Showing papers in "Medical & Surgical Urology in 2019"

Metastatic Prostate Cancer: Clinical Aspects and Therapeutic Management in the Region of Thies Senegal

Abstract: Aim: To study the epidemiological, clinical and therapeutic aspects of advanced prostate cancer in Thies. Patients and methods: This is a descriptive study over a period of 6 years (January 2012 to December 2017) involving 156 patients. Results: The average age of our patients was 75.3 years (52 to 100 years). The annual incidence was estimated to 26.5 cases. The average time to referral was 30 months (3 months; 5 years). The main reason for consultation was urinary symptoms. Bone pain was the main extra-urinary symptoms noted in 73.71% of cases. Digital rectal examination was suggestive of cancer in the majority of cases (n=116). Mean PSA was 532.25 ng/mL (Range: 10.000-100 ng/mL). Pathological examination revealed prostatic adenocarcinoma in all patients. Gleason score ranged between 6 and 9 with an average of 7. At imaging bone metastases was found in 73.71% of cases. Other sites of metastasis were mainly pulmonary (14.10%) and hepatic. Of the cohort 156 patients were treated by hormonal therapy alone and 72 patients by hormone therapy associated with prostatic surgery. Conclusion: The mortality remains high despite improved diagnostic and treatment.

Bilateral Ureteral Duplication and Right Ectopic Ureter Presenting with Incontinence: A Case Report

Abstract: Bilateral duplicated system with ectopic ureter is a rare entity. Duplication and its associated anomalies are more common in females. Anomalies of the renal collecting system should be considered by clinicians and surgeons in patients presenting with urinary incontinence. We present a 32-year-old female with a Bilateral Ureteral Duplication with Right Ectopic Ureter presenting with low volume Incontinence. We emphasized the importance of imaging in the diagnosis of anomalies of the renal collecting system presenting with incontinence. In the absence of a dysplastic renal moiety, an ureteroneocystostomy is an ideal procedure of choice to correct incontinence from ectopic ureters in females.

Treatment of Muscle Invasive Urothelial Bladder Cancer- A Review of the Literature

Abstract: Carcinoma of the bladder is the fourth and fifth most frequently diagnosed cancer in the United States and Europe respectively. Muscle-Invasive Urothelial Bladder Cancer (MIBC) (cT2-T4) is an aggressive disease with poor 5-year Overall Survival (OS) of 50%. Epidemiological studies are unavailable in most African countries; however, Africa was found to have a lower incidence. Current optimal management is based on Radical Cystectomy (RC) and pelvic Lymph Node Dissection (LND), generally associated with pre-operative cisplatin-based chemotherapy. Adjuvant chemotherapy may be necessary in patients who did not benefit from neoadjuvant chemotherapy. A selected few patients who desire bladder preservation may benefit from bladder sparing procedures but should be cautioned about the risk of recurrence. The African literature lacks structured prospective studies on the management of urothelial muscle invasive bladder cancer and much of the clinical data are extrapolated from current evidence-based guidelines.

Kidney Angiomyolipoma with Inferior Vena Cava Thrombosis during Third Trimester of Pregnancy

Abstract: Kidney angiomyolipoma is a rare renal benign neoplasm. In exceptional cases, it can extend to inferior vena cava causing thrombosis. We report here a case of a 33 years old patient who presented an angiomyolipoma caval thrombus during pregnancy.

Early use of Bladder Relaxant (Oxybutynin) in Posterior Urethral Valve Patients. Is it Justified

Abstract: Introduction: Posterior Urethral Valves (PUV) constitute the most common infravesical urinary obstruction in boys. Bladder dysfunction, the pattern of which changes with the age and is common cause of morbidity in PUV patients. Urodynamic study provides a useful tool to identify the bladder dysfunction and allow timely and appropriate management. The aim of this study was to determine the efficacy of early use of bladder relaxant (oxybutynin) on urodynamic parameters in PUV patients and to compare our results with other authors. Material and Methods: Patients with posterior urethral valves more than 4 years of age were included in the study. After the diagnosis, oxybutynin was started prophylactically in all patients. Invasive urodynamic study was done in all patients minimum one year after start of oxybutynin. Bladder relaxant (oxybutynin) was stopped 48 hours before the study. Various urodynamic parameters which were noted in each patient include compliance, bladder stability (normal/overactivity), bladder capacity, detrusor pressure during voiding (sustained, waxing and waning or myogenic failure), detrusor sphincter dysynergia and post void residue. Results: 47 patients were included in the study. Age of patients ranged from 4 years to 14.8 years with mean age of 8.4 years. Normal detrusor pressure during filling (stable bladder) was seen in 95.7% of patients, bladder overactivity in 4.3% of patients, compliance (compliance good in 89.4% and compliance poor in 6.4%), bladder capacity (normal (70.2%), decreased (10.6%) and increased (19.1%), detrusor pressure during voiding (sustained (68.1%), waxing and waning (21.3%) and myogenic failure (10.6%)). Conclusion: Early use of oxybutynin immediately after the diagnosis of PUV, improves the urodynamic parameters in these patients possibly because of protective effect of oxybutynin on bladder function and structure.

Definitive Therapy of Early Prostate Cancer with Transurethral MicrowaveThermotherapy after Prostate Volume Reduction by Androgen Deprivation: A17-Year Experience of a Potential Alternative to Radical Surgery

Abstract: Background: Transurethral Microwave Thermotherapy (TUMT) has shown limited efficacy as a treatment for prostate cancer, mainly because of the inability of microwaves to reach the peripheral region of the prostate. Pretreatment with Androgen Deprivation Therapy (ADT) may increase TUMT efficacy by reducing the prostate size. Objective: To examine the clinical outcomes of patients undergoing TUMT after at least 3 months of ADT. Design, setting, and participants: One hundred twenty-three men with early, non-metastatic prostate cancer and Prostate-Specific Antigen (PSA) levels of 4.0 ng/mL or higher were enrolled between 2001 and 2011 and followed up until 2017. TUMT was performed after at least 3 months of ADT and the efficacy of this treatment was confirmed by radical Transurethral Resection of the Prostate (TURP) performed at least 3 months after TUMT. Intervention: ADT and TUMT, Outcome Measurements and Statistical Analysis, Post-intervention prostate volume, presence of remnant cancer cells, and clinical outcomes. Results and limitations: Prostate volume was significantly reduced (mean, 35.2%) after 3 months of ADT. Histopathological examination of TURP chips revealed no cancer cells in 102 of 123 patients. Twenty-one patients demonstrated remnant cancer cells; in 13 patients these were non-viable, and in 8 they were degraded. During the 17- year follow-up period, 28 patients received regular or intermittent anti-androgen therapy to maintain PSA levels below 4.0 ng/mL. No patients died of prostate cancer. Conclusion: Combination ADT and TUMT therapy in 123 patients suggests that early prostate cancer is easily destroyed by heat. A significant reduction of prostate volume after ADT increased TUMT efficacy in the peripheral zone and apex. Patient summary: In this study, ADT reduced the volume of the prostate gland by around 35%, enhancing the ability of TUMT to kill cancer cells. This approach should be further evaluated as a less-invasive alternative to current, conventional therapies.

Uretero-arterial Fistula by a Double-J Ureteric Stent in a Stented Internal Iliac Artery Aneurysm

Abstract: We represent a-65-year-old male patient presented with indwelling left JJ stent for obstructed solitary kidney drainage. The obstruction was due to internal iliac artery aneurysm, had been managed by trans-femoral self-expandable coated endovascular stenting. This patient readmitted with recurrent attacks of hematuria with displaced JJ stent and rising serum creatinine twice. In the first admission, the patient was managed by JJ stent readjustment and Percutaneous Nephrostomy tube (PCN) and was discharged safely. Again, he presented with UAF associated with aggressive hematuria mostly due to vascular endoleak rupture. The patient developed severe sepsis and multiple organ dysfunction syndrome.

Amikacin as the Most Potent Antibiotic Locally, is it Required Prior to Extracorporeal Shock Wave Lithotripsy (ESWL) in Patients with Double J Stents?

Abstract: Objective: To assess the efficacy of Amikacin as the anti-biotic of least recorded resistance locally in preventing urinary infective episodes following ESWL (Extracorporeal Shock Wave Lithotripsy) in patients with DJ stents in-situ. Materials and methods: A retrospective review of a cohort of 60 adult patients with upper urinary tract calculi and DJ stent in-situ, who received one dose of Amikacin intravenously immediately before ESWL was carried out. All patients had a documented negative urine culture prior to ESWL. The incidence rate of post ESWL bacteriuria was calculated and compared to the published incidence rates of bacteruria patients who did not receive any prophylaxis. Results: A total number of 60 adult patients with DJ stent in-situ, who received Amikacin prophylaxis, underwent ESWL between the 1st of January 2017 and the 31st of December 2017. All of the 60 patients had a documented negative urine culture pre-ESL. Two patients were found to have positive urine culture post ESWL with an incidence rate of 3.33. This was not statistically different to the published percentage of patients who received no prophylaxis in the compared studies that showed incidence rates of 3.08 and 2.17 respectively (Chi-square=0.704, p=0.703). Conclusion: Intravenous Amikacin prophylaxis was not efficacious in reducing UTI and urinary sepsis following ESWL in patients with DJ stents in-situ, despite being the antibiotic of least resistance locally.

Micturition and Defecation, Neuro-Chemical Control

Abstract: The urinary bladder and the urethra; the rectum and the anal canal have the same embryologic anatomical source, from the cloaca. They share the same nerve supply and have systemic sensory and proprioceptors (mechanoreceptors) in the muscle responsive to mechanical changes. Toilet training switches the toilet control, supervised by the CNS, from para-sympathetic to mainly sympathetic control. Acquired high sympathetic tone at the Internal Urethral Sphincter (IUS) and the Internal Anal Sphincter (IAS) keeps both sphincters contacted and the urethra and anal canal empty and closed all the time. Voluntarily or in need with proper social circumstances, controlled by intact healthy CNS, the IUS and/or the IAS relax and the urethra and the anal canal will open to allow pass of urine, flatus and/or feces. The neurotransmitter at the sympathetic nerve endings is nor-epinephrine, which can be deficient in cases of nocturnal enuresis. The IUS and the IAS are collagen-muscle tissue cylinders. In women both sphincters are closely related to the vagina, and are subject to lacerations from vaginal delivery. Lacerated sphincters as a result of Child-Birth Trauma (CBT) become weak and cannot stand against sudden rise of abdominal pressure resulting in Urinary Incontinence (UI) and/or Fecal Incontince (FI).

The Disturbance of Energy and Material Exchange in Pathogenesis of Erectile Dysfunction

Abstract: Modern literature data related to the erectile dysfunction was stated in this article. The issues of systemic and local endothelial dysfunction are discussed in this Research Work. Also the issues of the interaction of terahertz infrared radiation with biological objects of varying complexity of implementation are discussed. The implementation of the effect of infrared waves of the terahertz range in bio system is possible at the molecular, cellular and systemic levels of regulation.

Localized Nephroblastoma in Adults: Is Surgery Enough? Case Report and Literature Review

Abstract: Introduction: Nephroblastoma or Wilms’ Tumor (WT) is the most common kidney tumor in children. While its incidence is close to 8 cases per million children, it is only 0.2 cases per million adults. In fact, no more than 300 cases have been described in the English or French literature. And while the treatment of nephroblastoma is very well codified in children, its rare incidence in adults leads to a lack of specific treatment regimen. Observation: A 28-year-old female, with no medical history, presented with right flank pain for 4 months. Clinical examination revealed a palpable kidney. CT scan found a large heterogeneous renal mass measuring 15 × 14 × 11 cm without evidence of adjacent structure ’ s infiltration. The patient underwent an open transperitoneal radical nephrectomy. Pathologic examination revealed a nephroblastoma. Due to lack of financial means, she was unable to have adjuvant chemotherapy. A control CT scan performed at 6 months revealed multiples recurrences. The patient died before being able to benefit from chemotherapy. Conclusion: This case illustrates the importance of adjuvant chemotherapy, despite R0 surgery in a localized nephroblastoma. The key to treat nephroblastoma is, first, nephrectomy, then chemotherapy, whatever the stage. Staging only plays a role in the chemotherapy protocol.