techniques many of these are diagnosed incidentally. CT has advantages in detecting the cysts with haemorrhage, intracystic debris, calcification and mixed adrenal mass. Minimally invasive surgery offers equivalent efficacy to traditional open procedures, while providing a shorter operation time, shorter convalescence and improved cosmesis. Patients after surgical resection should be followed up closely especially if functional cysts and histopathology of cystic tumor are present.
    International braz j urol: official journal of the Brazilian Society of Urology 09/2014; 40(5):656-665.
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    ABSTRACT: We aimed to assess the relationship between prostate volume (PV) and high grade prostate carcinoma (HGPCa) in patients with benign and suspicious digital rectal examination (DRE) in our prostate biopsy cohort. Between 2009-2012, 759 consecutive initial transrectal systematic 12 cores prostate biopsies were included. PVs were calculated with transrectal ultrasound. Only prostate adenocarcinomas (PCa) were included into the study. For standardization, patients with missing data, and who have been exposed to any form of hormonal or radiation therapy were excluded. Patients were categorized with DRE (negative or positive) and Gleason sum [<7: low grade PCa(LGPCa), ≥7: HGPCa]. Median PV was significantly lower in patients with HGPCa. There was a significantly increased risk of HGPCa with PV according to all groups in univariate logistic regression (LR). The significant relationship continued in multivariate LR with PSA and age. From the ROC curve analyses, again a significantly statistical concordance was found between the detection of HGPCa and PV (AUC:0.63, p<0.001), as well as between HGPCa and tPSA (AUC:0.73, p<0.001). tPSA and PV were also significantly concordant with HGPCa both in DRE negative and positive patients. There is a significant relationship between HGPCa and decreasing PV. The continued significant relationship both in DRE negative and positive patients reinforces this relation.
    International braz j urol: official journal of the Brazilian Society of Urology 09/2014; 40(5):613-619.
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    ABSTRACT: We aimed to compare the outcomes of pneumatic (PL), ultrasonic (UL) and combined (PL/UL) lithotripsy performed in percutaneous lithotripsy (PNL) according to success rates and stone clearence. The medical records of 512 patients treated with PNL between April 2010 and April 2013 were evaluated. Postoperative stone analysis revealed as calcium oxalate in 408 of these patients. The operation notes of 355 patients recorded in detail with complete parameters were reviewed. According to stone disintegration method, patients were divided into three groups: PL only in Group I, UL only in Group II, and UL/PL combination in Group III. Number of patients was 155, 110 and 90, respectively. Fluoroscopy screening time was significantly shorter in group II, and III compared to group I (p<0.001). The failure rates were 13.5% (21 patients) for group I, 3.6% (4 patients) for group II, and 3.3% (3 patients) for group III. There was a significant statistical difference in favor of group II and III by means of success (p=0.023). Group II and III had larger FSA, and this was statistically significant (p=0.032). Stone disintegration time (SDT) was 64.0±41.92 minutes for group I, 49.5±34.63 for group II, and 37.7±16.89 for group III. Group III has a statistically significant shorter SDT (p=0.011). We concluded that, in cases with high stone burden, where faster and efficient lithotripsy is needed, combined ultrasonic / pneumatic lithotripter may be the ideal choice and in suitable cases ultrasonic lithotripter usage provides important advantages to the surgeon.
    International braz j urol: official journal of the Brazilian Society of Urology 09/2014; 40(5):650-655.
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    ABSTRACT: Purpose: We investigated the characteristics and management of patients with intravenous misplacement of a nephrostomy tube. Materials and Methods: Between July 2007 and July 2013, 4148 patients with urolithiasis underwent percutaneous nephrolithotomy (PCNL) in our hospital. Intravenous misplacement of a nephrostomy tube occurred in two of these patients. Another patient with intravenous misplacement of a nephrostomy tube, who underwent PCNL in another hospital, was transferred to our hospital. The data of the three patients were retrospectively analyzed. Results: The incidence of intravenous misplacement of a nephrostomy tube following PCNL was 0.5% (2/4148) at our hospital. A solitary kidney was present in one of the three patients. The tip of tube was located into the inferior vena cava (IVC) in two patients and into the renal vein in one patient. All three patients were successfully managed with strict bed rest, intravenous antibiotics and one-step (one patient) or two-step (two patients) tube withdrawal under close monitoring. None of the patients underwent antithrombotic therapy. The original operations were performed successfully under close observation in two patients and changed to another operation in one patient. All patients were discharged uneventfully. Conclusions: The incidence of intravenous misplacement of a nephrostomy tube following PCNL is 0.5% at our hospital. Intravenous nephrostomy tube misplacement is an uncommon complication of PCNL. A solitary kidney may render patients susceptible to this complication. Most patients may be managed conservatively with strict bed rest, intravenous antibiotics and one-step or two-step tube withdrawal under close monitoring.
    International braz j urol: official journal of the Brazilian Society of Urology 09/2014; 40(5):690-696.
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    ABSTRACT: The ventral phalloplasty (VP) has been well described in modern day penile prosthesis surgery. The main objectives of this maneuver are to increase perceived length and patient satisfaction and to counteract the natural 1-2 cm average loss in length when performing implantation of an inflatable penile prosthesis. Similarly, this video represents a new adaptation for partial penectomy patients. One can only hope that the addition of the VP for partial penectomy patients with good erectile function will increase their quality of life. The patient in this video is a 56-year-old male who presented with a 4.0x3.5x1.0 cm, pathologic stage T2 squamous cell carcinoma of the glans penis. After partial penectomy with VP and inguinal lymph node dissection, pathological specimen revealed negative margins, 3/5 right superficial nodes and 1/5 left superficial nodes positive for malignancy. The patient has been recommended post-operative systemic chemotherapy (with external beam radiotherapy) based on the multiple node positivity and presence of extranodal extension. The patient's pre-operative penile length was 9.5 cm, and after partial penectomy with VP, penile length is 7 cm.
    International braz j urol: official journal of the Brazilian Society of Urology 09/2014; 40(5):708-709.
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    ABSTRACT: Although rare in developed countries (0.2 cases cases/100 000 men) (1), penile cancer (PC) is common in underdeveloped countries. In Brazil, Paraguai, Angola and India, the incidence of PC varies from 2.3 to 8.3 cases/100 000 men) (2,3). In Brazil annually around 1000 penile amputations are reported. In some Brazilian regions, prevalence of PC is similar to prostate cancer, affecting young males (3.53% < 26 years; 3.88% 27 - 35 years, 12% 36 - 45 years and 18.7% 46 - 55 years old)(4). In a strict epidemiological and bureaucratic point of view, the health authorities of those countries don't consider PC a public health problem in view of several other more prevalent diseases. Apart from epidemiological and statistical data, we disagree and believe that PC prevention is imperious in these nations. When dealing with the humanitarian and clinical aspects of PC, we conclude that the medical and scientific community such as the urological society and government agencies must pay attention to this disease: - PC when diagnosed and treated precociously is highly curable and with low toxicity. When treated in more advanced phases, its treatment is costly and with bad outcome (3). - Primary lesion treatment, even conservative, involves some degree of genital mutilation, with sensitivity alterations and even total loss of the ability for sexual activity. Amputations may also compromise self-esteem and corporal image, difficult or avoid orthostatic micturition, result in loss of masculinity (in a society centered in the phallus) and may also result in urethral strictures. - There are very few studies about the delayed sequelae of inguinal iliac lymphadenectomies: lymphoceles and repeated erysipela. Very few studies are available regarding treatment of lower limb chronic lymphedema. Usually this condition prevents labor and sports activities. There is no definite cure for genital edema. Is there a possible model of cancer prevention? In the scientific literature, there are no well successful specific programs of PC prevention reported and probably in a short or medium period of time they will not be available. But some aspects must be considered: PC is one of the solid tumors more related to human exposure to socio-environmental and behavior factors (3). Most of risk factors of PC (poverty, bad hygiene, phimosis, tobacco addiction, HPV infection and sexual promiscuity, among others) can be modified. Some interventions in life style and environment can reduce or almost eradicate this disease: tobacco avoidance must be strongly advocated (tobacco users have 2-4 more risk of PC ) (4-9), being the intervention of preventive medicine lato sensu with better results. Improvement of socio-economic conditions and basic sanitation worldwide are empirically associated with lower rates of PC, as in Denmark, where PC incidence drastically decreased after the great wars independently of circumcision not common in that country (10). Campaigns increasing the awareness of genital hygiene must be target to the high risk population as did the Brazilian Society of Urology. Human papilloma virus (HPV) infection is observed in 35-82% of PC patients. Although not a definitive causal agent, as in cervix and anal canal tumors (3,11) serotypes 16 and 18 may contribute to some cases. The reduction of infection through safe sex, less promiscuity and use of condoms may lower PC incidence. HPV vaccine and impact on PC incidence is controversial (11). There are no reported studies; in a hypothetical study in United Kingdom, after a wide vaccination coverage, it was estimated that individual protection against PC would be 50% and the lowering of the total number of projected cases in 2050 would only be of 5% (12). When the vaccination is universal to all girls (61.5%) as occurs is Australia, there is a reduction of genital warts in heterosexual males (13), but the impact of PC reduction was not studied. Lack of scientific data and the high cost of the vaccine (bi or quadrivalent) and the need of a wide population vaccination make impractical the vaccination in countries with higher incidence of PC. In the future, if these countries (most of which don't comply with the minimal vaccination program suggested by the World Health Organization) can reach conditions to total HPV vaccination, probably it will not be necessary eradicate PC anymore. Awareness against promiscuity reduces sexually transmitted diseases (STDs), an associated high risk factor of PC (not causal). The reinforcement for safe sex (condoms) and the reduction of promiscuous partners might reduce the incidence of PC (7-9). Kinky sexual acts, like sex with animals (8,9) were recently described as risk factors for PC and must be discouraged. Phimosis and circumcision: phimosis (associated with the subjacent smegma and difficult hygiene of glans) is a known risk factor for PC (3,4,7,14-16). Among Jewish men submitted to circumcision at birth, the incidence of PC is minimal (17). Neonatal circumcision reduces 5 to 7 times the occurrence of PC (16). Adolescent and adult circumcision doesn't have this protective effect. However, in a recent meta-analysis, childhood circumcision (= 18 years) is correlated to lower incidence of invasive PC. But this study only observed that the circumcision in benefic only to those with phimosis and not for the other children (18). Another possible benefit of childhood circumcision is the occurrence of lower grade PC (isolated evidence (4), requires confirmation). After circumcision of adult male subsaarian Africans it was observed reduction of several STDs (19,20) but the reduction of PC incidence was not studied. In view of all these aspects, one could advocate universal neonatal circumcision for all risk populations, an easy task, since most deliveries occur is hospitals. However, there are several controversies: neonatal circumcision may present complications (21) (must be performed by trained specialists); universal indication has been discussed by Pediatric societies and North American Pediatric Society and US Task Force (22). Some believe that ″health″ preputial skin must be preserved in individuals unable to decide against circumcision. There are some organizations against circumcision (www.mothersagainstcirc.org/www.intactamerica.org/?). CONCLUSIONS In the next decades, PC prevention will be based in politics and sanitarian measures depending on economic aspects, and the physicians will not always influence them. Our role is to sensitize health, sanitization and governmental authorities. In the future, PC prevention will efficiently reduce its incidence or almost eradicate the disease. Precocious diagnosis will provide less invasive treatments. At present, high risk populations should not wait any longer and the urological community must address them with campaigns of awareness and enlightening, as the one promoted by the Brazilian Urological Society (http://www.sbu.org.br/?campanha-penis). For these high risk populations in particular, circumcision performed by trained professionals must be offered and may be benefic, after discussion of risks and benefits with the patients, parents and relatives, and after the signature of a free consent form. REFERENCES 1. Barnholtz-Sloan JS, Maldonado JL, Pow-sang J, Giuliano AR: Incidence trends in primary malignant penile cancer. Urol Oncol. 2007; 25: 361-7. Erratum in: Urol Oncol. 2008; 26: 112. Guiliano, Anna R [corrected to Giuliano, Anna R]. 2. Velazquez EF, Cubilla AL: Penile squamous cell carcinoma: anatomic, pathologic and viral studies in Paraguay (1993-2007). Anal Quant Cytol Histol. 2007; 29: 185-98. 3. Guimaraes GC, Rocha RM, Zequi SC, Cunha IW, Soares FA: Penile cancer: epidemiology and treatment. Curr Oncol Rep. 2011; 13: 231-9. 4. Favorito LA, Nardi AC, Ronalsa M, Zequi SC, Sampaio FJ, Glina S: Epidemiologic study on penile cancer in Brazil. Int Braz J Urol. 2008; 34: 587-91; discussion 591-3. 5. Hellberg D, Valentin J, Eklund T, Nilsson S: Penile cancer: is there an epidemiological role for smoking and sexual behaviour? Br Med J (Clin Res Ed). 1987; 295: 1306-8. 6. Harish K, Ravi R: The role of tobacco in penile carcinoma. Br J Urol. 1995; 75: 375-7. 7. Maden C, Sherman KJ, Beckmann AM, Hislop TG, Teh CZ, Ashley RL, et al.: History of circumcision, medical conditions, and sexual activity and risk of penile cancer. J Natl Cancer Inst. 1993; 85: 19-24. 8. Zequi SC, Guimaraes GC, Fonseca FP: Sex with animals (SWA): characteristics and possible associa- tions with penile cancer and sexually transmitted dis-ease. actual results. A multicentric Brazilian case- control study. J Urol. 2010; 183(4 Supplement): e8. 9. Zequi S de C, Guimaraes GC, da Fonseca FP, Ferreira U, de Matheus WE, Reis LO, et al.: Sex with animals (SWA): behavioral characteristics and possible association with penile cancer. A multicenter study. J Sex Med. 2012; 9: 1860-7. 10. Frisch M, Friis S, Kjaer SK, Melbye M: Falling incidence of penis cancer in an uncircumcised population (Denmark 1943-90).BMJ. 1995; 311: 1471. 11. Shabbir M, Barod R, Hegarty PK, Minhas S: Primary prevention and vaccination for penile cancer. Ther Adv Urol. 2013; 5: 161-9. 12. Hegarty PK, Kayes O, Freeman A, Christopher N, Ralph DJ, Minhas S: A prospective study of 100 cases of penile cancer managed according to European Association of Urology guidelines. BJU Int. 2006; 98: 526-31. 13. Donovan B, Franklin N, Guy R, Grulich AE, Regan DG, Ali H, et al.: Quadrivalent human papillomavirus vaccination and trends in genital warts in Australia: analysis of national sentinel surveillance data. Lancet Infect Dis. 2011; 11: 39-44. 14. Tsen HF, Morgenstern H, Mack T, Peters RK: Risk factors for penile cancer: results of a population-based case-control study in Los Angeles County (United States). Cancer Causes Control. 2001; 12: 267-77. 15. Daling JR, Madeleine MM, Johnson LG, Schwartz SM, Shera KA, Wurscher MA, et al.: Penile cancer: importance of circumcision, human papillomavirus and smoking in in situ and invasive disease. Int J Cancer. 2005; 116: 606-16. 16. Schoen EJ, Oehrli M, Colby Cd, Machin G: The highly protective effect of newborn circumcision against invasive penile cancer. Pediatrics. 2000; 105: e36. 17. Girgis AS, Bergman H, Rosenthal H, Solomon L.: Unusual penile malignancies in circumcised Jewish men. J Urol. 1973; 110: 696-702. 18. Larke NL, Thomas SL, dos Santos Silva I, Weiss HA: Male circumcision and penile cancer: a systematic review and meta-analysis. Cancer Causes Control. 2011; 22: 1097-110. 19. Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, et al.:Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007; 369: 643-56. 20. Tobian AA, Serwadda D, Quinn TC, Kigozi G, Gravitt PE, Laeyendecker O, et al.: Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. N Engl J Med. 2009; 360: 1298-309. 21. Thorup J, Thorup SC, Ifaoui IB.:Complication rate after circumcision in a paediatric surgical setting should not be neglected. Dan Med J. 2013; 60: A4681. 22. American Academy of Pediatrics Task Force on Circumcision. Male circumcision. Pediatrics. 2012; 130: e756-85.
    International braz j urol: official journal of the Brazilian Society of Urology 09/2014; 39(5):611-613.
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    ABSTRACT: We aimed, in this study, to determine the distribution of α-1 AR subtypes in rat and human pelvis and calyces, and to evaluate, by comparing these two species, the possibility of rats to be used as models for humans. Twenty patients with renal carcinoma were included into the study. The patients underwent radical nephrectomy for renal cell carcinoma (RCC). After nephrectomy, specimens were evaluated and excisional biopsies from healthy pelvis and calyces tissues were performed. When pathology confirmed the non-invasion of RCC, specimen was included into the study. A total of 7 adult Wistar Albino (250-300 g) female rats were used in this study. Specimens included renal pelvis and calyces. All specimens were evaluated under light microscope histopathologically. The concentrations of the receptor densities did not differ between the two groups. With the demonstration of the α receptors in rat kidneys and calyces, many receptor-based studies concerning both humans and rats can take place. Novel medication targeting these subtypes -in this matter α1A and α1D for renal pelvis and calyces- may be helpful for expulsive therapy and/or pain relief. With the demonstration of similar receptor densities between human and rat tissues, rat model may be useful for α-receptor trials for renal pelvis and calyces.
    International braz j urol: official journal of the Brazilian Society of Urology 09/2014; 40(5):683-689.
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    ABSTRACT: Tubularized Incised Plate (TIP) urethroplasty is a technique for urethral reconstruction of hypospadias although there are some controversies for its use in recurrent cases. The aim of this study was to review the results of TIP technique in various studies and the usage of different flaps for covering the repair site. Extensive Search was performed for articles published between 1994 and 2013 in common electronic databases. The overall TIP complication rates were estimated by a fixed effects model meta-analysis. 17 articles of hypospadia repair using the TIP method were reviewed. All studies performed surgery and repair on the basis of the Snodgrass's method; however, some introduced modifications to the method. The prevalence of complications in repeated TIP surgery was 11.1 to 33.3% and the most prevalent complication in different studies was fistula. Based on the meta-analysis, the overall estimation of complications was 21.8% (95% CI: 18.3 to 25.5). Most studies performed the incision of the urethral plate to create a supportive coverage upon neourethra, and confirmed its success. We recommend further investigation on using different flaps in well-designed randomized controlled trials to choose the best surgical method for repairing recurrent hypospadias.
    International braz j urol: official journal of the Brazilian Society of Urology 09/2014; 40(5):588-595.
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    ABSTRACT: Objective: To compare cancer detection rates according to the number of biopsy cores in patients on whom a repeat prostate biopsy was performed for atypical small acinar proliferation (ASAP). Materials and Methods: The data of 4950 consecutive patients on whom prostate biopsies were performed were assessed retrospectively. A total of 107 patients were identified as having ASAP following an initial prostate biopsy, and they were included in the study. A six-core prostate biopsy (PBx) was performed on 15 of the 107 patients, 12 PBx on 32 patients, and 20 PBx on 60 patients. Cancer detection rates were compared according to the number of biopsy cores. The localization of the cancer foci was also evaluated. Results: The cancer detection rates in patients on whom 6 PBx, 12 PBx, and 20 PBx were performed were 20% (3/15), 31% (10/32), and 58% (35/60), respectively, and a statistically significant difference was found (p = 0.005). When cancer detection rates in patients with total prostate specific antigen (PSA) < 10ng/mL, PSA density ≥ 0.15, normal digital rectal examination, and prostate volume ≥ 55mL were compared according to the number of biopsy cores, a significant difference was identified (p = 0.02, 0.03, 0.006, and 0.04, respectively). Seventy-five percent of the foci where cancer was detected were at the same and/or adjacent sites as the ASAP foci in the initial biopsy, and 54% were identified in contralateral biopsies in which ASAP foci were present. Conclusion: As the biopsy core number increases, the cancer detection rate increases significantly in patients on whom a repeat biopsy is performed due to ASAP. The highest cancer rate is found in 20-core repeat biopsies performed equally from all foci.
    International braz j urol: official journal of the Brazilian Society of Urology 09/2014; 40(5):605-612.
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    ABSTRACT: To determine the growth rate of renal masses (RMs) under active surveillance (AS), and to describe the clinical outcome of AS patients. We conducted a retrospective review of an AS database to obtain demographics, radiological and pathologic characteristics and RM size of patients. RMs were followed at 6-12 month intervals for ≥1 year with computed tomography (CT), magnetic resonance imaging (MRI), or renal ultrasound. Kaplan-Meier analysis determined the annual likelihood of intervention. RMs were divided into 3 radiographic subcategories (solid, cystic, and angiomyolipoma). A linear regression model determined RM growth rates. 131 RMs in 114 patients were included. Median age, Charlson Comorbidity Index score and mean follow-up were 69.1 years, 4.0 and 4.2±2.6 years, respectively. Maximal tumor diameter (MTD) at diagnosis was 2.1 ± 1.3 cm. 49 RMs exhibited negative or zero net growth. Mean MTD growth rate for all RMs was 0.72±3.2 (95% CI: 0.16-1.28) mm/year. When stratified by MTD at diagnosis, mean RM growth rates were 0.84, 0.84, 0.44, 0.74 and 0.71 mm/year for RMs ≤1 cm, 1-≤2cm, 2-≤ 3cm, 3-≤ 4cm and ≥4cm, respectively (p≤0.01). The 5 and 10-year freedom from intervention rates were 93.1% and 88.5%, respectively. There was a single case of suspected metastases, but no deaths related to kidney cancer. RMs under AS grew slowly, and had a low incidence of requiring surgical intervention and progression. Solid enhancing masses grew slowly, and were more likely to trigger intervention. AS should be considered for selected patients with small RMs.
    International braz j urol: official journal of the Brazilian Society of Urology 09/2014; 40(5):627-636.
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    ABSTRACT: The aim of the present study was to determine state anxiety following radical treatment for localized prostate cancer (PCa), and the impact of trait anxiety on psychological well-being in affected patients. The present study was a cross-sectional survey of 70 men with localized PCa performed between February 2012 and July 2012. Of those, 21, 24, and 25 patients were treated by radical retropubic prostatectomy (RRP), permanent prostate brachytherapy (PPB), and external beam radiotherapy (EBRT), respectively. State anxiety, trait anxiety, and general health were assessed using the State-Trait Anxiety Inventory and 8 Items Short Form Health Survey (SF-8). The rate of very high and high state anxiety in patients who received RRP was 47.6%, while that in patients who received PPB and EBRT was 40.0% and 37.5%, respectively. In contrast, the rate of very high and high trait anxiety in the RRP group was much lower (23.7%). Trait anxiety showed a high correlation with state anxiety and the mental health component summary of SF-8 (correlation coefficient=0.715, -0.504). Trait anxiety was associated with the degree of state anxiety regarding treatments for PCa, followed by change in state anxiety, which might have effects on psychological well-being. Information regarding state anxiety as a consequence of treatments and trait anxiety measurement tool are important considerations for treatment decision-making in newly diagnosed PCa patients.
    International braz j urol: official journal of the Brazilian Society of Urology 09/2014; 40(5):620-626.
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    ABSTRACT: Purpose: Ischemic priapism, which is a compartment syndrome, needs urgent treatment in order to nourish corpora cavernosa. As the first step, the aspiration of blood and/or the irrigation of the cavernosal bodies are performed to prevent fibrotic activity and secure erectile capability. While performing aspiration and irrigation, there are some risks of the procedure in which most refrained one is cardiovascular side effects of adrenergic agonists. We aimed to evaluate extracorporeal transient distal penile corporoglanular shunt technique in place of aspiration/ irrigation techniques for early ischemic priapism treatment. Materials and Methods: In this transient shunt technique, a sterile closed system blood collection set (BD Vacutainer, Cat. No.: 367282; NJ, USA), which has two 21G needles, was used. The length of the needle and tubing was 19 mm. (0.75 inch) and 178 mm. (7 inches), respectively. This blood collection set was designed to be used not only for blood collection but can also be used for short term infusions (maximum 2 hours). Results: Ten patients out of fifteen with early ischemic priapism were successfully treated with this transient shunt technique. The permanent detumescence achieved in the first 10 minutes in nine out of fifteen patients.No additional procedure needed after the disappearance of rigidity in successfully treated patients. The permanent detumescence achieved in the first 10 minutes in nine out of fifteen patients. Conclusions: We demonstrated that this extracorporeal transient shunt technique gets some advantages over aspiration and irrigation in early ischemic priapism treatment. Our results indicate thatthe presented technique to be offered for the patients with an ischemic priapism episode of no more than 7 hours.
    International braz j urol: official journal of the Brazilian Society of Urology 09/2014; 40(5):710-711.
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    ABSTRACT: Purpose: To compare retrograde dye injection through an externalized ureteral catheter with direct needle injection of dye into proximal ureter for identification of unrecognized collecting system disruption and integrity of subsequent repair during open partial nephrectomy. Materials and Methods: We retrospectively reviewed the records of 259 consecutive patients who underwent open partial nephrectomy. Externalized ureteral catheters were placed preoperatively in 110 patients (Group 1); needle injection of methylene blue directly into proximal ureter was used in 120 patients (Group 2). No assessment of the collecting system was performed in 29 patients (Group 3). We compared intraoperative parameters, tumor characteristics, collecting system entry and incidence of urine leaks among the three groups. Results: The mean tumor diameter was 3.1 cm in Group 1, 3.6cm in Group 2, and 3.8 cm in Group 3 (p = 0.04); mean EBL 320cc, 351 cc and 376cc (p = 0.5); mean operative time 193.5 minutes, 221 minutes and 290 minutes (p < 0.001). Collecting system entry was recognized in 63%, 76% and 38% of cases in Groups 1, 2 and 3 respectively. (p = 0.07). Postoperative urine leaks requiring some form of management occurred in 11 patients from group 1 and 6 from group 2. (p = 0.2). No patient in Group 3 developed a urinary leak. Conclusions: Identification of unrecognized collecting system disruption as well as postoperative urine leak rate in patients undergoing partial nephrectomy were not influenced by the intraoperative technique of identifying unrecognized collecting system entry. Postoperative urine leaks are uncommon despite recognized collecting system disruption in the majority of patients.
    International braz j urol: official journal of the Brazilian Society of Urology 07/2014;