Laparoscopic uretero-ileal substitution preserving the natural anti-reflux mechanism: A case report.

Ureteral strictures constitute one of the most common sequelae of impacted ureteral stones. Uretero-ileal substitution is an established treatment for long benign ureteral strictures, measuring more than 2 cm, which are incurable by other less invasive treatment options. One of the common drawbacks of this procedure is its extensive nature and the urine reflux into the newly constructed ileal segment, resulting in urine stagnation and precipitation of urinary tract infections. We report a case of a minimally invasive laparoscopic uretero-ileal substitution for a long mid ureteral stricture, utilizing the natural anti-reflux mechanism.

Radiofrequency Ablation of Small Renal Masses: Outcomes, Complications and Effects on Renal Function.

INTRODUCTION: To describe oncological outcomes, effects on renal function and complications with radiofrequency ablation (RFA) of T1 renal tumors in an 8-year experience. MATERIALS AND METHODS: A retrospective study of RFA in 89 consecutive patients between 2005 and 2013 was undertaken. Those with metastatic disease, incomplete follow-up, genetic pre-disposition to renal tumors and biopsy proven benign pathology were excluded, with 79 patients meeting inclusion criteria. Data was collected on demographics, oncological outcomes, complications and effects on renal function. RESULTS: We demonstrate 94% disease-free survival at median follow-up of 29 months in a population consisting of 42 T1a and 37 T1b tumors. No disease related deaths were recorded in the follow-up period. Post-RFA decline in renal function was shown to correlate with tumor size and increased age (p = 0.0009/0.0021). Pre-existing renal impairment was a risk for post-RFA function decline (p < 0.005). Two complications were encountered in the series. CONCLUSION: RFA produces durable oncological outcomes in T1 tumors with a minimal effect on renal function and low risk of complications. Patients at risk of developing renal impairment can be identified from described risk factors.

The role of neutrophil-lymphocyte ratio as a prognostic indicator in patients undergoing nephrectomy for renal cell carcinoma.

INTRODUCTION: Prognosis in patients with cancer is influenced by underlying tumour biology and also the host inflammatory response to the disease. There is limited evidence to suggest that an elevated neutrophil-lymphocyte ratio (NLR) predicts a poorer prognosis in patients undergoing nephrectomy for renal cell carcinoma (RCC). The aim of this paper is to investigate if patients undergoing nephrectomy for RCC with NLR ≤4 have a better overall and recurrence-free survival than patients with NLR >4. METHODS: All patients who underwent nephrectomy at a single centre between January 1, 2011 and December 31, 2014 were identified. Patients were included if postoperative histology demonstrated RCC and if preoperative NLR was available. Patients were excluded if nephrectomy was not curative intent (i.e., cytoreductive nephrectomy), if primary tumour was graded to be T3b-4 disease, if there was presence of nodal or metastatic disease on preoperative staging, or if adequate followup notes were not available. Primary and secondary outcomes were overall survival and recurrence-free survival, respectively. RESULTS: A total of 154 patients were included in analysis of overall survival; 146 patients were included in analysis of recurrence-free survival. Patients with NLR ≤4 had a much better overall survival than patients with NLR >4 (95% vs. 78%; p=0.0219). Patients with NLR >4 also had higher rates of recurrence (p=0.0218). CONCLUSIONS: NLR may be a useful tool in identifying patients who may benefit from more frequent surveillance in the early postoperative period and may allow clinicians to offer surveillance schemes tailored to the individual patient.

Radiofrequency ablation of renal cell carcinoma: a follow up of outcomes.

INTRODUCTION: To present the oncological outcomes in a series of patients with cT1a renal cell carcinoma (RCC) treated with radiofrequency ablation (RFA) and its effect on the glomerular filtration rate (GFR). MATERIALS AND METHODS: Forty-five patients (48 renal units) treated at the Belfast City Hospital, over 4 years. Average age is 61.5 years (range 41-80). Eighteen patients (22 renal units) were included with American Society of Anesthesiologists (ASA) II and III. The rest were ASA I. Average tumor size was 2.63 cm (range 1.2 cm-6 cm). Renal function before and after RFA was recorded by means of the estimated glomerular filtration rate (eGFR) and the changes are presented. Oncological outcomes were established from follow up imaging. A satisfactory response was defined by disappearance or a persistence of non-enhancing lesion of smaller size at follow up. A partial response was defined by a persistent but non-enhancing similar size lesion. A failed response was defined by enlarging or persistently enhancing lesions. RESULTS: Mean follow up was 30.6 months (4-60 months). A good response was found in 33 (74%) patients. A partial response was found in 3 (8%) patients and failed response was identified in 8 (18%) patients. The average reduction in eGFR was 11 mL/min. Two patients had a 50% reduction in their eGFR. No patient required dialysis following treatment. CONCLUSION: RFA presents safe treatment choice for patients with RCC, particularly those that are high risk surgical candidates and those who refuse surgery. Short term results suggest good oncological outcomes and preservation of renal function.

Outcome of glansectomy and skin grafting in the management of penile cancer.

Purpose. To report outcome data for patients with penile cancer treated surgically with glansectomy and skin grafting. Materials and Methods. We retrospectively reviewed data on all patients undergoing surgical management of penile cancer by a single surgeon between 1998 and 2008. Outcomes in patients who underwent glansectomy and skin grafting were analysed. Results. Between 1998 and 2008 a total of 25 patients with a mean age 60 (39-83) underwent glansectomy and skin grafting. Six patients had carcinoma in situ (CIS); the stage in the remaining patients ranged from T1G1 to T3G3. Mean followup for patients was 28 months (range 6-66). Disease specific survival was 92% with 2 patients who had positive nodes at lymph node dissection developing groin recurrence. One patient developed a local recurrence requiring a partial penectomy. Conclusions. Penile preserving surgery with glansectomy and skin grafting is a successful technique with minimal complications for local control of penile carcinoma arising on the glans. Careful followup to exclude local recurrence is required.

Subclavian vein thrombosis: an unusual presentation of renal cell carcinoma.

Subclavian vein thrombosis is an uncommon clinical condition which is often associated with venous catheterization or secondary to excessive effort. We present a 54-year-old female with subclavian vein thrombosis as a first presentation of renal cell carcinoma. Although this is an unusual presentation, malignancy should be considered in the differential diagnosis. Hypercoagulability as part of a paraneoplastic syndrome was considered a possible etiology. In patients with otherwise unexplained subclavian vein thrombosis, full systemic examination and radiological evaluation of the abdomen, retroperitoneum and pelvis should be pursued. A review of the literature relevant to this unusual case is provided.

A Review in Management of Testicular Cancer: Single Center Review.

BACKGROUND: Testicular cancer is one of the few solid cancers that can be cured even when it is metastasized with overall survival rate of more than 90%. The aim of this study was to establish the age adjusted incidence of testicular cancer and to critically assess the management of testicular tumor. METHODS: This is a quantitative retrospective study utilizing a review of clinical notes for patients who underwent testicular orchidectomy. The number of cancer cases, types of pathology and cancer staging were examined. RESULTS: There is no substantial difference between the crude and the age-standardized incidence, moreover no difference from the reported crude incidence by the Scottish intercollegiate guidelines. We found 55.1% of seminoma, 14.28% of non-seminoma and 30.61% of combined (seminoma and non-seminoma), and stage I disease in 61.22% of cases, stage II in 36.73% of cases, and stage IV in 2.04% of cases. Most of the cancers were in the age group 20 - 50 with the majority (48.97%) in the age group 31 - 40. About 42.85% of cases were identified with high tumor markers; higher percentage of seminoma at stage II (40.74%). CONCLUSIONS: There is no substantial difference between the crude and the age-standardized incidence, moreover no difference from the reported crude incidence. Most of the cancers were in the age group 20 - 50 with the majority (48.97%) in the age group 31 - 40. Only 25% of seminomas had elevated tumor markers. Moreover, it is important to re-enforce strict adaptation to the IGCCCG prognostic factor-based classifications.

Urologists versus radiologists made PCNL tracts: the U.K. experience.

We aim to explore the practice of who makes the PCNL tract in the U.K. and Northern Ireland as well as presenting our data for two different approaches to PCNL tracts in Northern Ireland. A national questionnaire survey was carried out across the National Health Services hospitals in U.K. In addition, a retrospective analysis of 134 PCNL cases was carried out. Group I included 103 (77%) cases with urologist-made tracts, while group II included 31 (23%) cases with radiologists-made tracts. The survey suggested that 45% (42) of the hospitals adopted a radiologist-made tract, 44% (41) use urologist-made tract, while the remaining 11% (11) use both. Most of the radiologists' performed tracts in our series were for complex cases. Failed access occurred in 6 (5.8%) in group I and none in Group II. The overall stone-free rate was 92 and 50% for group I and II, respectively. There is a better stone clearance rate in Group I (p = 0.0016). This however is likely to be attributed to the complexity of the cases in group II. However, urologist made percutaneous tract is safe and efficacious but a team approach with radiology is needed for more complex cases.

Intratesticular epidermoid cyst: is radiological diagnosis enough?

Intratesticular epidermoid cysts are rare solid tumorlike lesions. They constitute 1% of all testicular tumors. Major advances have been achieved during the last decades, shifting the management of epidermoid cysts to a more conservative approach. We present a case of a 20-year-old male who was referred to the urology department with a two-year history of a gradually increasing painless right-sided scrotal lump. We will discuss the diagnostic work up of intratesticular epidermoid cyst, with the operative management and literature review.

Prevention of catheter-related urinary tract infections.

Catheter-associated urinary tract infection is the most common nosocomial infection, with hospitalized patients having a risk of 5% per day an indwelling catheter is in place. Use of catheters coated with silver alloy-hydrogel significantly reduces the risk of catheter-associated urinary tract infection and the burden on the NHS.

Vesico-vaginal fistula post cold cup bladder biopsy: mini review.

INTRODUCTION: We report a case of a vesico-vaginal fistula (VVF) post cold cup biopsy; to our knowledge this is the only reported case. We present the clinical history/presentation, investigation and the outcome of the treatment. VVFs are among the most distressing complications of gynecologic and obstetric procedures. The risk of developing a VVF is more than 1% after radical surgery and radiotherapy for malignancies. Management of these fistulas has been better defined and standardized over the last decade. METHODS AND RESULTS: A case of low grade superficial bladder cancer was treated with multiple resections of bladder tumor and a single installation of mitomycin post initial resection which successfully cleared her bladder cancer, but nevertheless led to a small size and scarred bladder. In addition there was a long history of smoking with its effects on tissue integrity and healing. VVFs are very rare and are an unpleasant outcome post a cold cup biopsy, adding to the psychological and social effects of the surgical treatment. CONCLUSION: Although cold cup biopsy is a normal day procedure performed by both residents and consultants, consensus should exist on how to treat a patient who has a bladder with defective integrity and small capacity. The rate of successful fistula repair reported in the literature varies between 70% and 100% in nonradiated patients, with similar results when a vaginal or abdominal approach is performed, the mean success rates being 91% and 97%, respectively.

The clinical association between free androgen index and erectile dysfunction in men.

OBJECTIVES: To assess the relation of sex hormone levels in men, as measured by Free Androgen Index (FAI), with severity of erectile dysfunction (ED) and with their response to treatment. METHODS: We retrospectively reviewed the medical records of men who consecutively attended the urology clinic with the complaint of ED between March 2004 and October 2007. The Sexual Health Inventory for Men (SHIM) score was used as the main outcome measure in this study, and its variation was tested by certain variables using the Epi Info software. RESULTS: A total of 150 men were studied. The majority of patients (93%) had FAI in the normal range levels, and had shown no relation to the SHIM score even after adjustment for other factors. However, FAI was highly related to patients' response to treatment, with the higher the level the higher was the proportion of patients responded well to treatment. Age of the patient was the only factor influencing the SHIM score they could attain, as shown by the linear regression analyses. CONCLUSION: The FAI level is not related to the severity of ED. Its role however, is confined to the way patients are going to respond to medical treatment of ED. Further studies are therefore needed to assess the effectiveness of using this parameter as a reliable test of bioactive testosterone for men with ED.

Laparoscopic bladder diverticulectomy.

Acquired bladder diverticulae are herniations of the bladder mucosa through detrusor muscle. Due to the ineffective emptying of the bladder diverticulum, urine accumulation may lead to urinary tract infection, stone disease, and lower urinary tract malignancy in the diverticulum. We report a case of laparoscopic bladder diverticulectomy for transitional cell carcinoma in an acquired bladder diverticulum. To our knowledge, this is the third case of laparoscopic diverticulectomy for a tumor. We report our experience with this case and the technical challenges encountered during the operation, together with literature review.

Long-term follow-up after retroperitoneal laparoscopic decortication of symptomatic renal cysts.

INTRODUCTION: The purpose of this study was to present our long-term experience of retroperitoneal laparoscopic decortication (RLD) for patients with severely symptomatic simple renal cysts. The feasibility, safety and efficacy of this technique is reported, along with immediate and long-term clinical outcomes. MATERIALS AND METHODS: Over a 6-year period, 22 consecutive patients with symptomatic simple renal cysts underwent RLD by a single surgeon. Demographic data, perioperative blood loss, length of operative procedure, length of hospital stay and complications were analyzed. Follow-up included clinical review and renal ultrasonography, at 6-monthly intervals for 1 year, and then annually. RESULTS: The mean patient age was 45 (range 31-63) years. RLD was successfully performed in all 22 patients - no open conversions were required. There was no mortality and there were no perioperative complications. Mean duration of surgery was 101.9 min (59-117 min) and operative blood loss was <150 ml in all cases (10-150 ml). Mean length of hospital stay was 3.2 (2-6) days and return to normal activities was achieved after a mean of 15 (10-30) days. At a mean follow-up of 60 (22-93) months, 17 patients (77%) were completely relieved of symptoms, while 5 (23%) patients complained of some pain not requiring any analgesia. Renal ultrasonography showed an absence of radiological recurrence of the symptomatic renal cyst in all cases. CONCLUSION: RLD is a safe and effective method to treat symptomatic renal cysts, with an immediate postoperative symptomatic relief, a short convalescence period and effective 5-year clinical and radiological outcome.

Greenlight prostatectomy: a challenge to the gold standard? A review of KTP photoselective vaporization of the prostate.

The use of lasers to carry out resection of the prostate gland is an ever-evolving field which has seen several different modalities of laser light used with varying success. This review looks at what makes the traditional transurethral resection of prostate the gold standard and provides the evidence on the evolution of the laser prostatectomy in trying to usurp it as the favored procedure for symptomatic benign prostatic hyperplasia. In particular, we show how the latest laser technology in the form of the Greenlight laser is challenging not only other lasers such as the holmium laser, but may form a strong contender to replace the transurethral resection of prostate.

Gonadotropins and prostate cancer: revisited.

Luteinizing hormone and follicle-stimulating hormone are called gonadotropins, because they stimulate the gonads - in males the testes and in females the ovaries. They are not necessary for life, but are essential for reproduction. In addition, the association of these hormones with prostate cancer has been the interest of many researchers. Their detection in the human prostate has been investigated using different methods, including immunologic and RT-PCR techniques. In addition, the increasing evidence of paracrine/autocrine functions of the gonadotropic glycoprotein hormones, their allocation to the superfamily of cystine knot growth factors, and luteinizing hormone/chorionic gonadotropin receptor gene expression in non-gonadal tissues led many researchers to investigate intraprostatic glycoprotein hormones and their receptor gene expression. We aim in this review to shed light on the physiology of the gonadotropins and their association with prostate cancer and highlight the future possibilities of their use as targets in treating this disease.