Urology Journal
Volume:4 Issue: 3, Summer 2007

While radical retropubic prostatectomy has been the gold standard surgical approach, the explosion of minimally invasive methods has led to the search for less invasive treatment options. We offer an overview of the evolution of laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic prostatectomy (RALP) in terms of the landmark publications and recent head-to-head comparisons, and we review our own experience. A Medline search was performed using the keywords prostate cancer, prostatectomy, laparoscopic, and robotic. All pertinent articles concerning localized prostate cancer were reviewed. The Montefiore experience consisted of a retrospective review of a prospectively maintained confidential database. Several laparoscopic and robotic series were identified including review articles of each modality as well as studies directly comparing the two. Both LRP and RALP compare very favorably with conventional open surgery in terms of safety and oncologic efficacy. Both minimally invasive approaches offer decreased blood loss, transfusion rate, and length of hospital stay when contrasted with open surgery. When compared directly, LRP and RALP offer similar surgical, oncologic, and functional outcomes. However, RALP likely requires a shorter learning curve. The use of minimally invasive techniques has revolutionized the surgical treatment of prostate cancer. Pure LRP has been shown to be feasible and reproducible. However, it has a steep learning curve and is difficult to learn. In contrast, RALP is easier to learn and is now the surgical treatment of choice in most centers of excellence in the United States. The superior optics with respect to visualization and magnification translates into a procedure that is equivalent, if not superior, with respect to perioperative parameters, oncologic outcomes, and functional outcomes to its open counterpart.

Our aim was to evaluate the efficacy and safety of laparoscopic surgery for the management of ureteral calculi. We performed 123 laparoscopic calculus removal in 103 men and 31 women. Indications for the procedure were extracorporeal shockwave lithotripsy or transureteral lithotomy failure and large calculus. The mean age of the patients was 39.6 ± 13.8 years. The calculi were between 1 and 5.6 cm and located in the upper, middle, and lower ureter in 90 (73.2%), 20 (16.3%), and 13 (10.5%) patients, respectively. Ureteral stent was used in 52 (42.3%) patients. We used 3 ports for camera and instruments. Intraperitoneal approach was used in 104 (84.6%) and extraperitoneal in 19 (15.4%). The mean operative time was 143.2 ± 60.5 minutes. One hundred and nineteen patients (96.7%) became stone free. Minor complications occurred in 14 (11.4%) patients. Conversion to open surgery was required in 1 patient due to migration of the calculus to the peritoneum after removal from the ureter. Intra-abdominal hematoma led to reoperation 1 day after the surgery in 1 patient. Operative time was different significantly between extraperitoneal and intraperitoneal approaches (171.3 ± 91.3 minutes and 137.3 ± 52.2 minutes, respectively; P =. 02). Our results confirm the efficacy and safety of laparoscopic removal of ureteral calculi in selected groups of patients, taking the advantage of this minimally invasive procedure such as better cosmetic results and patient’s satisfaction.

The aim of this study was to evaluate the effect of family history on the age of urinary calculus formation and its relation with characteristics of the calculi and patients. In a cross-sectional study in Tabriz, a total of 210 patients with upper urinary tract calculi were evaluated. Their demographics and clinical characteristics and detailed information on their family history were recorded. Of the patients, 28.6% had a positive family history for urinary calculi. Siblings were the majority of the affected family members (71.1%). The rate of a positive family history was slightly higher in women than in men (30.0% versus 28.1%; P =. 20). The mean age at the disease onset of the men with and without a positive family history was 37.2 years versus 39.3 years, respectively (P =. 20). Such a difference was not detected in the female patients, either (P =. 63). In general, the calculi were more detected on the left renal unit, but more prevalent on the right side in patients with a positive family history (P =. 008). No relation was found between the number and size of the calculi and the family history. About one-third of the patients with urinary calculi had a positive family history too. Men with affected family members are slightly more susceptible to the disease at younger ages. There might be differences in the side of the calculi and family members with a history of disease that warrants further studies.

The aim of this study was to evaluate percutaneous nephrolithotomy (PCNL) in horseshoe kidneys with calculi. Between 1995 and 2005, we performed PCNL in 9 patients with horseshoe kidney. In 3 of them, there was a single calculus and the rest had multiple calculi in the pelvis and at least 1 in the calyxes. Ultrasonography, plain abdominal radiography, and intravenous urography (IVU) were performed in all patients. We used fluoroscopy for entering the system and then, pneumatic or ultrasonic lithotripsy was used. In all except 1 patient (88.9%) we could access the system. Single calculi in 3 patients were removed. In 5 patients with multiple calculi, the calculus causing obstruction was removed, and in 3, the calculi located in the calyxes were removed too. Consequently, 66.7% were stone-free at the end of the procedure. In 2 patients, there were residual calculi in the calyxes and they underwent candidates for extracorporeal shockwave lithotripsy. Percutaneous nephrolithotomy can be used in patients with horseshoe kidney if the patient selection is appropriate and the surgeon is experienced enough. The success rate and complications are the same as the patients with normal anatomy. However, access to the lower calyx is more difficult due to its anatomic status.

The aim of this study was to evaluate the relationship between HER-2/neu oncogene expression and grade of transitional cell carcinoma (TCC) of the bladder. In this cross-sectional study, 75 formalin-fixed paraffin-embedded specimens of primary TCC of the bladder were stained with a monoclonal antibody against HER-2/neu oncoprotein. Another section was stained by hematoxylin-eosin and the tumor grade was determined according to the World Health Organization/International Society of Urological Pathologists criteria. Tumor specimens belonged to 49 men (65.3%) and 26 women (34.7%) with a mean age of 56.3 ± 9.1 years (range, 39 to 80 years). The tumor grades were 1, 2, and 3 in 14 (18.7%), 35 (46.7%), and 26 (34.7%) specimens, respectively. A total of 28 (37.3%) patients were positive for overexpression of HER-2/neu. There were 1 case of HER-2/neu-positive (7.1%) with a grade 1 tumor, 10 (28.6%) with grade 2, and 17 (65.4%) with grade 3; a significant relationship between HER-2/neu overexpression and grade of the bladder TCC tumors was found (P =. 002). Expression of HER-2/neu oncogene has a direct relationship with the grade of the bladder TCC. Further studies with longer follow-up period and a larger sample size can determine the probable role of HER-2/neu expression as a prognostic factor in the TCC of bladder.

For eligible patients with end-stage renal disease, the dialysis stage could be bypassed by preemptive kidney transplantation (PKT), when the organ is available. We compared this treatment option with kidney transplantation in patients with pretransplant dialysis (PTD). We retrospectively studied on 300 patients who received PKT between 1992 and 2006 from living donors. They were compared with 300 kidney recipients with PTD matched for the time of transplantation that had been on hemodialysis for at least 6 months. Episodes of rejection, graft function, and graft and patient survivals were compared between the two groups. No significant differences were noted in the sex of the recipients, age and sex of the donors, donor source, and posttransplant immunosuppressive therapy, but posttransplant follow-up was longer (P <. 001) and the recipients were older (P <. 001) in the PTD group. Seventy-one patients (23.7%) in the PKT group and 64 (21.3%) in the PTD had at least 1 rejection (P =. 49). The kidney allografts were functional in 272 (90.7%) kidney recipients in the PKT group and 278 (92.7%) in the PTD group during their follow-ups (P =. 30). Five-year graft and patient survival rates were slightly higher in the PTD group, which were not statistically significant (P =. 06 and P =. 07, respectively). In addition to comparable patient and graft survivals with the PKT and kidney transplantations after a period of dialysis, PKT eliminates hemodialysis costs and complications. We recommend PKT as a better choice for transplantation whenever possible.

The aim of this study was to evaluate the process of spermatogenesis in rats exposed to the cigarette smoke. Thirty adult male rats were divided into 2 groups of cases and controls. An apparatus made especially for this study was used to produce smoke from a commonly used cigarette and expose the rats to the smoke. The rats in the case group were exposed to the cigarette smoke for 10 weeks (90 minutes every day for 6 days in each week). The rats in the control group were meanwhile in the fresh room air. Development of the sperms was mildly reduced in 14 (93.3%) and 4 (26.7%) rats in the case and control groups, respectively (P <. 001). The mean average diameter of the seminiferous tubules was reported to be 0.421 ± 0.097 mm and 0.493 ± 0.026 mm in the case and control groups, respectively (P =. 04). The mean numbers of Sertoli cells were 9.2 ± 1.2 and 13.3 ± 1.8 in the case and control groups, respectively (P <. 001). A concurrent reduction in the number of germ cells and Leydig cells with the decrease in the number of Sertoli cells was seen in the rats of the case group. Cigarette smoke has a rather obvious effect on spermatogenesis in rats which may be due to toxic substances in the cigarette or the histologic reactions due to hypoxemia induced by smoke. Although further documentation, especially in humans is required, the potential impact of smoking on fertility in men should be considered in public health education.

Retractile testis may affect testicular parenchyma and spermatogenesis, and surgical treatment has been recommended for infertile men with retractile testes. We evaluated outcomes of orchidopexy in men with idiopathic infertility who suffered from bilateral retractile testes. We performed dartos pouch orchidopexy on 22 men with idiopathic infertility and bilateral retractile testes. The patients were subsequently followed up for 1 year and sperm parameters were assessed at 3-month intervals. Testicular volume was determined by ultrasonography 1 year postoperatively and compared with that before orchidopexy. Satisfaction with the appearance of the external genitalia, sexual desire, and the ability to have successful intercourse were assessed through a Likert-scale questionnaire. Before the operation, the mean testicular volume was 12.2 ± 5.0% lower than the lower normal limit of the testis volume in adults, and no clinically significant change was observed 1 year after the operation. Sperm density showed no significant changes postoperatively, but the mean proportion of sperms with high-grade motility witnessed a significant increase 1 year after the operation (P =. 007). The mean percentage of sperms with normal morphology had a significant decrease at 1 postoperative year. Significant improvements were reported in satisfaction with the appearance of the external genitalia, sexual desire, and successful intercourse 1 year after the operation. Retractile testes might be at risk of growth retardation. We found that orchidopexy in retractile testes may improve sperm motility and increase fertility potential of the patients. We recommend orchidopexy in infertile men with bilateral retractile testes.

The aim of this study was to evaluate the possibility of differentiating xanthogranulomatous pyelonephritis (XGPN) preoperatively from chronic pyelonephritis on the basis of demographic data, clinical parameters, and biochemical, microbiological, and radiological workups. Between 1995 and 2005, a total of 239 patients were diagnosed to have pyelonephritis at our center, of which, 56 underwent nephrectomy. Forty-five (80.4%) of the nephrectomy specimens showed diagnosis of chronic pyelonephritis and 11 (19.6%) showed XGPN. Compared to chronic pyelonephritis, XGPN was more likely to occur in the middle-aged women (90.9%) with diabetes mellitus (63.6%). A positive history of UTI was more frequent in these patients, too. The disease was likely to present with flank pain and tenderness in 100.0% and 90.9% of the patients with XGPN, respectively. Anemia (81.8%), hematuria (81.8%), and bacteriuria (90.9%) were more frequent in these patients than in those with chronic pyelonephritis. The mean blood hemoglobin was 7.0 g/dL in the patients with XGPN. Proteus mirabilis was detected in 6 patients (54.5%) of the XGPN group and only 2 of the chronic pyelonephritis group (P <. 001). Renomegaly and kidney calculus were more frequently noted in the patients with XGPN. Finally, XGPN led to a higher rate of postoperative complications. Demographic data, comorbidities, predisposing factors, and biochemical as well as roentgenological features are significant but nonspecific indicators of preoperative diagnosis of XGPN.