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   Table of Contents - Current issue
November-December 2019
Volume 30 | Issue 6
Page Nos. 243-285

Online since Monday, December 23, 2019

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Advancement of urological oncology and more p. 243
Stephen Shei-Dei Yang
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Genotyping and molecular characterization of extended-spectrum beta-lactamases-producing uropathogenic Escherichia coli in and around Coimbatore district, Tamil Nadu, India p. 244
Mylsamy Muraleetharan, Thirumoorthy Viswanathan
Background: Escherichia coli, an extraintestinal flora, develops virulence traits through a persistent encounter with host and constant exposure to antibiotics, which makes it line up as the most common urinary pathogen. Thus, this study aimed to screen the presence of virulence traits among multidrug-resistant urinary pathogenic E. coli among the urine samples collected from inpatients and outpatients of the multispecialty hospitals. Materials and Methods: Standard microbiological laboratory protocols were followed, and about 210 samples were processed and screened. Results: Among those samples, 114 were reported positive for the presence of uropathogenic E. coli(UPEC). Gender-wise distribution was found to be more among female patients (56%) than male patients (51%). During screening for hemolytic activity, 37% of test isolates were α hemolytic, 48% were β hemolytic, and 15% were γ hemolytic. Screening virulence among test isolates, sfa gene (49%), afa (42%), hly (68%), CNF (43%), and aer, accounts for 65%. Further, the multidrug resistance of the isolates was done by using ten antibiotics. All the isolates exhibited the multiple antibiotic resistance (MAR), and the highest percentage of resistance was found against ceftazidime (100%), and the least percentage of resistance was observed against imipenem (2%) followed by amikacin (8%). MAR index values of all the isolates ranged from 0.4 to 1. Conclusion: The presence of various virulence genes and the high degree of resistance among the isolates against the antibiotics used in this study confirm the prevalence of extended-spectrum β-lactamase producers among the UPEC.
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How safe could open extravesical bladder cuff resection guarantee complete removal of ipsilateral ureteral orifice? Highly accessed article p. 250
Yu-Chiao Lin, Chien-Hui Ou, Wen-Horng Yang, Yao-Lin Kao
Objectives: The aim of this study is to report our 8-year experience in terms of the success rate of complete bladder buff resection procedures bladder cuff resection (BCR) and further oncological outcomes in patients under open extravesical BCR for the management of primary upper tract urothelial carcinoma (UTUC). Materials and Methods: We retrospectively reviewed patients with primary UTUC who undergone laparoscopic nephroureterectomy and open extravesical BCR in our center. Complete BCR procedures were not defined by any ureteral orifice remnant noted in postoperative cystoscopy surveillance. The rate of complete BCR procedures was calculated. Patients were divided into residual ureteral orifice group (RUO) and nonRUO group (NRUO) and the intravesical and local recurrences and distant metastasis were analyzed and compared across the two groups. Results: A total of 105 patients were reviewed. After operation, 67 of them (63.8%) had ipsilateral strict criteria of complete BCR procedures defined on cystoscopy. Shorter mean operative time was noted in the RUO group comparing to the NRUO group (145 ± 73 vs. 192 ± 107 min, P = 0.03). Bladder recurrence was significantly higher in the RUO group (RUO vs. NRUO: 59.7% vs. 26%, P = 0.001) during a median of 39.7 months follow-up. Most of the intravesical recurrences were superficial (94%) and more prone to be found near the RUO/scar in the RUO group rather than the NRUO group (59.7% vs. 26.3%, P = 0.04). The RUO group strongly predicted superficial intravesical recurrence (odds ratio: 4.04, 95% confidence interval: 1.57–10.37, P = 0.004). No significant difference was recorded in muscle invasive bladder tumor, local recurrence, contralateral urinary tract recurrence, or distal metastasis across the groups. Conclusions: Open extravesical BCR does not guarantee the complete removal of ipsilateral ureteral orifice. Increased risk of superficial intravesical recurrence is noted in patients with RUO.
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Smaller Prostate Volume is Associated with Adverse Pathological Features and Biochemical Recurrence after Radical Prostatectomy p. 255
John Buie, Werner De Riese, Pranav Sharma
Introduction: The relationship between prostate cancer (PCa) and benign prostatic hyperplasia is unclear. Reduction in androgenicity and lower intraprostatic growth factor concentrations in smaller prostates may serve a more ideal environment for the development of aggressive tumors. We determined if prostate volume was associated with adverse pathological features, tumor volume, and biochemical recurrence (BCR) in men undergoing radical prostatectomy (RP) for PCa. Materials and Methods: We retrospectively identified 192 men who underwent RP at our institution for PCa from 2010 to 2016 years. Prostate volume was based on RP specimen weight, and cumulative tumor volume was calculated. Means were compared with one-way ANOVA test and proportions with Chi-square analysis. Multivariate logistic regression was performed to determine independent predictors of BCR after RP. Results: Patients with prostate volume >60 g were less likely to have high-risk PCa (Gleason grade group >4) (7.1% vs. 13.4%; P = 0.042), node-positive disease (7.1% vs. 13.4%, P = 0.042), and BCR (10.7% vs. 25.0%, P = 0.002) after surgery. Linear regression showed an inverse relationship between prostate and tumor volume (R = 0.267; P < 0.05). On multivariate logistic regression, prostate volume >30 g (odds ratio [OR]: 0.21, 95% confidence interval [CI]: 0.09–0.88; P = 0.015) and >60 g (OR: 0.14, 95% CI: 0.03–0.74; P = 0.002) were independent predictors of reduced BCR at mean follow-up of 24 months.Conclusions: Smaller prostate volume was associated with adverse pathological features, increased tumor volume, higher incidence of pathological node-positive disease, and increased rates of BCR. Prostate volume should be considered as a prognostic feature when counseling patients with both elevated prostate-specific antigen and newly diagnosed PCa.
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Comparative assessment of monopolar versus bipolar transurethral resection of prostate for the management of benign prostatic enlargement p. 262
Kshitij Raghuvanshi, Abid Raval, Devendra Kumar Jain, Ketan P Vartak, Sachin Patil, Shams Iqbal, Rajesh Dhake, Hrishikesh Deshmukh
Objectives: The objective is to compare monopolar transurethral resection of the prostate (M-TURP) versus bipolar TURP (B-TURP). Methods: In this prospective comparative study, 102 patients scheduled to undergo transurethral resection of prostate were enrolled and table randomized to surgery by M-TURP or B-TURP. International Prostate Symptom Score (IPSS), uroflowmetry, ultrasonography (kidney-ureter-bladder), prevoid, postvoid and laboratory investigations (for preanesthetic fitness) were done preoperative and 3-month postsurgery. Results: Patients were divided into two groups namely M-TURP and B-TURP. The mean age of patients was comparable between both groups. There is a significantly lower mean resection time in M-TURP compared to B-TURP. IPSS, postvoid residual volume, and Qmaximproved in both groups, and it was statistically insignificant. Drop in hemoglobin levels (g/dl) in patients of M-TURP was higher compared than B-TURP. Conclusions: Both M-TURP and B-TURP are safe and effective modality. However, B-TURP will surely replace M-TURP as gold standard.
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Therapeutic Efficacy and Quality of Life Improvement in Women with Detrusor Underactivity Following Transurethral Incision of the Bladder Ne p. 266
Yu-Khun Lee, Hann-Chorng Kuo
Aims: To investigate the effects of transurethral incision of the bladder neck (TUI-BN) on long-term outcomes and quality of life (QoL) improvements in women with detrusor underactivity (DU) refractory to standard medical treatment. Materials and Methods: Data were retrieved for female patients with treatment-refractory DU who underwent TUI-BN between 2007 and 2018. Urodynamic parameters were measured at baseline and follow-up and were analyzed for surgical outcome. Patients who were capable of spontaneously voiding with a voiding efficiency (VE) of ≥50% with or without the aid of abdominal pressure were considered to have achieved satisfactory outcomes. Changes in self-reported QoL were measured based on the International Prostate Symptom Score QoL (IPSS-QoL), and treatment improvements were measured based on the global response assessment (GRA) index. Moreover, the voiding statuses of patients before and after TUI-BN were compared. Results: Overall, 82 women, with a mean age of 60.8 ± 17.9 years (range 12–102), were included. Most patients experienced chronic urinary retention or large postvoid residual (PVR) urine. Median follow-up period was 5 years (range 1–12). Following TUI-BN, 40 (48.8%) patients achieved satisfactory outcomes, with a mean GRA of 1.4 ± 0.93. Mean maximum flow rate, voided volume, PVR volume, VE, and IPSS-QoL were all significantly improved. Among all patients, 50 (61%) were subsequently able to spontaneously void with or without the aid of abdominal pressure without the need for catheterization. Indwelling catheters were required in 19 (23.2%) patients at baseline and in 5 (6.1%) following TUI-BN (P < 0.01). Moreover, 5 (6.1%) patients developed stress urinary incontinence and 2 (2.4%) experienced vesicovaginal fistulae following TUI-BN procedures, all of whom recovered satisfactorily after treatment. Conclusions: TUI-BN is an effective procedure for reducing the bladder outlet resistance and improving VE and QoL. Moreover, the procedure is durable with an acceptable incidence of complications.
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Safety and efficacy of percutaneous nephrolithotomy in patients with large stones: A retrospective study p. 272
Shu-Chuan Hsiao, Yeong-Chin Jou, Ming-Chin Cheng, Cheng-Huang Shen, Chang-Te Lin, Pi-Che Chen, Wei-Hong Lai, Pei-Yi Chen
Aims: The aim of the study is to evaluate the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL) in patients with large stones. Subjects and Methods: From January 2011 to June 2016, 425 tubeless PCNLs were performed at our hospital. All patients underwent a single-stage procedure with a metal dilator. Of the 425 patients, 93 had stone sizes ≥5 cm (mean: 7.77 cm, Group 1) and 332 patients had stone sizes <5 cm (mean: 2.75 cm, Group 2). Data analysis was performed using Statistical Package for the Social Sciences, V. 21.0. Numerical variables were compared by independent-samples t-test. Categorical variables were compared by Chi-square or Fisher's exact test as appropriate. P < 0.05 was deemed statistically significant. Results: The duration of surgery was longer in Group 1 than in Group 2 (93.6 vs. 70.4 min, P < 0.001). There were no significant differences between the two groups in the incidence of postoperative fever (8% vs. 7%) or sepsis (both 1%). In addition, no significant difference was observed in the length of postoperative hospital stays (3.05 vs. 3.2 days) although the transfusion rate was higher in Group 1 (6/93 vs. 4/332, P = 0.003). No other major complications or conversion to open surgery occurred in either group. Conclusions: Tubeless PCNL performed in patients with stones ≥5 cm in size has a reasonable and acceptably higher transfusion rate, with no other associated major complications.
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Outcome analysis of pediatric pyeloplasty in varied presentation in developing countries p. 276
Sajni I Khemchandani
Objectives: The objective was to study the various presentations of pelviureteric junction (PUJ) obstruction in developing countries and its outcomes. Materials and Methods: We retrospectively reviewed the medical records of 239 children (260 renal units) who underwent surgery for PUJ obstruction between January 1994 and December 2016. Data on the patients presenting with symptoms and preoperative imaging findings of ultrasonography, intravenous urography, or diuretic renography were analyzed. Results: In all cases, we preferred dismembered Anderson-Hynes pyeloplasty with or without JJ stenting. Complications of pyeloplasty included prolonged urine leakage in 13 patients, of whom 4 responded to conservative management, 5 required percutaneous nephrostomy (PCN), and 4 were treated with endoscopic JJ stenting. Six patients had persistent obstruction: two responded to endopyelotomy, and in four, redo pyeloplasty was successful. Five patients with renal function of <10% were initially treated with PCN and ultimately required nephrectomy. Conclusions: In patients born with PUJ obstruction and impaired renal function, pyeloplasty fails to significantly improve function, possibly because of cortical loss. However, in patients with antenatal PUJ obstruction managed expectantly, there is a small but significant risk of modest permanent loss of renal function.
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A rare case of prolapsed and everted bladder through a widely patent urachus with an absent omphalocele p. 281
Azhar Amir Hamzah, Amer Hayat Khan, Ahmad Naoras Bitar
A prolapsed and everted bladder through a widely patent urachus with an absent omphalocele is considered as an extremely rare and unique case, which requires emergency treatment and surgical intervention. A newly born baby was born at term and then referred from a district hospital for a mass at the umbilical region. She was referred as a case of gastroschisis, but she was eventually found to have a rare patent urachus with bladder eversion and prolapse onto the abdominal wall. The prolapsed bladder was repaired without any complications, and an umbilicoplasty was performed successfully. The infant recovered uneventfully and without any difficulty in voiding. A significant reduction in bladder dome inflammation as well as in mucosal necrosis can be obtained by performing the repair procedure as soon as possible.
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CME Test p. 284

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Author Index  
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Keyword Index  
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Title Index  
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