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   Table of Contents - Current issue
September-October 2019
Volume 30 | Issue 5
Page Nos. 197-242

Online since Thursday, October 24, 2019

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Adiponectin and proto-oncogene MYC in prostate cancer: How far are we with the evidence? p. 197
Lukman Hakim
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Urological science going south p. 199
Stephen Shei-Dei Yang
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Randall's plaque, the origin of nephrolithiasis: Where do we stand now? p. 200
Li-Hsien Tsai, Chao-Hsiang Chang, Szju-Ju Chen, Wen-Chi Chen
The prevalence of renal stones, or nephrolithiasis, has been increasing consistently over the past few decades. Changes in lifestyles and dietary habits of the population may be responsible for the rise. Moreover, chronic diseases such as diabetes, hypertension, obesity, and metabolic syndrome are significant risk factors for renal stone formation. The 5-year recurrence rate of renal stones is around 50%. Those affected have a higher risk of comorbidities such as recurrent urinary tract infections, chronic kidney disease, and even end-stage renal disease. There is exciting ongoing research into newer treatments for renal stones. Currently, the prevailing hypothesis is that renal stones originate from Randall's plaques, which are patches of creamy-yellow calcium deposits found attached to the renal pelvis. However, the early steps involved in stone formation are still unclear. With the help of advanced technology and newer modalities, we can now observe the formative events upstream to actual stone formation. There are two recently updated theories that detail the biochemical events and structural changes that occur during this initial period. These well-designed works have expanded our awareness of Randall's plaques and provided direction for further research.
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Histopathological analysis and scanning electron microscopic study of chlorpyrifos exposed kidney of neonates in pregnant rats exposed during gestation period p. 206
Jyoti Upadhyay, Nidhi Tiwari, Mahendra Rana, Satpal S Bisht
Background: Pesticide exposure has the potential for causing acute or chronic health effects at certain developmental stages of life. It can result in irreversible damage to structure and function of an organ. The exposure of females to pesticides before or after pregnancy is a matter of concern because of the possibility of having a child born with congenital disorders and developmental defects. Prenatal exposure of any toxicants can program the developing foetus to develop diseases that manifest in later life. Very few reports are available related to the pesticide exposure induced morphological changes in kidney which has prompted us to undertake this research study. Aim: The aim of this study is to evaluate the effect of pesticide, chlorpyrifos on the kidney development of rat neonates after being exposed prenatally to pesticides throughout their gestational period. Materials and Methods: Virgin female wistar rats weighing 200-250 gms were mated with adult males. It consisted of twelve, divided into two sub groups six rats per each were treated with selected pesticides, chlorpyrifos (insecticide) readily available commercially for various agricultural and non-agricultural settings. Insecticide chlorpyrifos was given at a dose of 10mg/kg per orally to the female rats throughout their gestation period. After gestation period rat neonates were sacrificed and their kidney section was processed for histopathological analysis. The SEM study of chlorpyrifos exposed kidney section of rat neonates was performed, investigating changes in morphometric and ultra-structural features of kidney in rat neonates. Results: The histopathological analysis shows morphological changes in the kidneys of prenatally pesticides exposed rat neonates markedly different from control group. Chlorpyrifos exposed neonates kidney shows damaged kidney corpuscles and glomeruli. Conclusion: This study concluded that pesticide exposure during gestation period to pregnant rats causes significant renal toxicity in their neonates.
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Characteristics of bacterial colonization after indwelling ureteral stents in urinary stone patients with diabetes mellitus and chronic kidney disease p. 211
Anak Agung Gede Oka, Gede Wirya Kusuma Duarsa, Sri Rahayu Wulandari, Tjokorda Gde Bagus Mahadewa, Budi Santosa, Wayan Yudiana, Pande Wisnu Tirtayasa
Background: Placement of ureteral stents has been standard after the endoscopic procedures because it relieves obstruction caused by the stone and facilitates urine drainage. Bacterial colonization in the stent plays an essential role in the pathogenesis of stent-associated infections. The goal of this study was to determine the frequency, type of pathogens, and the significance of risk factors that may affect bacterial colonization of ureteral stents after endourology procedures in urinary stone patients. Methods: Thirty patients underwent percutaneous nephrolithotomy or ureterorenoscopy for renal and ureteric stones were enrolled in this study. Urine specimens were collected for culture examination before stent insertion and on removal. The stents were then removed based on the clinical decision via the cystoscope, and three distal tip segments of the stents were sent for culture examination. Results: Four patients (13.3%) before stent insertion and 11 patients (36.7%) before stent removal had positive urine cultures. Eighteen (60%) stents were positive for the culture. Diabetes mellitus (DM) (P = 0.018) and chronic kidney disease (CKD) (P = 0.040) had a significant difference in increasing the risk of bacterial colonization. Pseudomonas aeruginosa was the most common pathogen isolated from the stent culture. Conclusion: An indwelling ureteral stent carries a significant risk of bacterial colonization both on patients with DM and also CKD. P. aeruginosa appears as the most common bacteria in stent culture due to immunocompromised factors of these patients.
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The effect of dutasteride and tomato extract combination on reducing blood loss after transurethral resection of the prostate p. 216
Eriawan Agung Nugroho, Selly Adyta Kemara, Siti Amarwati, Tommy Supit
Context: Lycopene, a carotenoid found in tomatoes, possesses antiangiogenic activities that might be useful in the management of prostate enlargement. However, the current evidence is still inconclusive in regard to this matter. Aims: The aim of the study was to investigate the effect of combined oral dutasteride and lycopene consumption in reducing posttransurethral resection of the prostate (TURP) bleeding. Settings and Design: Twenty-two individuals diagnosed with benign prostatic hyperplasia were randomly allocated into two groups of equal size. Thirty days prior to TURP, individuals in Group 1 (control) were given daily oral dutasteride 0.5 mg and placebo pill and individuals in Group 2 (intervention) were given dutasteride 0.5 mg and lycopene 30 mg. Subjects and Methods: The parameters measured in this study were pre- and post-TURP plasma erythrocyte count and microvessel density (MVD) of resected prostate tissue stained with CD34. Statistical Analysis Used: Data homogeneity was tested using the Shapiro–Wilk test. Individuals' characteristics were analyzed using the Mann–Whitney U-test and plasma erythrocyte and MVD analyzed using the t-test. Spearman's correlation analysis was performed to find significant correlations between the two variables. Results: There were two dropouts. The mean MVD in the control group was significantly higher compared to the intervention group (28.2 ± 12.3 vs. 18.3 ± 7.6 vessel/mm2, P = 0.044). Reduction of post-TURP plasma erythrocytes was significantly higher in the control group compared to the intervention group (−0.34 ± 0.18 vs. −0.17 ± 0.12 106/μL, P = 0.048). Conclusions: Daily consumption of dutasteride and lycopene for at least 30 days reduced the formation of blood vessels in the prostate and reduced blood loss post-TURP.
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The role of c-myc and adiponectin receptors in prostate cancer metastases p. 220
Ferry Safriadi, Sugandi Sugandi, Rainy Umbas, Bethy Suryawati Hernowo
Purpose: This study aims to analyze the relationship between c-myc and adiponectin receptor expressions to prostate cancer staging and prove the role of c-myc and adiponectin receptors as risk factors of metastatic prostate cancer. Materials and Methods: This was a comparative study. The study sample consisted of 35 cases of metastatic prostate cancer and 35 cases of organ-confined prostate cancer. c-myc and adiponectin receptor expressions were examined by using immunohistochemistry and histoscore assessment with the cutoff point of 4. Chi-square and Mann–Whitney U-test were used to assess differences in c-myc and adiponectin receptor expressions. Stratification test and multiple logistic regressions were used to assess the correlation between the variables. Results: There were significant differences of c-myc expression (P = 0.000; odds ratio [OR]: 67.16 [95% confidence interval (CI): 3.820–180.50]) and adiponectin receptor expression (P = 0.001; OR: 6.0 [95% CI: 2.1–17.5]) between the two groups. The stratification test revealed that when c-myc and adiponectin receptor expressions were positive, the OR was 7.50 (95% CI: 1.827–30.783). Conclusion: c-myc and adiponectin receptors play an essential role in prostate cancer metastases. Positivity of both parameters will increase the probability of metastases.
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Presence of residual stones is not a contraindication for tubeless percutaneous nephrolithotomy p. 226
Shun-Kai Chang, Chang-Te Lin, Chun-Hsiung Kang, Ming-Chin Cheng, Yeong-Chin Jou, Cheng-Huang Shen, Pi-Che Chen, Wei-Hong Lai
Objective: The objective of this study was to evaluate the safety of performing tubeless percutaneous nephrolithotomy (PCNL) for patients with residual stones. Materials and Methods: This study was conducted between 2007 and 2015, and a total of 815 patients were included in this study who underwent tubeless PCNL. Postoperatively, 591 patients were found to be stone free (Group 1), whereas residual stones were noted in 224 patients (Group 2). The hospital course and postoperative complications up to 3 months were analyzed by retrospective review. The complications were analyzed by Clavien–Dindo classification and grouped to severe/life-threatening complications (≥Grade 4) and none or nonsevere complications (≤3). All the demographic variables were scrutinized by regression analysis. Results: The mean days of hospital stay were 3.15 and 3.70 in Group 1 and Group 2, respectively (P < 0.001). Sixty-seven patients from Group 1 (11.3%) and 65 patients from Group 2 (29%) suffered postoperative complication (P < 0.001). A multivariate logistic regression model confirmed a higher risk of complications for the residual stone group versus the stone-free stone group (odds ratio [OR]: 2.37,P < 0.001). However, life-threatening complication rate reveals no difference between the two groups (1.4% vs. 3.1%,P = 0.093). Sixteen patients (2.7%) from Group 1 and 12 patients (5.4%) from Group 2 were rehospitalized in 3 months; however, the difference was not statistically significant (P = 0.064). The adjusted logistic regression model also established a nonelevated risk of rehospitalization (OR: 1.11, P = 0.823). Ninety-seven patients in the residual stone group received secondary stone managements in 3 months, but none of them underwent secondary PCNL. Conclusion: Patients from the residual stone group had remarkably longer hospital stay and higher postoperative complication rate because of more complicated stone nature. However, there was no significant difference in the incidence of severe complication and rehospitalization in both the groups. Tubeless PCNL is a relatively safe procedure and not contraindicated for patients with residual stones.
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Augmentation enterocystoplasty for patients with ketamine-induced cystitis: An 8-year experience and a review of series p. 232
Chu-Hsuan Hung, Shu-Wei Hsieh, Shao-Kuan Chen, Chih-Ming Lin
Purpose: Ketamine abuse has been a worldwide issue recently. Ketamine-induced cystitis (KC) is an annoying urinary tract symptom secondary to long-term ketamine abuse. The aim of our study is to review clinical outcomes of bladder augmentation enterocystoplasty (AE) for the patients with KC. Materials and Methods: We performed bladder AE for eight patients with refractory symptoms of KC (severe bladder pain, micturition pain, urgency, frequency, and contracted bladder). All the patients received conservative treatment at clinics or referred from other hospital. Results: Between 2007 and 2015, eight patients (seven males and one female), aged 26–48 years (mean 32.7 years), underwent AE as indicated. The duration of ketamine abuse ranged from 2 to 15 years (mean 6.8 years). Contracted bladder was noted in all patients, hydronephrosis in two and hydroureter in one under intravenous pyelography. Postoperative hospitalization ranged from 12 to 47 days (mean 22.4 days). Significant increases in estimated glomerular filtration rate (86.43 ± 21.47 vs. 103.14 ± 29.32 ml/min/1.73 m2,P < 0.05), functional bladder capacity (47.75 ± 10.07 vs. 273.13 ± 54.96 ml,P < 0.0001), and pain visual analog score (6.0 ± 1.2 vs. 1.75 ± 0.89,P < 0.0001) were noted after AE. Surgical complications included adhesion ileus, progressive impaired renal function, and enterovesical fistula. All the patients were satisfied with the outcomes of the surgery, based on their responses to the self-report questionnaires. All patients reported marked improvement in micturition pain and urinary frequency, which greatly elevated life quality. Most patients were followed up at the outpatient department within 1 year or were lost to follow-up after surgery. Conclusion: This case series demonstrated that for surgical management of refractory bladder pain and low bladder capacity resulting from KC, AE might be effective. However, cessation of ketamine use is the most important to prevent recurrence of the above symptoms.
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Thyrotoxic goiter and asymptomatic thyroid nodule as an initial presentation of clear cell renal cell carcinoma: A report of two cases p. 238
Mohd Ghani Khairul-Asri, Simran Sidhu, Navarasi S Raja Gopal, Saiful Azli, Mohamed Abdelwahab Badawi, S.H.M Hadi, Omar Fahmy
Thyroid nodule as a metastasis to renal cell carcinoma (RCC) is rarely found. We present two cases – presented with thyroid nodules and diagnosed as metastatic RCC; one patient had thyrotoxic goiter, whereas the second patient presented with asymptomatic thyroid nodule. Subsequently, hemithyroidectomy and total thyroidectomy were performed, respectively. Then, both patients underwent radical nephrectomy for the primary tumor. At present, patients are under regular oncology follow-up, with no evidence of disease recurrence.
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CME Test p. 241

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