Bladder hyperactivity is described as the presence of “voiding urgency, generally associated with increased daytime frequency and nocturia, with or without urinary incontinence, in the absence of urinary tract infection or other obvious pathology”. Onabo-tulinum toxin A (BTA) is a recommendable therapeutic option in case of failure, contraindication or refusal of the conservative therapy or other non-pharmacological therapies. The injection of BTA in the detrusor has been performed under local, regional or general anesthesia either in the conventional or major ambulatory surgery operative room or in the cystoscopy room. The objective of this paper is to describe the procedure to perform BTA therapy as an ambulatory operation under intravesical local anesthesia in the cystoscopy room, describing its advantages and limitations.
OBJECTIVES: Lower Urinary Tract Dysfunction (LUTD) is the most common clinical problem in pediatric urology. To our knowledge non-validated instruments properly designed to screen lower urinary tract symptoms in the pediatric population has been translated and adapted to Spanish population. Pediatric Lower Urinary Tract Symptoms Score (PLUTSS) has proven to be a valid questionnaire for screening and evaluation of the response of children with LUTD to therapy. The aim of this study was to validate the PLUTSS questionnaire into Spanish, and put it to clinical use in pediatric patients, with cross-cultural equivalence to the original version.METHODS: The PLUTSS questionnaire was validated between February 2015 and February 2016. The Spanish version was obtained by using the forward/ back-translation method with expert, bilingual translator, complying with the ISPOR principles. The questionnaire was administered to 80 patients with either lower urinary tract symptoms (40) or without any urological complaints (40). A descriptive statistical analysis of interscale correlation was performed. To confirm reliability, test-retest reliability was assessed by intra-class correlation coefficient, and the internal consistency was assessed by Cronbach´s alpha coefficient. ROC curve was used to define cutpoint and its validity in discrimination between groups.RESULTS: The median of the two groups was significantly different: 20.53 (patients with LUTD) vs 3.27 (controls).Internal consistence of the 13-item scale (without quality of life item) was high: Cronbach alpha coefficient 0.827. The test-retest analysis of reproducibility showed an intra-class correlation coefficient of 0.997 (95% IC: 0.994-0.999)(p<0.0001). CONCLUSIONS: The Spanish version of the PLUTSS questionnaire has proven to be acceptable and culturally equivalent to the original version. It has a good degree of consistency, validity and reliability. PLUTSS showed a high power to discriminate patients with LUTD.
OBJECTIVE: To evaluate the overall survival rate and renal function in our series after radical nephrectomy (RN) and partial nephrectomy (PN) in renal tumors in an early stage.METHODS: We retrospectively reviewed the medical records of 229 patients who underwent RN or PN for renal cancer T1-T2N0M0 in our center between 1995 and 2015. We described demographic factors, first symptom, TNM, histology, post-surgery data, recurrence rate and renal function. We utilized Fisher test, Chi square test and T-Student and we considered statistical significance when p< 0.05.RESULTS: 203 patients underwent RN and 26 PN. 39.4% of the tumors who received RN were T1bN0M0 and 76.92% of PN were T1aN0M0. We report nine complications grade II of modified Clavien System for RN and only one grade I for PN. We detected an 11.3% recurrence in RN and none in PN. 66% of patients from RN are alive today, 12.81% died as result of renal cancer and 22.7% suffered a non-cancer-specific death. No deaths were observed in PN group. We observed similar mean preoperative serum creatinine (Cr) in both groups. Creatinine after the first post-operative month was 1.81mg/dL and 1.06mg/dL for RN and PN, respectively; At one year post-operative we registered Cr 1.82mg/dL and Cr 0.97mg/dL, respectively.CONCLUSIONS: Both methods provide excellent oncologic results for renal carcinoma in an early stage. PN is safe and reduces the incidence of renal dysfunction with a lower rate of non-cancer-specific death.
OBJECTIVE: The purpose of this study was to determine the prevalence of different microorganisms isolated from the urogenital tract of infertile men and assess whether there are differences in semen parameters according to the presence or absence of genital infections. METHODS: 280 semen samples from infertile men were studied retrospectively. Semen parameters were analyzed according to the World Health Organization criteria (WHO 2010). Microbiological analysis was performed using the modified method of Stamey and Meares proposed by Santoianni et al.RESULTS: Microbiological studies showed absence of microorganisms or presence of usual colonizing flora in 67.86% of the samples (GROUP 1) and presence of at least one pathogen or potential pathogen in 32.14% (GROUP 2). No significant differences in ejaculate volume (p=0.353), pH value (p=0.801), motility (p>0.30), citric acid concentration (p=0.383) and viscosity (p=0.948) were observed between the two groups. The relative sperm count was significantly lower in infected patients than in those without pathogens (p=0.05). Teratozoospermia index (TZI) was evaluated. Samples of infected patients showed TZI values higher than patients without microorganisms or normal genital tract flora (p<0.0001).CONCLUSIONS: A third of the studied population had genital infections. Based on our results, sperm culture may be considered in the early stages of the study of the infertile patient. Early diagnosis of an infectious disease could be useful for a suitable treatment for couples with reproductive failure.
OBJETIVE: Primary undifferentiatedpleomorphic sarcoma (UPS) of the testicular tunics is rare,and synchronism with other malignancies of the urinarytract is uncommon, and may complicate the stagingand therapeutic approach. We report the case of apatient diagnosed with primary paratesticular UPS withsynchronous Renal Carcinoma.METHODS: Patient presenting with intrascrotal tumorwho underwent left radical orchiectomy. In staging workup studies a second urologic neoplasia was found in thekidney. Histological diagnosis using immunohistochemicaltechniques for adequate characterization was performed.Adjuvant treatment options were evaluated. We review theliterature and discuss the case.RESULTS: The UPS diagnosis was performed withimmunohistochemistry. Paratesticular origin from testiculartunics was evident in the macroscopic evaluation.After finding the synchronic ipsilateral renal tumor, heunderwent conventional left radical nephrectomy, ipsilateraladrenalectomy, excision of remnant left cord and para-aorticand pelvic lymphadenectomy. He received chemotherapy and adjuvant radiotherapy. Currently, after twelve monthsof follow-up there is no evidence of disease.CONCLUSIONS: The UPS is a heterogeneous groupwith an exclusion immunohistochemical diagnosis. Itsmanagement requires a multidisciplinary approach; theinitial surgical treatment is accepted for the paratesticularmass with high section radical orchiectomy. Althoughthere is insufficient evidence of the efficacy of adjunctivelymphadenectomy, chemotherapy and/or radiotherapy.
OBJETIVE: Our aim is to present a novel mutation of the Birt-Hogg-Dubé Syndrome. METHODS: We present a case report of a 70-year-old male with three solid nodulary lesions of 4, 2.6, and 3 cm each in the right kidney, and two lesions of 1.5 and 1.3 cm in the left kidney. RESULTS: Needle biopsy was performed. The pathological analysis of right kidney lesions revealed a renal tumor suggestive of chromophobe renal cell carcinoma and medullar tumor with zones that suggested oncocytosis. Genetic test results were positive for a novel heterozygous mutation c.1198G>A; p.V400I in exon 11 of the FLCN gene. CONCLUSION: In patients presenting with bilateral multifocal renal tumors of oncocytic hybrid histology, BirtHogg-Dubé syndrome should be the first diagnosis in mind. The mutation found in this patient has not been previously described in the literature in the context of BHD.
OBJECTIVE: We aimed to identify the changes in the application rate of two surgical techniques in distal hypospadias repair in years and compare the most popular two surgical repair techniques for distal hypospadias in terms of surgical outcomes, the factors that affect the outcomes, which were performed over a 20 year period. METHODS: In this study, the records of 492 consecutive patients that had undergone an operation for distal hypospadias in the urology clinic of Ankara between May 1990 and December 2010 using either Mathieu or TIPU surgical techniques were reviewed retrospectively. The patients who had glanular, coronal, and subcoronal meatus, were accepted as distal hypospadias cases. Among the 492 examined medical records, it was revealed that 331 and 161 surgical interventions were performed by using the Mathieu urethroplasty technique (Group-1) and TIP urethroplasty technique (Group-2), respectively. Group-1 was divided into two subgroups; namely Group-1a (patients with primary hypospadias) and Group-1b (patients with previous hypospadias operation). Likewise, Group-2 was divided into two subgroups; namely group-2a and group-2b. The patients’ ages, number of previously urethroplasty operations, localization of the external urethral meatus prior to the operation, chordee state, length of the newly formed urethra, whether urinary diversion was done or not, post-operative complications and data regarding the follow-up period were evaluated, and the effects of these variables on the surgical outcome were investigated via statistical analyses. The primary objective of this study is to identify the changes in the application rate of two surgical techniques in distal hypospadias repair over the a 20 year period, and the secondary objectives are to compare the most popular two surgical repair techniques for distal hypospadias in terms of surgical outcomes, and the factors affecting the outcomes. Independent samples t test and Pearson’s Chisquare test was used for statistical analysis. p<0.05 was considered as statistically significant.RESULTS: There were no statistically significant differences between the subgroups in terms of age, length of the neo-urethra, number of previously performed urethroplasty operations, surgical success rates, or complications (p>0.05). The concurrent utilization of the cystostomy and urethral stent was significantly more frequent in group-1 (p<0.05; Pearson’s Chi-square test). It was determined that over time, TIP urethroplasty has become a more preferred technique for the repair of distal hypospadias. CONCLUSIONS: Both surgical techniques have similar success rates in distal hypospadias cases. TIP urethroplasty has become the method of choice over time.