Diferencias entre el Urocultivo Previo y el cultivo del Catéter doble J. Implicancias clínicas / DIFFERENCES BETWEEN PREVIOUS URINE CULTURE AND DOUBLE J CATHETER CULTURE. CLINICAL IMPLICATIONS

Las infecciones urinarias complicadas, dentro de las cuales se encuentran las asociadas a catéteres, son un hallazgo frecuente de la práctica clínica. Las complicaciones infecciosas después de los procedimientos urológicos son una fuente importante de morbimortalidad y consumen múltiples recursos sanitarios. La colonización bacteriana en el catéter ureteral juega un papel esencial en la patogénesis de la infección, y el uso de profilaxis antimicrobiana en urología es controvertido. El objetivo de nuestro trabajo fue evaluar la utilidad de la profilaxis antibiótica en la extracción del catéter doble J

Complicated urinary infections, among which are those associated with catheters, are a frequent finding in clinical practice. Infectious complications after urological procedures are an important source of morbidity and mortality and consume multiple healthcare resources. Bacterial colonization in the ureteral catheter plays an essential role in the pathogenesis of infection, and the use of antimicrobial prophylaxis in urology is controversial. Te objective of our work was to evaluate the usefulness of antibiotic prophylaxis in the extraction of the double J catheter

Surgical Technique of Supine Percutaneous Nephrolithotomy in Children / Técnica quirúrgica de la nefrolitotomía percutánea en supino en niños

Percutaneous nephrolithotomy (PCNL) in children has becomemore widely used due to its high efficacy and safety and to the development of miniaturized instruments. A supine approach is promising due to advantages such as better ventilation, reproducibility, and ergonomics. The purpose of the present study is to describe our surgical technique with special considerations in the pediatric population. We used an oblique supine position supported by one silicone gel positioning pad under the hip and another under the ipsilateral flank. The anatomical landmarks used to guide the puncture were the 11th and 12th ribs, the posterior axillary line, and the iliac crest. Initially, a ureteral catheter was introduced endoscopically. A retrograde pyelography was performed to guide the puncture, which was performed using a biplanar technique. A hydrophilic guide wire was then advanced through the needle. Dilation was performed with Alken telescopic dilators until 14 Ch. Fragmentation was performed either with a 13 Ch semirigid cystoscope or a flexible ureteroscope using a holmium: yttrium aluminum garnet (Ho:Yag) laser.We left a double J catheter. Supine PCNL in the pediatric population has comparable efficacy in terms of stone free rate to that of the prone approach as well as less complications. Certain considerations in children are careful padding and placement of the patient close to the edge of the table. Puncture should be guided by ultrasound to reduce radiation exposure. Miniaturized equipment is not widely available, so adaptation of adult equipment for the pediatric population is sometimes necessary.

La nefrolitotomía percutánea en niños se ha vuelto ampliamente utilizada por su alta efectividad, seguridad, y por la miniaturización de los instrumentos endoscópicos. El abordaje en supino es prometedor por sus ventajas, como mejor ventilación, reproducibilidad, y ergonomía. El propósito es describir nuestra técnica quirúrgica con las consideraciones especiales a tener en cuenta en la población pediátrica. Todos nuestros pacientes han sido intervenidos bajo la siguiente técnica quirúrgica: en una posición oblicua en supino, utilizando soportes de silicona ubicados debajo de la cadera y del flanco ipsilateral, se marcan los reparos anatómicos: las costillas once y doce, la línea axilar posterior y la cresta ilíaca. Inicialmente se introduce un cateter ureteral por vía endoscópica, con el cual se realiza una pielografía retrógrada para guiar la punción con una técnica biplanar. Se avanza una guía hidrofílica y, sobre esta, los dilatadores telescopados de Alken hasta un tracto de 14 Ch. Se realiza la fragmentación con un cistoscopio semirígido de 13 Ch o con un ureteroscopio flexible utilizando el láser Ho:Yag. Se deja un cateter JJ. La nefrolitotomía percutánea en la población pediátrica es comparable en términos de tasa libre de cálculos al abordaje en prono, con menos complicaciones. Una consideración importante en niños es una adecuada posición, cerca al eje de la mesa. La punción debe ser guiada por ultrasonido para disminuir la exposición a radiación. La disponibilidad de equipos miniaturizados es limitada, por lo cual usualmente es necesario adaptar los equipos de adultos.

Comparison of three different endoscopic approaches in the treatment of bladder calculi / 영남의대학술지

BACKGROUND: This study compared the following three endoscopic techniques used to treat bladder stones: transurethral cystoscope used with a pneumatic lithoclast or nephroscope used with a pneumatic lithoclast and nephroscope used with an ultrasonic lithoclast.METHODS: Between January 2013 and May 2016, 107 patients with bladder stones underwent endoscopic treatment. Patients were classified into three groups based on the endoscopic techniques and energy modalities used in each group as: group 1 (transurethral stone removal using a cystoscope with pneumatic lithoclast), group 2 (transurethral stone removal using a nephroscope with pneumatic lithoclast), and group 3 (transurethral stone removal using a nephroscope with ultrasonic lithoclast). Baseline and perioperative data were retrospectively com-pared between three groups.RESULTS: No statistically significant intergroup differences were observed in age, sex ratio, and stone size. A statistically significant intergroup difference was observed in the operation time—group 1, 71.3±46.6 min; group 2, 33.0±13.7 min; and group 3, 24.6±8.0 min. All patients showed complete stone clearance. The number of urethral entries was higher in group 1 than in the other groups. Significant complications did not occur in any patient.CONCLUSION: Nephroscopy scores over cystoscopy for the removal of bladder stones with respect to operation time. Ultrasonic lithoclast is a safe and efficacious modality that scores over a pneumatic lithoclast with respect to the operation time.

Pediatric Urology: Past, Present and Future / Urología pediátrica: pasado, presente, futuro

At Johns Hopkins, around the turn of the 20th century, Halsted revolutionized the training of future surgeons by having them serving as apprentices, learning mainly by spending long, celibate hours in the hospital observing surgery with the mantra of "See one, do one, teach one." Urology was an infant specialty at that time, growing under Halsted's pupil, Hugh Hampton Young. Young himself pioneered operations for exstrophy that have withstood the test of time. It was only because of the invention of the cystoscope that Urology separated from its parent, General Surgery, clearly an early example of disruptive innovation. Although described separately at that time, Pediatric Urology was not practiced as a distinct full-time entity until the century was nearly complete. Pediatric surgeons cared for the bulk of pediatric urological disorders. Hypospadias and many penile disorders fell under the auspices of plastic surgeons. During the 1950s, the Section of Pediatric Urology became the first surgical section of the American Academy of Pediatrics. The Society of Pediatric Urology (SPU) was soon born. It was roughly two decades later the Canadian Bob Jeffs sought specialty training from D.I. Williams at the Great Ormand Street in London. He later returned to Toronto as the first North American full-time committed pediatric urologist. Other Americans soon followed, and by 1980 the establishment of Pediatric Urology programs in North American children's centers became the norm, with trainees going abroad for fellowship training in London or at Alder Hey in Liverpool.

En Johns Hopkins, a principios del siglo XX, Halsted revolucionó la formación de los futuros cirujanos haciéndoles servir como aprendices, aprendiendo principalmente pasando largas horas célibes en el hospital observando cirugía con el mantra de "Ver a uno, hacer a uno, enseñar a uno." La urología era una especialidad incipiente en aquella época, que crecía bajo la tutela del alumno de Halsted, Hugh Hampton Young. El propio Young fue pionero en operaciones de extrofia que han resistido el paso del tiempo. Sólo gracias a la invención del cistoscopio se separó la Urología de su progenitora, la Cirugía General, un claro ejemplo de innovación disruptiva. Aunque en aquel momento se describió por separado, la Urología Pediátrica no se practicó como una entidad diferenciada a tiempo completo hasta casi finalizado el siglo. Los cirujanos pediátricos atendían la mayor parte de los trastornos urológicos pediátricos. La hipospadias y muchos trastornos del pene eran competencia de los cirujanos plásticos. En la década de 1950, la Sección de Urología Pediátrica se convirtió en la primera sección quirúrgica de la Academia Americana de Pediatría. Pronto nació la Sociedad de Urología Pediátrica (SPU). Aproximadamente dos décadas más tarde, el canadiense Bob Jeffs recibió formación especializada de D.I. Williams en el Great Ormand Street de Londres. Más tarde regresó a Toronto como el primer urólogo pediátrico norteamericano comprometido a tiempo completo. Pronto le siguieron otros estadounidenses, y en 1980 la creación de programas de urología pediátrica en centros infantiles norteamericanos se convirtió en la norma, con alumnos que se desplazaban al extranjero para realizar una beca de formación en Londres o en Alder Hey (Liverpool).

Variables que influyen en el pronóstico de la cirugía fotovaporización prostática mediante láser verde en el tratamiento de hiperplasia prostática benigna (HBP), en el servicio de urología del Hospital Carlos Andrade Marín / Influential variables in the prognosis of prostate photovaporization surgery through green laser in the treatment of benign prostatic hyperplasia in the Urology Department of HCAM

Introducción: Determinar los factores de riesgo preoperatorios e intraoperatorios que influyen en el resultado final de la intervención con láser verde KTP en pacientes con Hiperplasia prostática benigna. Materiales y Métodos: Se realizó un estudio retrospectivo en una cohorte de 153 pacientes con diagnóstico de Hiperplasia Benigna de Próstata (HBP), sometidos a cirugía mediante láser verde KTP y realizada desde mayo 2010 a septiembre 2013 en el Hospital Carlos Andrade Marín. Analizamos variables preoperatorias como edad, volumen prostático medido por ecografía, peso prostático por tacto rectal, PSA, antecedentes urológicos, antecedentes patológicos personales y clasificación ASA; así como variables intraoperatorias: tiempo quirúrgico y complicaciones. Resultados: Éxito quirúrgico ocurrió en el 59% de la muestra. En el análisis bivariado y multivariado, tanto el volumen prostático medido por ecografía (≥ 40 cm3) y las complicaciones intraoperatorias fueron significativas. Discusión: La fotovaporización con láser verde es una técnica implementada en nuestro medio para el tratamiento de HBP. Es preciso estudiar múltiples variables para predecir el éxito o fracaso de la intervención quirúrgica. Palabras clave: laser verde, hiperplasia prostática benigna, fotovaporización.

Introduction: To determine preoperative and operative risk factors that may influence the final outcome of prostatic surgery using KTP green laser in patients with Benign Prostatic Hyperplasia. Methods: Retrospective study performed within cohort of patients with Benign Prostatic Hyperplasia who underwent surgery using KTP greenlight laser, conducted between May 2010 to September 2013, at Carlos Andrade Marín Hospital. Several pre-operative variables were analyzed, among them: age, ultrasound, prostatic volume, prostatic weight assessed by rectal examination, PSA, urological history, medical history and ASA classification; and also intraoperative variables like surgical time and surgical complications. Results: Successful outcome was seen in 59% of treated patients. In the bivariate and multivariate analysis prostatic volume measured with ultrasound and intraoperative complications achieved significance. Discusion: Green laser photovaporization is a technique already implemented in our country for the BPH treatment. Multiple variables should be analyzed in order to predict surgical outcome.

Comparison between transurethral holmium :YAG laser cystolithotripsy and percutaneous suprapubic cystolithotomy in the management of bladder stones in children

Vesical stones in children are common in developing countries. Historically, open cystolithotomy has been the treatment of choice in the management of bladder calculi. Recently there are different treatmrnt of vesical stones like Transurethral Holmium laser cystolithotripsy and Percutaneous cystolithotripsy. To Compare between transurethral Holmium: YAG laser cystolithotripsy and percutaneous suprapubic cystolithotomy in the management of bladder stones in children. A total of 33 children [31 boys and 2 girls] with vesical stones were treated at Urology Department of Al-Sadder Medical City in Najaf between January 2013 and June 2014. Mean patient age at the time of diagnosis was 4.2 years [range 8 months to 10 years]. The patients were divided into 2 groups according to the procedure of stone removal. Group 1 [15 patients] underwent percutanous suprapubic cystolithotomy and group 2 [18 patients] underwent transurethral Holmium: YAG laser cystolithotripsy. Stone size ranged from 7 to 25 mm [mean 16.2mm]. Operative time ranged from 10 to 25 minutes [mean 18 minutes] in percutanous suprapubic cystolithotomy [group 1] and was ranged from 15 to 70 minutes [mean 30 minutes] in transurethral Holmium: YAG laser cystolithotripsy [group 2]. The day of catheter removal was 24 to 96 hours [mean 36 hours] in group 1, while it range 0 to 48 hours [mean 8 hours] in group 2. The hospital stay was shorter after transurethral Holmium: YAG laser compared to percutanous suprapubic cystolithotomy [30 vs. 72 hours]. No significant intraoperative or postoperative complication was encountered except prolong urinary leak in two patients [13.3] in group 1 and transient mild haematuria in three children [16.6%] and low grade fever in two children [11%] in group 2. In all cases [100%] the stones were removed successfully in first session in group 1 while one patient [5.5%] need second session due to residual small stone in group 2. Transurethral Holmium: YAG laser and percutanous suprapubic cystolithotomy management of vesical stones in children are efficient, with a low incidence of complications. Transurethral Holmium: YAG laser offers a shorter hospital stay and urethral catheterization but longer operative time compared to percutanous suprapubic cystolithotomy

Practical Aspects of Botulinum Toxin-A Treatment in Patients With Overactive Bladder Syndrome / 대한배뇨장애요실금학회지

Intravesical onabotulinumtoxinA (BoNT-A) injection is an effective treatment for overactive bladder syndrome (OAB) that is refractory to antimuscarinics. An injectable dose of 100 U has been suggested to achieve the optimal balance of benefit and safety in patients with OAB. BoNT-A (total volume of 10 mL) was administered as evenly distributed intradetrusor injections (5 U) across 20 sites approximately 1 cm apart (0.5 mL per site) using a flexible or rigid cystoscope. Treatment with BoNT-A was generally well tolerated by most patients, and most treatment-related adverse events were localized to the urinary tract. The prevalence of OAB increases with age, and elderly patients are more vulnerable to complications. The short-term efficacy of intravesical BoNT-A injection for refractory OAB with no treatment-related complications in the elderly population has been documented. Frail elderly patients can experience the same treatment results, such as significantly improved urgent urinary incontinence and quality of life, as young and nonfrail elderly patients with 100-U BoNT-A injections. However, increased risk of larger postvoid residual (PVR) urine and lower long-term success rates were noted in frail elderly patients; around 11% had acute urinary retention, while 60% had PVR urine volume >150 mL after treatment. In addition, intravesical injection of BoNT-A effectively decreased urgency symptoms in elderly patients with OAB and central nervous system lesions. The adverse effects were acceptable, while the long-term effects were comparable to those in patients with OAB without central nervous system lesions. Nonetheless, the possibility of longstanding urinary retention and chronic catheterization in this vulnerable population requires careful evaluation before treatment with intravesical BoNT-A. In conclusion, the current findings indicate that intravesical BoNT-A is an effective and safe treatment for OAB in elderly patients.

Is Diagnostic Cystoscopy Painful? Analysis of 1,320 Consecutive Procedures

Objective To prospectively evaluate self-reported pain levels associated with diagnostic cystoscopy. Materials and Methods Patients who underwent diagnostic cystoscopy and subsequently graded their pain level during the procedure were enrolled. Pain was graded on a Likert visual analog scale (VAS) of 1-10 where 0 = no pain and 10 = excruciating unbearable pain. Local lidocaine gel 2% was used as intraurethral lubricant. Results Data from 1320 consecutive cystoscopies (929 males, 391 females, age range 15-93 years) between 6/2009-1/2010 were analyzed. This was the first cystoscopy for 814 patients. The overall mean VAS was 2.74 ± 1.51 (range 0-9) for rigid cystoscopy and 2.48 ± 1.53 (range 0-10) for flexible cystoscopy (P = 0.004). The reported mean pain level for first-time cystoscopy was significantly higher than that for repeat cystoscopy (2.8 ± 1.6 vs. 2.2 ± 1.4, P < 0.001), regardless of gender or type of cystoscope. Men reported significantly higher pain levels than women 2.6 ± 1.5 vs. 2.4 ± 1.4 (P < 0.04). The highest mean pain level was reported by men (3.4 ± 1.6) and women (2.5 ± 1.6) for rigid cystoscopy compared to flexible cystoscopy (2.5 ± 1.4 and 1.1 ± 1.9, respectively, P < 0.001). Pain levels > 5 were reported in 75 (5.7%) cystoscopies. Conclusions Cystoscopy was not associated with distressing levels of pain. Pain levels during first cystoscopies were higher than those for repeated ones. Using a flexible cystoscope is associated with a lower pain level in both men and women and it should be used for both genders. .

Semen expulsion under the ureterocystoscope / 中华男科学杂志

<p><b>OBJECTIVE</b>To determine the exact location of the opening of the ejaculatory duct in men and provide some basic anatomical evidence for seminal vesiculoscopy and the treatment of ejaculatory duct obstruction.</p><p><b>METHODS</b>We performed ureterocystoscopy for 21 male patients aged 26 - 47 years with hematuria (n = 12), hematospermia (n = 2), glandular cystitis (n = 6), and anejaculation after radical resection of rectal carcinoma (n = 1), and meanwhile, with the consent of the patients, massaged the prostate and ejaculatory duct and observed the outlet of the expelled fluid. Under the microscope, we described the fluid samples with sperm as the expulsion from the ejaculatory duct.</p><p><b>RESULTS</b>Ureterocystoscopy showed that the exact anatomical sites of the expulsion of prostatic fluid and semen in the patients were the side and lower side of the prostatic utricle opening above the verumontanum and the ventral side of the verumontanum. Quantities of sperm were found in the expulsion fluid of 13 of the patients, and no expulsion, including semen, was seen from the prostatic utricle opening.</p><p><b>CONCLUSION</b>Anatomically, the ejaculatory duct openings of males are located at the two sides of the verumontanum adjacent to the opening of the prostatic utricle, rather than in the prostatic utricle above the verumontanum.</p>

Optimal effect-site concentration of remifentanil when combined with dexmedetomidine in patients undergoing cystoscopy / 대한마취과학회지

BACKGROUND: Cystoscopic procedure is a very common practice in the field of urology due to its ability to survey the bladder for a variety of indications. However, patients who undergo cystoscopy feel intense pain and discomfort. This study investigated the half maximal effective concentration (EC50) of remifentanil in preventing cystoscope insertion pain under sedation using dexmedetomidine. METHODS: The study was prospectively conducted on 18 male patients, aged 18 to 65. Remifentail infusion was initiated together with dexmedetomidine, and started at a dose of 2.4 ng/ml on the first patient. The effect-site concentration (Ce) of remifentanil for each subsequent patient was determined by the previous patient's response using Dixon's up-and-down method with an interval of 0.3 ng/ml. Patients received a loading dose of 1.0 microg/kg dexmedetomidine over 10 minutes, followed by a maintenance dose of 0.6 microg/kg/hr. After the patient's OAA/S score (Observer's Assessment of Alertness/Sedation scale) reached 3-4, and the Ce of remifentanil reached target concentration, the urologist was allowed to insert the cystoscope and the pain responses were observed. RESULTS: The effect-site concentration of remifentanil required to prevent cystoscope insertion pain in 50% of patients under sedation using dexmedetomidine was 1.30 +/- 0.12 ng/ml by Dixon's up-and-down method. The logistic regression curve of the probability of response showed that the EC50 and EC95 values (95% confidence limits) of remifentanil were 1.33 ng/ml (1.12-1.52 ng/ml) and 1.58 ng/ml (1.44-2.48 ng/ml), respectively. CONCLUSIONS: Cystoscopic procedure can be carried out successfully without any pain or adverse effects by optimal remifentanil effect-site concentration (EC50, 1.33 ng/ml; EC95, 1.58 ng/ ml) combined with sedation using dexmedetomidine.

Transurethral cystolithotripsy for large vesical calculi

To assess efficacy and safety of transurethral cystolithotripsy in the management of large vesical calculi. Adult patients with large vesical calculi [>2.5cm] were selected for this prospective study. Patients with associated urethral stricture and big adenomas were excluded. Stone size was measured on ultrasound in the largest diameter. Patients were operated under spinal or general anaesthesia. Nephroscope with 28 fr sheath was used transurethrally along with 2 cm lithoclast probe. Initial fragmentation was achieved with Swiss lithoclast. Later bigger fragments were dealt with stone punch. In the end all fragments were evacuated with Ellick evacuator. Bladder was drained with Foley's catheter for 24 hours. TURP [transurethral resection of prostate] was done if required. Patients with bigger glands were excluded to restrict operating time. Patients were followed up for two weeks. Forty patients were selected. Mean age of the patients was 55 years [range 18-73 years]. There were 32 males [80%] and 8 females [20%]. Stone size was 4.72 +/- 2.52 cm with range of 2.5-7.0 cm. Five patients had multiple stones, four of them had associated neurogenic bladder. Procedure time ranged from 20-90 minutes [mean 45.8 minutes]. Complete fragmentation of calculi was achieved in all patients. Twelve patients underwent TURP under same anaesthesia. Time consumed on resection of prostate was not included in procedure time. There were no major complications. Transurethral cystolithotripsy is very effective and safe for large vesical calculi [>2.5cm]. It is time consuming but saves patients from hazards of open surgery.

Cystoscopic Extraction Technique and External Drainage Rescue of a Failed Attempt to Traverse a Severe Transplanted Ureteral Obstruction

PURPOSE: The aim of this research was to evaluate the efficacy of the cystoscopic extraction and external drainage techniques for unsuccessful antegrade stenting in transplanted severe ureteral obstruction. MATERIALS AND METHODS: A total of 26 patients with severe transplanted ureteral obstruction in whom the cystoscopic extraction technique and/or external drainage technique was performed were retrospectively evaluated. After the severe obstruction was successfully traversed, balloon dilatation followed by double-J stent insertion was performed. RESULTS: Of the 26 patients (male:female, 9:4; mean age, 38.1 years) who underwent failed ureteral stenting with the conventional procedure, 16 patients underwent successful stenting with the cystoscopic extraction technique, and 10 patients underwent successful stenting following external drainage. The mean serum creatinine of the 26 patients before stenting was 42.9 mg/dL (range, 32.7 to 54.1 mg/dL), which decreased to 10.3 mg/dL (range, 8.7 to 11.8 mg/dL) after stenting. The complications of the procedure were lower abdominal pain in 22 patients and gross hematuria in 9 patients. All complications were relieved with medical care within 3 to 5 days after the procedure. No major complications occurred. CONCLUSIONS: The cystoscopic extraction technique and external drainage technique are safe and useful for traversing a severe transplanted ureteral obstruction after a failed conventional procedure.

Immunohistochemistry study in a case of nephrogenic adenoma of bladder

Nephrogenic adenoma is a rare benign lesion of bladder that may be confused with malignant lesions. There is a strong relation with urinary tract irritation and intravesicle instrumentations. Nephrogenic adenoma was initially thought to originate from urothelial metaplasia; however, no solid proof is available. We present a case of 55-year-old lady with urinary problem. Cystocopic examination showed a sessile mass, and biopsy revealed circumscribed proliferation of tubules, cysts, and papillae that were lined by low cuboidal to columnar epithelial cells. Nephrogenic adenoma can be a significant diagnostic pitfall due to the presence of certain histological features such as the presence of enlarged nuclei with prominent nucleoli. Immunohistochemistery study was strongly positive for CK7, P504S, CD10, and EMA, but negative for CK20, PSA, and P63

Encrusted and incarcerated urinary bladder catheter: what are the options?

Urinary bladder catheter encrustations are known complications of long-term urinary catheterisation, which is commonly seen in clinical practice. These encrustations can impede deflation of the balloon and therefore cause problems in the removal of the catheter. The options in managing an encrusted and incarcerated urinary bladder catheter include extracorporeal shock wave lithotripsy and lithoclast. We describe here another technique of dealing with a stuck and encrustated catheter, via direct crushing of the encrustations with a rigid cystoscope inserted through a suprapubic cystostomy tract

Comparative study of immunohistochemical analysis in tissues and molecular detection in exfoliated tumour cells in urine of human telomerase reverse transcriptase [hTERT] in urinary bladder cancer in Egyptians

Bladder cancer ranks the third most common malignancy in Egypt following to breast cancer and leukemia. Telomerase plays important roles in cancer development and promotion. Its activity is present in most human malignant tumor cells. Its activity was also detected in voided urine and in bladder washes of patients with bladder cancer, making it a potential marker for non invasive detection of bladder cancer in urine. The present study aims to correlate the expression of the hTERTmRNA in exfoliated tumour cells in urine to the in situ expression of hTERT protein in the corresponding tumour specimens and to evaluate the relationship to hTERT expression and the clinicopathologic tumour characteristics. The study comprised twenty three bladder cancer cases [22 urothelial and one squamous cell carcinomas]. Semiquantitative immunohistochemical detection of hTERT expression was evaluated using combined score evaluated by two examiners which included scoring of intensity and percentage of positivity Semiquantitative expression of hTERTmRNA relative to housekeeping gene GAPDH mRNA was evaluated from RNA extracted from exfoliated cells in urine. Expression of hTERT by immunohistochemistry [IHC] and RT-PCR was detected in 100% of the bladder cancer series. Both methods were significantly correlated [p=0.004]. There was no correlation detected between hTERT expression by both methods and clinicopathologic characteristics of the tumours represented by stage and grade. The high concordance between the semiquantitative expression of hTERT protein by IHC in tumour sections and hTERTmRNA in exfoliated tumour cells validate the potential use of hTERT as a diagnostic non invasive marker for diagnosis of bladder cancer in high risk Egyptian patients and in the follow up following cystoscopic resection of superficial tumours. To the best of our knowledge this is the first study which compares hTERT in situ expression in bladder tumours and hTERT mRNA in exfoliated tumour cells in urine

The Effects of Music Therapy on Anxiety and Pain in Patients with Retrograde Ureteral Stenting under Local Anesthesia / 기본간호학회지

PURPOSE: The present study was done to examine the effect of music therapy on anxiety and pain in patients for whom a ureteral stent was inserted under local anesthesia. METHOD: The participants in this study were 22 patients who received a ureteral stent at the Day Surgery Center of C University Hospital during the period from May to October in 2006. The patients were divided into a control group (n=11) and an experimental group (n=11). For the experimental group, music was played according to their musical preference using headphones. The music was provided from the point when the patient took the posture for the operation and was covered with a sterilized drape to the point when the cystoscope was removed after finishing the operation. The control group was only provided with ordinary nursing services. RESULTS: The results show that the provision of music therapy to these patients is effective in reducing the patients' salivary cortisol and Vas-anxiety score and stabilizing their systolic blood pressure. CONCLUSION: We conclude that music therapy can be actively used as a nursing intervention for reducing anxiety in patients who receive operations under local anesthesia.

Flexible cystoscope: a useful aid to difficult male catheterization

To assess usefulness of flexible cystoscope in difficult male urethral catheterization. Fauji Foundation Hospital and Maryam Memorial Hospital, Rawalpindi during a period of four years. In a consecutive series of thirty patients with acute urinary retention and initial difficulty in urethral catheterization, a flexible cystoscope and a guide wire was used to insert the Foley's catheter. Ten patients [33.3%] presented with acute urinary retention due to benign enlargement of prostate. Five patients [16.6%] required re-catheterization following unsuccessful trial after transurethral resection of prostate. Four patients [13.3%] had carcinoma of prostate. This technique was used five times [16%] to catheterize prior to intravesical instillation of cytotoxic drugs. Two patients [6.6%] had bladder neck distortion due to transitional cell carcinoma of bladder, one [3.3%] had an extravesical haematoma and another one [3.3%] had massive post traumatic clot retention. The procedure was successful in 86.7% of the cases. Difficulty to negotiate the urethra was faced in cases of urethral strictures [6.6%]. Flexible cystoscope is a safe, quick and effective method for difficult urethral catheterization in male patients

Early Experience of Retroperitoneoscopic Nephroureterectomy for Transitional Cell Carcinoma of Renal Pelvis and Ureter / 대한비뇨기과학회지

PUSPOSE: To evaluate the results of our experience with a retroperitoneoscopic nephroureterectomy, in patients with transitional cell carcinomas of the renal pelvis and ureter, compared to those treated by open nephroureterectomy. MATERIAL AND METHODS: Between August 2003 and February 2006, 17 patients with a transitional cell carcinoma of the upper urinary tract underwent retroperitoneoscopic nephroureterectomy. The distal ureter and bladder cuff was treated with a Gibson incision in 11 patients, with an endoscopic stapler employed in 6 patients. During the endoscopic stapler firing of the bladder cuff, complete removal of the ureteral orifice was confirmed using a flexible cystoscope. The patients' operative and clinical records were retrospectively reviewed, and compared to 16 patients with a transitional cell carcinoma of the upper urinary tract treated using an open nephroureterectomy. RESULTS: The retroperitoneoscopic nephroureterectomies were successfully performed in all patients. The mean operative time, transfusion rate and time to drain removal were not significantly different between the two groups. The initiations of the postoperative oral intake and ambulation, as well as the hospital stay were shorter in the retroperitoneoscopy than the open group. Complications were detected in 1 and 5 patients of the retroperitoneoscopy and open groups, respectively. With respect to the follow-up results, no statistical differences were seen in either bladder or extravesical recurrence between the two groups. CONCLUSIONS: A retroperitoneoscopic nephroureterectomy is a less invasive technique than an open nephroureterectomy for patients with a transitional cell carcinoma of the renal pelvis and ureter. Especially, using an endoscopic stapler for the lower ureter and bladder cuff may shorten the operative time. However, long term follow-up will be necessary to confirm the cancer control effects.

Initial Experience of Laparoscopic Pyeloplasty: Retrograde Stenting Using Flexible Cystoscopes / 대한비뇨기과학회지

PURPOSE: To describe our initial experience of laparoscopic pyeloplasty, with retrograde stenting, using flexible cystoscopes, in 9 cases of ureteropelvic junction obstruction (UPJO). MATERIALS AND METHODS: Between September, 2004 and January, 2006, 9 cases of UPJO were treated by laparoscopic pyeloplasty. All of the medical records were reviewed retrospectively. The cases comprised of 5 males and 4 females, with a mean age of 37 years (13-58). All patients showed a preoperative grade 4 hydronephrosis. RESULTS: Two laparoscopic pyeloplasty approaches were performed; a transperitoneal approach in 5 cases and a retroperitoneal approach in the other 4. All cases were treated with dismembered Anderson-Hynes pyeloplasty. The mean operating time was 249 minutes (170-324), including a mean of 7.1 minutes (6.5-8) for ureteral stenting. The patients were found to have aberrant vessels and renal stones in 1 and 3 cases, respectively. There were no intra-operative complications or open conversion. Of the 9 cases, 8 (89%) showed a decrease in their hydronephrosis grade on the excretory urographs taken 12 weeks postoperatively. The remaining case showed a marked improvement in the hydronephrosis, despite having no change in the hydronephrosis grade. No case experienced postoperative flank pain or recurrence of acute pyelonephritis. Therefore, symptomatic improvements were observed in all our cases (100%). CONCLUSIONS: Laparoscopic pyeloplasty, with retrograde stenting, using flexible cystoscopes, can be considered an effective and convenient method for the treatment of UPJO.

Endoscopic Primary Realignment under Open Cystostomy in the Patients with Posterior Urethral Rupture that were Impossible for Lithotomy Position, Accompanied by Pelvic Bone Fracture : Long-term Results / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the long-term results of endoscopic primary realignment of a posterior urethral rupture accompanied by a pelvic bone fracture. MATERIALS AND METHODS: Our study population consists of 7 patients who were able to be followed up for at least 5 years, of an initial 8 that underwent endoscopic primary realignment of a posterior urethral rupture due to a pelvic bone fracture. Operations were carried out in the following order; the bladder was incised to allow a metal sound, with stitching fiber then tied at its end so it could be advanced into the injured proximal urethra through the bladder neck. The fiber was then traced using a cystoscope and connected to a urethral catheter, which could be indwelled in the bladder by pulling the sound back. RESULTS: The mean follow-up period was 8.1 (5.2-9.7) years. The mean operation time was 48.3 (28-71) minutes. There were no severe disruptions of the pelvic hematoma, transfusions or other additive injuries during the operations. Post-operation complications were observed in 4 patients; 3 cases of mild urethral stricture, which were treated with an endoscopic intra-urethrotomy followed by clean intermittent catheterization, 3 cases of erectile dysfunction and 1 case each of urinary incontinence and a urethral stone. CONCLUSIONS: This study clearly implies that endoscopic primary realignment of a severe posterior urethral rupture accompanied by a pelvic bone fracture is less invasive and a safer method, without pelvic hemorrhage or additional injuries. Early endoscopic intervention also improves the quality of life by reducing the possibility of an invasive procedure, and also prevents severe urethral stricture and the resultant complications by maintaining the continuity of the urethra.