Urology

is a common electrolyte disorder that frequently is overlooked and undertreated. Although the pathophysiological process of hyponatremia is complex, arginine vasopressin (AVP) is a common etiologic factor. Excess AVP release by osmotic or nonosmotic stimuli or both can lead to sodium and water imbalance. Conventional treatment options for hyponatremia, including water restriction and administration of sodium chloride with or without loop diuretics, do not directly address the underlying water retention induced by excess AVP in many cases. Clinical trials showed that AVP-receptor antagonists, including lixivaptan, tolvaptan, and conivaptan, produce aquaresis, the electrolyte-sparing excretion of free water, to correct serum sodium concentration. We review results from recent clinical trials involving AVP-receptor antagonists in the treatment of hyponatremia associated with AVP excess.

Background: During bladder filling, the trigone contracts help keep the ureteral orifices open and the bladder neck shut. The trigone generates spontaneous activity as well as responding to neuromuscular transmitters, but the relationship between these phenomena are unclear. Objectives: To characterise the cellular mechanisms that regulate and modify spontaneous activity in trigone smooth muscle. Design, setting, and participants: Muscle strips from the superficial trigone of male guinea-pigs were used for tension experiments and immunofluorescent studies. Measurements: In isolated trigonal cells, intracellular Ca 2+ was measured by epifluorescence microscopy using the fluorescent Ca 2+ indicator Fura-2. Results and limitations: Spontaneous intracellular Ca 2+ transients and contractions were observed in trigonal single cells and strips and were significantly higher compared to the bladder dome. Ca-free superfusate and verapamil terminated spontaneity. T-type Ca 2+ channel block with NiCl 2 depressed slightly Ca 2+ transients but not spontaneous contractions. Neither the BK Ca channel blocker iberiotoxin nor the SK Ca channel blocker apamin had any effect on single cell activity. By contrast, the Cl À channel blocker niflumic acid attenuated significantly both Ca 2+ transients and muscle contractions. Agonist stimulation (carbachol, phenylephrine) up-regulated activity. Gap junction labelling (Cx43) was approximately 5 times denser in the trigone than in detrusor smooth muscle. The gap junction blocker 18-ß-glycyrrhetinic acid modulated spontaneous contractions in the trigone but not in the bladder dome. Conclusions: Trigone myocytes employ membrane L-type-Ca 2+ channels and Cl À channels to generate spontaneous activity. Intercellular electrical coupling ensures its propagation and, thus, sustains contraction of the whole trigone.

The first full-time professorship for urology at a German university was established in 1937 and in 1942, a rare teaching qualification (Habilitation) for urology was granted, both at the prestigious Berlin University. At the same time, nearly a third of all physicians who worked in the field of urology were classified as “non-Aryan” according to Nazi race laws and were forced out of their profession and their homeland. Many of them committed suicide or, if they refused to flee, were murdered in concentration camps. German urologists also contributed to compulsory sterilization of men according to the “law for the prevention of hereditarily diseased offspring” between 1934 and 1945.

Historical sources on the history of urology in Nazi Germany were reviewed and analyzed. These include textbooks and medical journals from the 1930s and 1940s, as well as files from different state and university archives.

For urologists, the changing political environment in Germany after 1933 offered possibilities to assert their personal and professional interests. Unfortunately, in many cases, moral principles were thrown overboard, and physicians advanced their own careers and the specialty of urology at the expense of their patients and their Jewish colleagues.

Under national socialism, German urologists backed Nazi health and race policies and in exchange gained further professionalization for their specialty, including university positions and increased independence from surgery. Only in recent years has this chapter of German urology’s past become a topic of debate among members of the professional society.

We determined whether chronic testicular pain is related to pelvic floor overactivity after ruling out other disease pathology. Materials and Methods: A total of 41 patients with chronic testicular pain evaluated at our Pelvic Floor Department at a tertiary academic center were included in this retrospective study. All patients underwent standard pelvic floor investigation, including history using a standardized questionnaire and electromyography registration of the pelvic floor. In the questionnaire patients were asked about complaints in 3 domains (micturition, defecation and sexual function) suggestive of pelvic floor dysfunction. Electromyography registration of the pelvic floor was performed. The resting tone of the pelvic floor was considered increased at 3 V or greater. Results: Mean patient age was 48 years. Of the patients 93% had at least 1 symptom suspicious of pelvic floor dysfunction. A total of 22% had complaints in 1 of the domains of micturition, defecation or sexual function, 24% had complaints in 2 domains and 49% had complaints in all 3 domains. On electromyography registration of the pelvic floor 88% of patients appeared to have an increased resting tone of the pelvic floor muscles at a mean of 6.7 V (normal less than 3). The patients with a normal pelvic floor resting tone were significantly older than those with an increased resting tone (65.6 vs 45.6, p ϭ 0.0001). Conclusions: Chronic testicular pain can be a symptom of pelvic floor overactivity, especially in younger patients. A diagnostic evaluation should be performed when no pathophysiology can be found.

It is sometimes argued that the non-therapeutic, non-consensual alteration of children’s genitals should be discussed in two separate ethical discourses: one for girls (in which such alterations should be termed ‘female genital mutilation’ or FGM), and one for boys (in which such alterations should be termed ‘male circumcision’). In this article, I call into question the moral and empirical basis for such a distinction, and argue that all children—whether female, male, or intersex—should be free from having parts of their genitals removed unless there is a pressing medical indication.

Introduction. Urolithiasis is one of the common disorder with which about 1/5th is found in the ureter, of which 2/3rd is seen in the lower ureter. Medical expulsive therapy is one of the routine modalities of treatment which uses various drugs acting on the ureter smooth muscle by different mechanism. We aim to compare the efficacy of combination vs. single drug. Methods. This randomized controlled trial was done in 176 consecutive patients over a period of six months (March 2019 to August 2019) in Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching. Participants were divided into two groups (Group A, tamsulosin plus tadalafil, and Group B, tamsulosin) from computer-generated random numbers. Therapy was continued for a maximum of 3 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic and emergency room visits for pain, early intervention, and adverse effects of drugs were recorded. Results. Among 176 patients who were e...

Purpose: We determined whether biofeedback enhanced pelvic floor exercises begun 6 weeks after radical prostatectomy improve the early recovery of continence. Materials and Methods: We randomized 30 patients who underwent radical retropubic prostatectomy into a group that received 5 biofeedback sessions and a control group. Results: Overall 87% of patients were pad-free at 6 months with similar results in the treatment and control groups (86% versus 88%). There was no statistically significant difference in pad test results or voiding diary records in the 2 groups. Conclusions: A treatment program of biofeedback enhanced pelvic floor exercises begun 6 weeks after radical retropubic prostatectomy did not significantly affect continence in this study.

We appreciate the authors 1 for their study concluding that bladder pain syndrome (BPS)/interstitial cystitis (IC) severity may not increase the likelihood of suicidal ideation except via severity of depression symptoms. Here we would like to highlight certain issues related to this study with regard to depression and suicidal ideation (SI) in IC. In their study, the authors mention that depressionnot the severity of IC symptoms-was found to be a significant predictor for SI, suggesting factors other than IC symptoms account for SI. Those factors could not be evaluated because of the nature of study (ie, using only a single self-report item without any clinical evaluation). This may result in misdiagnosing IC as well as missing (using the RICE high-specificity case definition used in the study) the chronic functional pain syndromes (eg, fibromyalgia) which have been found to be associated with IC. 2 Further, pain mapping studies in IC patients have shown pain outside the bladder region (in many areas of the body) in the vast majority (up to 73%) of patients 3 and to the extent that many (up to 26%) patients may have pain in Ͼ10 body sites 3 (similar to chronic functional pain syndromes). This is associated with more depression, poorer psychosocial adjustments, and diminished quality of lifepotentially important contributors to SI. More than half (59.4% in the no SI group and 61.2% in SI group) of the IC patients were not receiving treatment at the time of study, thus probability of their BPS/IC symptoms being nonbothersome cannot be ruled out. This also suggests other reasons for depression and SI. Hence, suicidal ideation in IC may not be caused only by IC/IC-related depression per se. Contribution of these associated chronic functional pain syndromes-which themselves can cause depression in addition to increasing the depression related to IC-for suicidal ideation in IC patients also needs attention for better management of these patients.

Purpose: The intrarenal resistive index is a physiological parameter that indirectly reflects the degree of resistance in the intrarenal vasculature. Resistive index measurements have been advocated for the diagnostic evaluation of several renal pathologies, including obstructive uropathy. However, despite extensive research in this field during the last decade clear guidelines on the use of resistive index measurements for discriminating obstructive from nonobstructive dilatation of the upper urinary tract remain elusive. Therefore, we reviewed the literature to clarify the proper role of resistive index measurements in the context of obstructive uropathy.

Fluoroquinolones are the most commonly used prophylactic antimicrobials for ultrasound-guided transrectal prostate biopsy due to their broad pathogen spectrum, pharmacokinetics, bioavailability and ease of oral administration. However, although Escherichia. coli (E. coli) is the most common pathogen associated with infections after transrectal prostate biopsy, the prevalence of fluoroquinolone resistant strains of E. coli is increasing. Levofloxacin resistant E. coli sepsis occurred in four (0.6%) of 665 patients who received oral levofloxacin prophylaxis and underwent transrectal prostate biopsy from July 2002 to December 2006 in this institute. All patients had obstructions of the lower urinary tract and three of the four had a history of previous use of quinolones. Although two of the four patients developed septic shock, all of the patients were treated with carbapenems immediately and made a complete recovery. Since a case of multiresistant E. coli sepsis and fatal anaerobic sepsis after transrectal prostate biopsy had been reported , intravenous carbapenem is recommended as antimicrobial therapy for sepsis after transrectal prostate biopsy.

Purpose: To our knowledge epidemiological data on the incidence of failed hypospadias repair and the number of patients seeking further surgical treatment remain unknown. We report an observational, descriptive survey of patients who were evaluated and treated for urethral stricture disease and/or penile defects after primary hypospadias repair.

Objectives. To investigate the effectiveness and morbidity of percutaneous laser endoureterotomy in the management of ureterointestinal anastomotic strictures after radical cystectomy and urinary diversion. Methods. Between May 1997 and August 2000, 19 percutaneous endoureterotomy incisions, including 3 repeated incisions, were performed on 15 patients with a mean age of 61 years (range 41 to 80) to treat ureterointestinal strictures. A total of 16 renal units were treated (9 left, 7 right), including one bilateral procedure. All procedures were performed using a 200-m holmium laser fiber in antegrade fashion with a 7.5F flexible ureteroscope. A nephroureteral stent was left in place for 4 to 6 weeks postoperatively. Success was defined as radiologic improvement and/or the ability to return to full activity in the absence of flank pain, infection, or the need for ureteral stents or nephrostomy tubes. Results. With a median follow-up of 20.5 months (range 9 to 41), the overall success rate was 57% (8 of 14 renal units). Two patients were lost to follow-up. The mean operative time was 91 minutes, and no perioperative complications occurred. Three patients required repeated endoureterotomies, with two requiring open reimplantation. Overall, the endoureterotomy failed in 6 patients in the series, with five of the six failures involving left-sided strictures. Conclusions. Percutaneous endoureterotomy is an effective, minimally invasive treatment option for patients with ureterointestinal strictures after urinary diversion. Better visualization and a more precise incision may make the holmium laser a safer cutting modality than alternative methods in patients with ureteroenteric strictures. Patients with left-sided ureterointestinal strictures should be cautioned that endourologic management might have a lower success rate. UROLOGY 58: 924-929, 2001.

The correlation between timing of the primary neurosurgical repair and urological prognosis in infants with open spinal dysraphism remains unknown. We investigated the impact of primary repair timing on neurogenic bladder prognosis in children with myelomeningocele. Materials and Methods: We retrospectively reviewed the records of 401 children with myelomeningocele followed at our multidisciplinary clinic between 1996 and 2005. Among these patients 129 were included in the study based on the availability of urological followup data at age 3 years, which was chosen as an ideal point for the standardization of urological findings. Children were assigned to 1 of 2 groups-those who underwent primary neurosurgical repair within 72 hours of delivery (group 1) and those undergoing repair after 72 hours (group 2). We compared the incidence of febrile urinary tract infections, hydronephrosis, vesicoureteral reflux and secondary tethering of the spinal cord at age 3 years, as well as cystometric bladder capacity and detrusor leak point pressure between the 2 groups. Results: Urological followup data at age 3 years revealed significantly increased incidence of febrile urinary tract infections, vesicoureteral reflux, hydronephrosis and secondary tethering of the spinal cord in children in group 2 compared to group 1 (chi-square, p Յ0.05 for all comparisons). Urodynamic assessment also showed a significantly lower bladder capacity and a substantially higher detrusor leak point pressure in children who received primary repair at later than 72 hours (t test, p Ͻ0.05).

We categorized trends in failure of the stone baskets as reported in the United States Food and Drug Administration Manufacturer and User Facility Device Experience database. Materials and Methods: We queried the online database using the code for stone baskets (FFL) from January 1996 to December 2009. Variables extracted were the type of basket, malfunction and treatment, and patient outcome. Results: We identified 556 adverse events related to stone baskets. The device configuration was tipped in 48% of cases, tipless in 36%, forceps in 8% and the Stone Cone™ in 8%. Malfunction type included detachment of a portion of the basket in 49% of cases, breakage without detachment in 39% and inability to withdraw the basket in 12%. Compared to the early period studied (1996 to 2004) there was a 3-fold increase in adverse events from 2005 to 2007 and a 6-fold increase from 2008 to 2009. Of adverse events 79% and 11% were managed by endoscopy and open surgery, respectively. Of the patients 42 experienced serious complications requiring major surgery, including ureteral reconstruction in 7, reimplantation in 4 and nephrectomy in 7. Conclusions: With the increased use of stone baskets in the upper collecting system the number of adverse events has increased. Urologists should remain vigilant to prevent, recognize and manage these events.

OBJECTIVE To assess the effect of smoking on sperm vitality, sperm DNA integrity, semen reactive oxygen species, and zinc levels in fertile men. METHODS One-hundred sixty men were investigated. They were divided into 2 equal groups: healthy fertile nonsmokers and healthy fertile smokers. They were subjected to history taking, clinical examination, and semen analysis. In their semen, sperm hypo-osmotic swelling test, sperm DNA fragmentation test, seminal reactive oxygen species, and zinc were assessed. RESULTS Compared with fertile nonsmokers, fertile smokers were significantly associated with lower hypo-osmotic swelling test and seminal zinc levels and significantly associated with higher sperm DNA fragmentation percent and seminal reactive oxygen species levels. CONCLUSION Smoking (cigarettes/day and duration) has detrimental effects on sperm motility, viability, DNA fragmentation, seminal zinc levels, and semen reactive oxygen species levels, even in fertile men, and it is directly correlated with cigarette quantity and smoking duration. UROLOGY 80: 822-825, 2012.

PURPOSE To evaluate patients who cyst hydatid (CH) in their retroperitoneal space and organs in order to determine a standard treatment option for CH. MATERIALS AND METHODS The files of 56 patients who were treated for CH in our clinic were evaluated retrospectively. All patients underwent either percutaneous drainage (PD) or surgery. Patients were divided into two groups as PD (Group one) and surgery groups (Group two). Preoperative and postoperative results were compared statistically. RESULTS 31 of 56 patients were male. Mean age of the patient was 39.7 (10-85). 16 patients had been treated with PD and 40 with different surgical interventions such as total cystectomy, partial cystectomy, partial nephrectomy, total nephrectomy, surrenalectomy, and laparoscopic partial surrenalectomy. Patients' followed up was 18 months (6-38m). Relapse was seen in 1 patient who underwent PD. On comparing the results, hospitalization period was prolonged in the surgical group with enlarged cyst...

The purpose of this guideline is to provide a clinical strategy for the diagnosis and treatment of erectile dysfunction. A systematic review of the literature using the Pubmed, Embase, and Cochrane databases (search dates 1/1/1965 to 7/29/17) was conducted to identify peer-reviewed publications relevant to the diagnosis and treatment of erectile dysfunction. Evidence-based statements were based on body of evidence strength Grade A, B, or C and were designated as Strong, Moderate, and Conditional Recommendations with additional statements presented in the form of Clinical Principles or Expert Opinions. The American Urological Association has developed an evidence-based guideline on the management of erectile dysfunction. This document is designed to be used in conjunction with the associated treatment algorithm. Using the shared decision-making process as a cornerstone for care, all patients should be informed of all treatment modalities that are not contraindicated, regardless of in...

Purpose: Tookad® is a novel intravascular photosensitizer. When activated by 763 nm light, it destroys tumors by damaging their blood supply. It then clears rapidly from the circulatory system. To our knowledge we report the first application of Tookad vascular targeted photodynamic therapy in humans. We assessed the safety, pharmacokinetics and preliminary treatment response as a salvage procedure after external beam radiation therapy. Materials and Methods: Patients received escalating drug doses of 0.1 to 2 mg/kg at a fixed light dose of 100 J/cm or escalated light doses of 230 and 360 J/cm at the 2 mg/kg dose. Four optical fibers were placed transperineally in the prostate, including 2 for light delivery and 2 for light dosimetry. Treatment response was assessed primarily by hypovascular lesion formation on contrast enhanced magnetic resonance imaging and transrectal ultrasound guided biopsies targeting areas of lesion formation and secondarily by serum prostate specific antigen changes. Results: Tookad vascular targeted photodynamic therapy was technically feasible. The plasma drug concentration was negligible by 2 hours after infusion. In the drug escalation arm 3 of 6 patients responded, as seen on magnetic resonance imaging, including 1 at 1 mg/kg and 2 at 2 mg/kg. The light dose escalation demonstrated an increasing volume of effect with 2 of 3 patients in the first light escalation cohort responding and all 6 responding at the highest light dose with lesions encompassing up to 70% of the peripheral zone. There were no serious adverse events, and continence and potency were maintained. Conclusions: Tookad vascular targeted photodynamic therapy salvage therapy is safe and well tolerated. Lesion formation is strongly drug and light dose dependent. Early histological and magnetic resonance imaging responses highlight the clinical potential of Tookad vascular targeted photodynamic therapy to manage post-external beam radiation therapy recurrence.

The Contrast Media Safety Committee of the European Society of Urogenital Radiology (ESUR) has looked at the effects of contrast media (CM) on the kidney including prevention of contrast mediuminduced nephropathy (CIN) as well as at the possibility of identifying patients with increased risk of CIN nephropathy. This has resulted in five reports dealing with (i) serum creatinine; (ii) contrast medium-induced nephrotoxicity; (iii) haemodialysis and contrast media; (iv) use of gadolinium CM instead of iodinated CM; and (v) CM injection in diabetic patients receiving metformin. The review presents an overview of four of these five reports.

To investigate the causes and costs of flexible ureteroscope damage, and to develop recommendations to limit damage. Methods: The authors analysed repair figures and possible causes of damage to 35 instruments sent for repair to a leading UK supplier over a 1-year period, and calculated cost figures for maintenance of the instruments as opposed to repair and replacement costs. Results: All damages were handling-induced and therefore did not fall under the manufacturer's warranty: 28 % were damaged by misfiring of the laser inside the instrument; 72 %, mainly crushing and stripping of the ureteroscope shaft tube, were likely to have occurred during out-of-surgery handling, washing and disinfection. Seventeen (4 %) instruments were not repaired and consequently taken out of service due to the extensive costs involved. Eighteen (51 %) ureteroscopes were repaired at an average cost of 10 833 USD. Conclusion: Damages to flexible ureteroscopes bear considerable costs. Most damages occur during handling between surgical procedures. Thorough adherence to handling procedures, and courses for theater staff and surgeons on handling flexible instruments may help to reduce these damages and prove a cost-saving investment. The authors provide a list of recommended procedural measures that may help to prevent such damages. (Asian J Androl 2005 Dec; 7: 433-438)

Context: Approximately 15-25% of men who undergo radical prostatectomy for localized prostate cancer (PCa) will experience recurrence of their cancer; men with poorly differentiated cancer, non-organ-confined disease, and positive surgical margins are at the highest risk.

Purpose: Vascular targeted photodynamic therapy with WST11 (TOOKADÒ Soluble) is in phase III clinical trials of an interstitial transperineal approach for focal therapy of prostate cancer. We investigated the safety and efficacy of the endourethral route in the context of benign prostatic hyperplasia in the dog model. Materials and Methods: An optical laser fiber was positioned in the prostatic urethra of 34 dogs, including 4 controls. It was connected to a 753 nm diode laser at 200 mW/cm fluence, delivering 200 to 300 J. WST11 (5 to 15 mg/kg) was infused intravenously in 2 modes, including continuous, starting 5 to 15 minutes before and during illumination, or a bolus 5 to 10 minutes before illumination. Prostate ultrasound, cystourethrogram, urodynamics and histopathology were performed. Followup was 1 week to 1 year. Results: Endourethral WST11 vascular targeted photodynamic therapy was uneventful in all except 1 dog, which experienced urinary retention but reached the 1-week end point. All prostates except those in controls showed hemorrhagic lesions. They consisted of 2 levels of concentric alterations, including periurethral necrosis with endothelial layer destruction and adjacent inflammation/atrophy with normal blood vessels. Prostatic urethral width increased as early as 6 weeks after treatment, while prostatic volume decreased, reaching 25% by 18 to 26 weeks. A parallel decrease in urethral pressure at 6 weeks lasted up to 1 year. Conclusions: We confirmed the vascular effect of endourethral WST11 vascular targeted photodynamic therapy. To our knowledge we report for the first time that the resulting periurethral necrosis led to significant, sustained widening of the prostatic urethra, accompanied by long-term improvement in urodynamic parameters. These findings support future clinical applications of this minimally invasive approach to benign prostatic hyperplasia.

OBJECTIVES To compare the long-term, prostate-specific antigen relapse-free survival outcome and incidence of toxicity for patients with low-risk prostate cancer who underwent brachytherapy or intensitymodulated radiotherapy (RT). METHODS A total of 729 consecutive patients underwent brachytherapy (n ϭ 448; prescription dose 144 Gy) or intensity-modulated RT alone (n ϭ 281; prescription dose 81 Gy). The prostate-specific antigen relapse-free survival using the nadir plus 2 ng/mL definition and late toxicity using the National Cancer Institute's Common Terminology Criteria for Adverse Events were determined. RESULTS The 7-year prostate-specific antigen relapse-free survival rate for the brachytherapy and intensity-modulated RT groups was 95% and 89% for low-risk patients, respectively (P ϭ .004). Cox regression analysis demonstrated that brachytherapy was associated with improved prostatespecific antigen relapse-free survival, even after adjustment for other variables. The incidence of metastatic disease between treatment sessions was low for both treatment groups. Late grade 2 gastrointestinal toxicity was observed in 5.1% and 1.4% of the brachytherapy and intensitymodulated RT groups, respectively (P ϭ .02). No significant differences were seen between treatment groups for late grade 3 or greater rectal complications (brachytherapy 1.1% and intensity-modulated RT 0%; P ϭ .19). Late grade 2 urinary toxicity occurred more often in the brachytherapy group than in the intensity-modulated RT group (15.6% and 4.3%, respectively; P Ͻ .0001). No significant differences were seen between the 2 treatment groups for late grade 3 urinary toxicity (brachytherapy 2.2% and intensity-modulated RT 1.4%; P ϭ .62). CONCLUSIONS Among low-risk prostate cancer patients, the 7-year biochemical tumor control was superior for intraoperatively planned brachytherapy compared with high-dose intensity-modulated RT. Although significant toxicities were minimal for both groups, modest, but significant, increases in grade 2 urinary and rectal symptoms were noted for brachytherapy compared with intensitymodulated RT.

The internal validity of an epidemiological study can be affected by random error and systematic error. Random error reflects a problem of precision in assessing a given exposure-disease relationship and can be reduced by increasing the sample size. On the other hand, systematic error or bias reflects a problem of validity of the study and arises because of any error resulting from methods used by the investigator when recruiting individuals for the study, from factors affecting the study participation (selection bias) or from systematic distortions when collecting information about exposures and outcomes (information bias). Another important factor which may affect the internal validity of a clinical study is confounding. In this article, we focus on two categories of bias: selection bias and information bias. Confounding will be described in a future article of this series.

Background: Grading of noninvasive papillary urinary bladder carcinoma (PUC) is routinely performed in clinical oncologic practice; however, reports regarding diagnostic and prognostic accuracy are contradictory. Objective: To compare the 1973 and 2004 World Health Organisation (WHO) classifications in terms of interobserver variability and prognostic implications. Design, setting, and participants: Two hundred PUC were retrospectively reviewed by four independent expert genitourinary pathologists blinded with respect to patient identity and clinical outcome. Tumour grading was assigned according to the 1973 and 2004 WHO classifications. Surveying a mean postsurgical follow-up of 71.8 mo (range: 18-163 mo), clinical outcome in terms of recurrence-free and progression-free survival was recorded for all patients. Intervention: All of the patients underwent transurethral resection of the bladder. Measurements: The generalised k (kappa statistic) for interobserver variability was calculated, and Kaplan-Meier analysis as well as univariate regression analysis were performed to evaluate prognostic implications in terms of recurrence and progression rates. Results and limitations: During the follow-up, a total of 84 (42%) patients experienced recurrence, whereas another 18 (9%) patients featured disease progression. Owing to the rare presence of papillary urothelial neoplasms of low malignant potential (PUNLMP) in our cohort (0-3.5%), the 2004 WHO classification

Objective To obtain face and construct validity for a new training course to be used in any type of box/video trainer and to give a comprehensive overview of validated exercises for box/video training. Design Cross-sectional study. Setting University Medical Centre. Population Students, residents and consultants. Methods Participants (n = 42) were divided into three groups according to their laparoscopic experience: 'Novices' (n = 18), 'Intermediates' (n = 14) and 'Experts' (n = 10). A laparoscopic training course consisting of six exercises was constructed. To emphasise precision, a penalty score was added. Every participant performed two repetitions of the exercises; total score per exercise was calculated. To determine face validity, participants filled in a questionnaire after completion of the exercises. An evidence-based literature search for validated box/video trainer exercises was performed. Main outcome measures Face and construct validity. Results The mean score of the 'experts' was set as the training target. Total scores appeared to be positively correlated with individual's laparoscopic experience. The overall score and the score for each exercise were significantly higher in the intermediate and expert groups when compared with the novice group (P £ 0.001). All participants completed the questionnaire. The overall assessment of the exercises was considered to be good. The course was found to be most appropriate for training residents year 1-3. Conclusion Face and construct validity for an inexpensive course for box/video training was established. A comprehensive and practical overview of all validated and published exercises for box/ video trainers is provided to facilitate an inexpensive, but optimal and tailored selection for training purposes.

To investigate the abundance of chondroitin sulfate proteoglycans at the bladder lumenal and subepithelial surfaces in bladder biopsies derived from patients with interstitial cystitis (IC) and controls. Methods. Tissue sections derived from biopsies from 31 IC patients and 24 pathologically normal control sections were labeled for proteoglycans using the 2B6 anti-"stub" antibody and detected by immunohistochemistry. Results. On the lumenal surface, 5 of 31 (19%) IC sections were positive for proteoglycans versus 14 of 24 (58%) control sections (P = 0.000 1 1). At the basal surface, 5 of 19 IC patients were positive versus 7 of 12 controls (P = 0.032). Conclusions. A deficit of bladder lumenal and basal proteoglycans is associated with IC. The deficit in basal layer proteoglycans suggests an altered urothelial differentiation program. The lumenal deficit suggests that the charge-dependent exclusion of ions from the bladder surface is compromised in IC.

Our aim was to evaluate the effect of neat semen vitrification on human sperm vital parameters and DNA integrity in men with normal and abnormal sperm parameters. Semen samples were 17 normozoospermic samples and 17 specimens with abnormal sperm parameters. Semen analysis was performed according to World Health Organization (WHO) criteria. Then, the smear was provided from each sample and fixed for terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. Vitrification of neat semen was done by plunging cryoloops directly into liquid nitrogen and preserved for 7 days. The samples were warmed and re-evaluated for sperm parameters as well as DNA integrity. Besides, the correlation between sperm parameters and DNA fragmentation was assessed pre- and post vitrification. Cryopreserved spermatozoa showed significant decrease in sperm motility, viability and normal morphology after thawing in both normal and abnormal semen. Also, the rate of sperm DNA fragmentation was...

Sub-Saharan Africa (SSA) comprises the countries in Africa that do not have a Mediterranean coastline. This region is home to over 600 million people, most of whom are women and children/young adults who live in the rural areas. Most SSA countries are 'poor' and have low average life expectancy. The subcontinent has a low density health workforce and they are required to provide their services mostly under difficult circumstances. Not surprisingly they are the most likely to migrate to greener pastures. Healthcare provision in general is therefore a challenge in this region and urology is no exception. This article explores some of the more significant challenges facing urological practice and training in SSA. These include those challenges to healthcare practice in general (political instability, poverty, poor healthcare and family planning policies and HIV/AIDS) and those to urology specifically (limited number of trained urologists, limited training capacity, limited availability of modern equipment and drugs, nonrecognition of men's health as a subspecialty). Brief suggestions to overcome these problems are made and the need for a wholesome review of the political, economic and healthcare policies is emphasised.

A procedure for the correction of urinary stress inconti-Lence has been devised which has given results approximatag and often surpassing those which follow the commonly tsed operations. A description of this new attack upon an old ¢oblem is given as well as an account of a test devised to acilitate the selection of cases in which the outcome of treataent is likely to be successful. This procedure has been arried out on 50 patients to date. Thirty-eight cases were of he usual variety of stress incontinence in females and 25 of hese had previously had a total of 40 standard gynecological perations without relief of this distressing condition. The emaining 12 patients were treated for unsatisfactory uritory control due to a variety of causes. The basic plan of this procedure was derived from a study ~f vesical dysfunction following removal of the rectum (11). A dgh incidence of disturbance in the lower urinary tract, hiefly retention, followed excision of the rectum by either he abdominoperineal approach or the perineal route alone, 'et the incidence was low following operations omitting the ~erineal dissection. Traditionally this dysfunction has been Lscribed to damage of nerves, but in this study no specifically teurological change could be demonstrated. Furthermore, ransurethral revision of the vesical outlet in those patients laving persistent retention after perineal rectal removal pro° ~ided more satisfactory results than are usually obtained in nstances of established neurogenic bladder. On the other rand, transurethral resection after rectal excision was less ;atisfactory than in cases of simple prostatism. Accordingly, t seemed apparent that a major factor producing retention tfter perineal excisions existed which was not neurological md which was not pure prostatism. An observation that nost of the patients with thi_a complication had mobility and harked sagging of the vesicaTbase and outlet suggested that ack of elevation and fixation might be this unrecognized actor. In some cases firm upward pressure on the perineum vith a fist or harness would provide temporary elevation and ixation and these patients could thereby void satisfactorily. n fact one patient declined transurethral surgery when he bund that perineal support on voiding permitted emptying md relieved overflow incontinence. From time to time myserious cases appeared in which, after removal of the rectum, t transurethral prostatectomy relieved retention only to re-;ult in incontinence! Finally, the following case seemed to ntegrate these observations and suggestions: L. W., M.H. history No. 70735, a 54 year old male, had complete lrinary retention following abdomino-perineal removal of the recum. Neurological changes in the urinary apparatus could not be lemonstrated. Two transurethral resections resulted in total inconinence even though the external urethral sphincter had not been tamaged. Perineal pressure would provide good control. Simple su-From the Departments of Surgery (Urology) and Obstetrics and ~ynecology of Cornell University Medical College and the New York ~Iospital, and the Department of Urology of the Memorial Hospital. prapubic suspension of the vesical outlet by suturing to the pubis immediately and completely corrected his urinary control which has remained normal for a period of 46 months. By analogy, the knowledge gained from the study of these rectal cases was applied to the problem of the common stress incontinence of females. A simple operative elevation and fixation via the suprapubic route was planned; but first a prognostic test was devised, based particularly upon the observations regarding sagging of the vesical outlet and the effect of perineal pressure. This test provides simple temporary elevation and fixation of the vesical outlet as an evaluation for each case considered for operation. Its value was promptly appreciated because a successful result from the new operation was rarely obtained if the preoperative test was unfavorable. Furthermore, the cause of some failures following the suspension and standard operations for incontinence can be revealed by this trial procedure.

More successful methods of vasectomy reversal would benefit those undergoing this treatment and might also increase the popularity of vasectomy. We conducted a randomized, prospective clinical trial of vasectomy reversal methods, comparing a new absorbable stent with 2-layer reattachment.We studied 116 men seeking vasectomy reversal between November 1990 and March 1994. Data were analyzed primarily by intention to treat.Patients in the stent (64 cases) and no stent (52) randomized groups were similar in age distribution, age of spouses, years since vasectomy, proportion who had undergone prior vasectomy reversal and proportion who had previously achieved pregnancy. Operation time was more than 19 minutes shorter in the stent randomized group (p = 0.006). Fewer patients in the stent than the no stent group had patent vasovasostomies (81.0 versus 89.6%, respectively, p = 0.2) postoperatively. Fewer stent randomized patients had motile sperm (76.2 versus 81.3%, respectively, p = 0.5) and normal total motile sperm counts (49.2 versus 52.1%, respectively, p = 0.8) than did those without a stent. Conception occurred in 22 and 51% of all couples in the stent and no stent groups. The relative risk of conception among those in the stent group was 0.42 (95% confidence interval 0.24 to 0.71, p = 0.002). A Mantel-Cox log-rank test comparing pregnancies in each group according to the number of postoperative months revealed that the no stent group achieved more earlier pregnancies (p = 0.003).The 2-layer microscopic vasovasostomy results in greater pregnancy rates than vasovasostomy using the absorbable stent.

Editorial Comment: Since 35% of the patients did not return the case report forms and the expected placebo effect for subjective symptomatology ranges between 20 and 40?6, a randomized double-blind placebo controlled study clearly is necessary, as the authors suggest. Urology, suppl., 4 9 111-113, 1997 Objectives. On the assumption that interstitial cystitis (IC) is the result of a defective mucous lining of the bladder epithelium, a study was carried out to investigate the activity of hyaluronic acid (HA) in the treatment of IC. HA is an important glycosaminoglycan (GAG) present in all connective tissues, including the GAG layer of the vesical mucosa. It exhibits a variety of pharmacologic properties that enhance its appeal for the therapy of IC.

To investigate the physiopathologic mechanisms of the rupture of the corpora cavernosa by means of a histologic study of the tunica albuginea. In 6 patients (age range 28 to 49 years, mean 38) with traumatic penile rupture, samples of the tunica albuginea were taken during corrective surgery far from the site of the lesion. These specimens were analyzed with light microscopy by the same pathologist and compared with other samples of tunica albuginea taken from 7 patients who underwent penile surgery for other reasons. Five of the 6 patients with traumatic penile rupture had histologic anomalies of the tunica albuginea (fibrosclerosis in all 5 patients [83%] and phlogistic cellular infiltrations composed of lymphocytes or histiocytes in 3 patients [50%]). Only 1 patient (17%) with traumatic rupture of the corpus cavernosum had a completely healthy tunica albuginea. None of the control specimens revealed any histologic alterations. Structural anomalies could alter the mechanical prope...

Background: After decades of irradiation as standard therapy for clinical stage I testicular seminoma, alternative treatment approaches have emerged including postorchiectomy surveillance and adjuvant chemotherapy. This study was performed to assess a dual policy of surveillance and selective single-agent carboplatin (for high-risk cases) in a multicenter setting. From 1994From to 1999 patients with stage I seminoma were included. Sixty (29.6%) were considered poor-risk cases (i.e. with vascular invasion and/or pathological tumor stage pT2 or greater) and received two courses of adjuvant carboplatin, whereas 143 (70.4%) without risk criteria underwent close surveillance.

Various biological and artificial materials have been introduced for endoscopic treatment of vesicoureteral reflux. Over the past years, dextranomer combined with hyaluronic acid (Dx/Ha) has been established as the most commonly used tissue-augmenting substance for subureteral injection because of its biocompatibility. Nevertheless, the histopathologic analysis of failed Dx/Ha injections showed changes in consistency and volume of the deposit and granulomatous reactions of the adjacent tissue. We report a case of late-onset obstruction 2 years after the injection of Dx/Ha. In the current literature, this potential long-term complication is hardly mentioned. UROLOGY 83: 920e923, 2014.