Urology Journal
Volume:6 Issue: 1, Winter 2009

Patients with arteriogenic erectile dysfunction (ED) caused by traumatic localized arterial lesions can be treated successfully by penile revascularization (PR) surgery. We aimed to determine the subjective and objective outcomes of PR surgery in patients with arteriogenic ED. We searched for relevant publications released up to May 2008 in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Biological Abstracts. The citation lists of review articles and included trials were also searched. Published studies on different operative techniques of PR for men with ED due to traumatic penile arterial lesions were selected by 2 reviewers. Data on participants’ characteristics, study quality, population, intervention, cure and adverse effects were collected and analyzed. There were 25 studies that compared the selected operative techniques. Concerning subjective cure, the results in men younger than 30 years old were better than older ones (odds ratio, 3.7; 95% confidence interval, 2.2 to 6.4; P =. 001). Venous leak (odds ratio, 1.8; 95% confidence interval, 1.2 to 2.6) and history of smoking (odds ratio, 3.4; 95% confidence interval, 2.2 to 5.6) influenced success rate. Inconsistent measurements of outcomes limited the findings, and none of the studies were randomized controlled trials. Traumatic patients with arteriogenic ED might benefit from PR. Patient selection is vital for a successful outcome. Variations in penile vascular anatomy are also likely to be important when individualizing penile revascularization procedures. In a limited number of highly selected individuals PR can be successful for the long-term. Randomized controlled trials examining different PR techniques are needed to better examine the PR techniques.

our aim was to evaluate the effect of Rowatinex, an essential oil preparation of terpenic type, on kidney calculi clearance after extracorporeal shock wave lithotripsy (SWL). A randomized controlled trial was performed at Hormozgan Hospital in Bandar Abbas, Iran, on 100 patients with 10-mm to 20-mm kidney calculi. They underwent SWL, and then, they were randomly assigned into 2 groups to receive either Rowatinex, 100 mg, 3 times per day, or placebo after SWL. Patients were followed up with plain abdominal radiography, ultrasonography, and excretory urography (if required), 2 and 4 weeks postoperatively. Two weeks following SWL, 6 (12%) and 9 (18%) patients in the Rowatinex and control groups had fragmented calculi without clearance, 26 (52%) and 24 (48%) had less than 50% clearance, 9 (18%) and 15 (30%) had more than 50% but not total clearance, and 9 (18%) and 2 (4%) patients were stone free, respectively. Rowatinex had a significant effect on the stone-free rate (P =. 02). Four weeks post-SWL, 3 (7.3%) and 7 (14.6%) other patients in the Rowatinex and control groups became stone free, respectively. Overall, Rowatinex had no significant effect on the stone-free rate (P =. 46). No complications or differences between the two groups in symptoms and signs were reported. Rowatinex does not have a significant effect on clearance rate of kidney calculi after SWL. However, it can accelerate calculus passage after 2 weeks, and it does not have any significant adverse effects.

Our aim was to determine the incidence and spectrum of significant alternate or incidental diagnoses established or suggested on spiral computed tomography (CT) in a large series of patients with suspected renal colic. Records of all patients that had undergone spiral CT (5-mm to 7-mm slice thickness) for acute flank pain during a 5-year period were reviewed. The radiological diagnoses of urinary calculi and obstruction as well as clinical entities not suspected otherwise were analyzed. A total of 4000 CTs had been performed in the evaluation of acute flank pain. Urinary calculi had been identified in 3120 patients (78.0%). There were 398 patients (9.9%) who had an alternate cause of flank pain or an incidentally detected condition on CT. Of these patients, 102 (25.6%) had more than one additional finding. A total of 153 clinical conditions had been identified mimicking flank pain secondary to calculus and obstruction. In 47 patients (1.2%), incidental solid masses had been detected. Spiral CT is a valuable technique in the evaluation of acute flank pain with uncertain clinical diagnosis. A wide spectrum of alternate and additional diagnoses including abdominal solid organ tumors and other significant abdominal conditions such as pancreatitis can be established or suggested on spiral CT performed for suspected acute urinary colic

The aim of this study was to evaluate the success rate of urethrocutaneous fistula repair using buccal mucosal graft in patients with a previous hypospadias repair. We reviewed records of our patients with urethrocutaneous fistula developed after hypospadias repair in whom buccal mucosal graft fistula repair had been performed. All of the patients had been followed up for 24 postoperative months. A successful surgical operation was defined as no fistula recurrence or urethral stricture. Retrograde urethrography and urethrocystoscopy would be performed in patients who had any history of decreased force and caliber of urine or any difficulty in urination. Fistula repair using buccal mucosa patch graft had been done in 14 children with urethrocutaneous fistula developing after hypospadias reconstruction. The mean age of the children was 8.70 ± 1.99 years old (range, 4 to 11 years). Seven fistulas were in the midshaft, 4 were in the penoscrotal region, and 3 were in the coronal region. Repair of the fistulas was successful in 11 of 14 patients (78.6%). In the remaining children, the diameter of the fistula was smaller than that before the operation, offering a good opportunity for subsequent closure. Our findings showed that fistula repair using buccal mucosal graft can be one of the acceptable techniques for repairing fistulas developed after hypospadias repair

Bladder neck-sparing modification of radical retropubic prostatectomy has been reported to lower the risk of urinary incontinence after prostatectomy. We reviewed the outcomes in men with prostate cancer who had undergone prostatectomy with either bladder neck preservation or bladder neck reconstruction. In this retrospective study, a total of 103 patients who had undergone radical retropubic prostatectomy were assessed. The patients were divided into two groups of bladder neck preservation (51 patients) and bladder neck reconstruction (52 patients). We compared frequency of biochemical failure, bladder neck stricture, and urinary incontinence between these two groups. Biochemical failure was defined as a serum prostate-specific antigen level higher than 0.2 ng/mL and its rising trend in at least 2 postoperative subsequent measurements. Continence was defined as no need to use sanitary pads or diapers. The two groups were comparable in terms of age, serum prostate-specific antigen level, Gleason score, and prostate volume. After a mean follow-up period of 32.5 months, all patients with bladder neck preservation and 46 (88.5%) with bladder neck reconstruction were continent (P =. 03). There were no significant differences in the frequency of biochemical failure and bladder neck stricture that required dilation between the two groups of patients. Bladder neck preservation during radical retropubic prostatectomy may improve long-term results of urinary continence and be effective in eradicating prostate cancer without increasing recurrence rate.

Our aim was to evaluate the value of serum prostate-specific antigen doubling time (PSADT) to identify patients with high-grade prostate cancer who require more aggressive therapy from those with low-grade cancer. Of 460 patients with extended 12-core transrectal ultrasonography-guided biopsy of the prostate, 59 with confirmed prostate cancer were selected. They had not received any previous treatment for prostate cancer and had at least 2 consecutive serum PSA tests with a rising trend. The PSADT was calculated in patients with 2 serum PSA levels measured with an interval more than 3 months. Of 59 patients with prostate cancer, 35 (59.3%) had low-grade and 24 (40.7%) had high-grade tumors. There was no difference in age between the two groups. The median PSADT in patients with high-grade and low-grade tumors were 12.70 ± 2.66 months (range, 0.7 to 44.8 months) and 25.00 ± 22.50 months (range, 1.65 to 41.2 months; P =. 001). A total of 21 patients with high-grade tumors (87.5%) had a PSADT less than 12 months, while only 9 of those with low-grade tumors (25.7%) had a PSADT less than 12 months. A PSADT cutoff of 12 months provided a sensitivity of 74% and a specificity of 87% for differentiation of high-grade from low-grade cancers. We showed that men with a short PSADT (< 12 months) were at a higher risk of harboring a high-grade prostate cancer. Our data suggests PSADT to identify patients with high-grade tumors who require more aggressive therapy.

The conventional treatment of acute kidney allograft rejection consists of high-dose corticosteroids and polyclonal antibodies. We report our experience of tacrolimus rescue therapy in patients with acute rejections refractory to corticosteroids and polyclonal antibodies. A total of 34 patients with a mean age of 42.3 years and clinical diagnosis of acute kidney allograft rejection underwent tacrolimus rescue therapy when treatment with corticosteroids and polyclonal antibodies failed. Kidney allograft biopsy results were available in 21 patients. All of the patients received tacrolimus, 0.1 mg twice daily, and in those who responded to the therapy after 4 to 6 months, tacrolimus was changed into cyclosporine. Pathologic examination of 21 biopsy specimens of the kidney allografts showed acute vascular rejection in 7 patients (33.3%), acute humoral rejection in 6 (28.6%), acute cellular rejection in 3 (14.3%), and accelerated acute rejection in 3 (14.3%). Twenty-six patients (76.5%) responded to rescue therapy with tacrolimus and discharged with a mean serum creatinine level of 1.4 mg/dL (range, 1.1 mg/dL to 1.7 mg/dL). Allograft nephrectomy was done in 8 patients (23.5%) because of no response to treatment of rejection, the pathology reports of which consisted of acute vascular rejection in 5 patients and extensive necrosis in 3. Tacrolimus therapy is able to salvage kidney allografts with acute refractory rejection. We recommend that tacrolimus be used as an alternative to the conventional drugs used for antirejection therapy. However, severe infectious complications as a result of overt immunosuppression must be considered.

Our aim was to evaluate the efficacy of utilizing in situ anterior vaginal wall sling in the treatment of stress urinary incontinence (SUI). The study included 11 women with a median age of 50 years (range, 36 to 60 years) who were operated on during the period of November 2005 to August 2006. They were diagnosed with SUI and were operated on using placard-shaped in situ anterior vaginal wall sling technique. Nine patients underwent surgical treatment for the first time, while 2 patients had postoperative recurrent SUI. In all of the patients, urethral hypermobility with or without cystocele was observed. The mean follow-up period was 22.5 months (range, 17 to 28 months). Ten patients (90.9%) were considered cured and 1 (9.1%) started leakage of urine after 1 month during the postoperative period. One patient (9.1%) had urinary retention. Three patients (27.3%) had evidence of wound infection which was treated by appropriate oral medical therapy. In situ anterior vaginal wall sling technique is accredited with a good success rate and low incidence of complications. It is easy to learn and cost-effective, making it a suitable technique for SUI. Longer follow-up and larger number of patients are needed before final conclusion could be drawn.

The purpose of this study was to determine the frequency of androgen decline in the aging male (ADAM) in a group of Indian men working in the health sector. A free medical health checkup camp was organized for the male workers aged between 40 and 60 years employed in surgical departments of our hospital. Of 180 listed male workers, 170 attended this camp and 157 eligible men participated in the study. After clinical history and systemic inquiry, the participants were requested to complete the Saint Louis University’s ADAM questionnaire, and their serum levels of free and total testosterone were measured. Symptomatic andropause was found in 106 men (67.5%) on the basis of their responses to the questionnaire, of whom 41 (38.7%) had low serum free testosterone levels and 32 (30.2%) had low serum levels of total testosterone. Fifty-one men were asymptomatic according to the questionnaire and in this group, 11 (21.6%) had low serum free testosterone levels and 6 (11.8%) of these had low total testosterone levels. The frequency of andropause was 33.1% on the basis of low serum free testosterone levels and it was 26.1% when both symptoms and low serum free testosterone levels were taken into account. In our study, the high frequency of symptoms related to ADAM was unusual. This might be due to the nature of the questionnaire itself. Serum free testosterone measurement may be a better single test for diagnosis of hypogonadism than serum total testosterone measurement.

In the previous issue of the Urology Journal, a comparison of Avicenna’s Canon of Medicine with modern urologic findings was done in part I of this article, addressing bladder anatomy and physiology and bladder calculi. In part II of this review, the remaining chapters of the Canon of Medicine on bladder calculi are reviewed. Avicenna points to perineal urethrostomy (preineostomy), which is today performed as the last therapeutic line or as a temporary remedy before surgical treatment. He also describes surgery via transperineal route and warns the surgeon of the proximity of vasa deferentia, prostate gland, and neurovascular bundle and their exposure in this position. Usage of grasping forceps for removal of bladder calculus and emphasis on removing all calculus fragments are the interesting points of this chapter. Avicenna explains a technique similar to the use of a babcock for prevention of calculus migration. Complications of bladder calculus surgery and cystostomy are also addressed with scientific precision in the Canon.