Pub Date : 2019-07-01DOI: 10.1590/S1677-5538.IBJU.2018.0559.1
L. Favorito
Mazzeo and collegues from Sao Paulo Brazil shows in a very interesting paper the morphologic and structural changes of renal parenchyma during the clamping of the renal pedicle. Partial nephrectomy (open, laparoscopic or robotic) is considered the gold standard for treating localized renal tumors (1-6). Warm renal ischemia is commonly performed during partial nephrectomy to achieve a bloodless surgical field, however renal ischemia has been associated with renal function impairment (7). Previous studies shows that the swine is the most adequate model for comparison to human kidney anatomy and physiology (8, 9). Traditionally, 30 minutes is considered the maximum safe time for renal warm ischemia. In a recent study with swine model (10), the renal warm ischemia of 30 minutes by arterial clamping did not caused significant glomerular damage or nephron loss, but if an artery and vein (en bloc) clamping was used, the 30 minutes of warm ischemia caused a decrease in the number of glomeruli. In the present paper the authors shows that the number of renal parenchymal lesions derived from ischemia is associated with the duration of the insult, but a interesting result was the significant difference between the types of clamping, and the group with clamping of artery and vein presented a lower frequency of injuries than the group with only the renal artery clamping. According the results of this experimental study during a partial nephrectomy, the en bloc clamping for warm ischemia should be favored over only the renal artery clamping to minimize renal injury after partial nephrectomies, but more studies will be necessary in the future to confirm these results. EDITORIAL COMMENT Vol. 45 (4): 763-764, July August, 2019 doi: 10.1590/S1677-5538.IBJU.2018.0559.1
{"title":"Editorial Comment: Study of kidney morphologic and structural changes related to different ischemia times and types of clamping of the renal vascular pedicle","authors":"L. Favorito","doi":"10.1590/S1677-5538.IBJU.2018.0559.1","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0559.1","url":null,"abstract":"Mazzeo and collegues from Sao Paulo Brazil shows in a very interesting paper the morphologic and structural changes of renal parenchyma during the clamping of the renal pedicle. Partial nephrectomy (open, laparoscopic or robotic) is considered the gold standard for treating localized renal tumors (1-6). Warm renal ischemia is commonly performed during partial nephrectomy to achieve a bloodless surgical field, however renal ischemia has been associated with renal function impairment (7). Previous studies shows that the swine is the most adequate model for comparison to human kidney anatomy and physiology (8, 9). Traditionally, 30 minutes is considered the maximum safe time for renal warm ischemia. In a recent study with swine model (10), the renal warm ischemia of 30 minutes by arterial clamping did not caused significant glomerular damage or nephron loss, but if an artery and vein (en bloc) clamping was used, the 30 minutes of warm ischemia caused a decrease in the number of glomeruli. In the present paper the authors shows that the number of renal parenchymal lesions derived from ischemia is associated with the duration of the insult, but a interesting result was the significant difference between the types of clamping, and the group with clamping of artery and vein presented a lower frequency of injuries than the group with only the renal artery clamping. According the results of this experimental study during a partial nephrectomy, the en bloc clamping for warm ischemia should be favored over only the renal artery clamping to minimize renal injury after partial nephrectomies, but more studies will be necessary in the future to confirm these results. EDITORIAL COMMENT Vol. 45 (4): 763-764, July August, 2019 doi: 10.1590/S1677-5538.IBJU.2018.0559.1","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"50 1","pages":"763 - 764"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88291116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1590/S1677-5538.IBJU.2018.0193
M. Floyd Jr., R. Khadr
We read with interest the recent paper by da Silva et al. examining effects of antibiotic prophylaxis and risk of urinary tract infection for spinal cord injured patients undergoing urodynamic studies. The authors describe a multi institutional study involving 661 patients who underwent urodynamic evaluation over 2 years (1). Three different antibiotic protocols are described in separate institutions and a cumulative infection rate of 3.18% was found. No differences between patient age or ASIA classification were found to have an association with the development of subsequent urinary tract infection. However, patients with injuries at T6 or above were at increased risk of developing urinary tract infection following urodynamic evaluation (1). The authors are to be commended for conducting this study as there remains a paucity of literature regarding the topic with only 1 trial to date examining the topic (2). The authors should acknowledge that the length of time between injury, first and subsequent urodynamic evaluation is not recorded and the rate of autonomic dysreflexia (if any) is not mentioned. It is stated that in the consideration of variables a numbers that several factors were included yet there is no baseline assessment of subjective symptoms based on patient questionnaires such as the neurogenic bladder symptom score (3). In the spinal cord injured patient videourodynamic assessment is the preferred method of urodynamic assessment. Specific to our Spinal cord injury unit we routinely perform videourodynamic evaluation of spinal cord injured patients both as inpatients and outpatients and all undergo mandatory dipstick assessment prior to the procedure. If suggestive of infection the procedure is deferred but we do not prescribe antimicrobials pre investigation. Additionally we record bladder symptom scores at baseline with a validated questionnaire (SF Qualiveen) and repeat scores following definitive treatment to evaluate response (4).
{"title":"Re: Antibiotic prophylaxis prior to urodynamic study in patients with traumatic spinal cord injury. Is there an indication?","authors":"M. Floyd Jr., R. Khadr","doi":"10.1590/S1677-5538.IBJU.2018.0193","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0193","url":null,"abstract":"We read with interest the recent paper by da Silva et al. examining effects of antibiotic prophylaxis and risk of urinary tract infection for spinal cord injured patients undergoing urodynamic studies. The authors describe a multi institutional study involving 661 patients who underwent urodynamic evaluation over 2 years (1). Three different antibiotic protocols are described in separate institutions and a cumulative infection rate of 3.18% was found. No differences between patient age or ASIA classification were found to have an association with the development of subsequent urinary tract infection. However, patients with injuries at T6 or above were at increased risk of developing urinary tract infection following urodynamic evaluation (1). The authors are to be commended for conducting this study as there remains a paucity of literature regarding the topic with only 1 trial to date examining the topic (2). The authors should acknowledge that the length of time between injury, first and subsequent urodynamic evaluation is not recorded and the rate of autonomic dysreflexia (if any) is not mentioned. It is stated that in the consideration of variables a numbers that several factors were included yet there is no baseline assessment of subjective symptoms based on patient questionnaires such as the neurogenic bladder symptom score (3). In the spinal cord injured patient videourodynamic assessment is the preferred method of urodynamic assessment. Specific to our Spinal cord injury unit we routinely perform videourodynamic evaluation of spinal cord injured patients both as inpatients and outpatients and all undergo mandatory dipstick assessment prior to the procedure. If suggestive of infection the procedure is deferred but we do not prescribe antimicrobials pre investigation. Additionally we record bladder symptom scores at baseline with a validated questionnaire (SF Qualiveen) and repeat scores following definitive treatment to evaluate response (4).","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"18 1","pages":"860 - 861"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89782331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1590/S1677-5538.IBJU.2018.0756.1
L. Favorito
In this interesting paper Dr. Maciel and collegues from Sao Paulo – Brazil conduct an external validation of a previously developed nomogram (1) to predict inguinal lymph node (ILN) metastases in penile cancer in patients with clinically negative lymph nodes. The authors analyzed 65 men with penile cancer who underwent inguinal lymph node dissection. Of 65 men, only 24 (36.9%) presented with positive LNs. The authors concluded that the present nomogram applied in Brazilian population had low accuracy and low precision for correctly identifying patients with penile cancer who have positive ILN. Penile cancer is a rare neoplasia with low incidence in developed countries. In Brazil the incidence rate of penile cancer is 2.9 6.8/100,000 inhabitants, resulting in this country having one of the world’s highest incidence rates for this neoplasia (2-4). The most common sites of penile cancer metastasis are the superficial and deeper nodes of the inguinal and iliac region. The occurrence and extent of inguinal lymphatic metastasis are the most important prognostic factors in patients with penile cancer and usually imply worse oncologic prognosis (5). Extended Inguinal lymphadenectomy (open, laparoscopic or robotic) is the most useful and commonly performed surgery for staging and to cure inguinal metastasis in penile cancer cases. Although it is a widespread technique, post operatory complications often occur (6-8). This paper is very important, but in the future, papers with prospective studies and with a more significant sample will be necessary to confirm the application of this nomogram to predict inguinal lymphatic metastasis in patients with penile cancer. EDITORIAL COMMENT Vol. 45 (4): 679-680, July August, 2019 doi: 10.1590/S1677-5538.IBJU.2018.0756.1
{"title":"Editorial Comment: External validation of nomogram to predict inguinal lymph node metastasis in patients with penile cancer and clinically negative lymph nodes","authors":"L. Favorito","doi":"10.1590/S1677-5538.IBJU.2018.0756.1","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0756.1","url":null,"abstract":"In this interesting paper Dr. Maciel and collegues from Sao Paulo – Brazil conduct an external validation of a previously developed nomogram (1) to predict inguinal lymph node (ILN) metastases in penile cancer in patients with clinically negative lymph nodes. The authors analyzed 65 men with penile cancer who underwent inguinal lymph node dissection. Of 65 men, only 24 (36.9%) presented with positive LNs. The authors concluded that the present nomogram applied in Brazilian population had low accuracy and low precision for correctly identifying patients with penile cancer who have positive ILN. Penile cancer is a rare neoplasia with low incidence in developed countries. In Brazil the incidence rate of penile cancer is 2.9 6.8/100,000 inhabitants, resulting in this country having one of the world’s highest incidence rates for this neoplasia (2-4). The most common sites of penile cancer metastasis are the superficial and deeper nodes of the inguinal and iliac region. The occurrence and extent of inguinal lymphatic metastasis are the most important prognostic factors in patients with penile cancer and usually imply worse oncologic prognosis (5). Extended Inguinal lymphadenectomy (open, laparoscopic or robotic) is the most useful and commonly performed surgery for staging and to cure inguinal metastasis in penile cancer cases. Although it is a widespread technique, post operatory complications often occur (6-8). This paper is very important, but in the future, papers with prospective studies and with a more significant sample will be necessary to confirm the application of this nomogram to predict inguinal lymphatic metastasis in patients with penile cancer. EDITORIAL COMMENT Vol. 45 (4): 679-680, July August, 2019 doi: 10.1590/S1677-5538.IBJU.2018.0756.1","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"156 1","pages":"679 - 680"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82908989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1590/S1677-5538.IBJU.2019.02.02
L. Reis, D. L. Andrade, F. J. Bianco Jr.
Prostate cancer is the most common solid tumor in men in western countries. Notwithstanding, its high incidence, most patients survive their prostate cancer diagnosis and die from other causes (1). This low cancer death event rate poses remarkable challenges for both patients and their treating physicians. Fundamentally the “overs”, meaning overdiagnosis and overtreatment (2). Both particularly important as significant issues for patients arise as consequences of treatment. Distastefully, urinary incontinence and erectile dysfunction, among other, both exerting substantial impact in quality of life (3). This decade has witnessed results from three randomized trials. These robust studies clearly pointed to a limited benefit of definitive intervention such as surgery or radiation vs. surveillance modalities. The lack of differences in all cause survival and the relative low rate of metastasis 10 and 15 years after diagnosis have changed dramatically our knowledge on what is best to do when a man presents with a newly diagnosed prostate cancer (4-6). Not surprisingly, active surveillance (AS) has become a definitive alternative and common option. This strategy of management certainly decreased the morbidity rates associated to radical surgery or radiation (7). Specifically, AS is now a preferred option for many men with low-risk prostate cancer, gaining worldwide adoption due to robust data and is currently highlighted by many guidelines as the best treatment strategy for men with low risk (8, 9). What constitutes the best approach to AS is an open question, as many protocols currently exists. However, to the patient selection questions, the field of urology sets the tone in low risk PSA <10 ng/ml, WHO GG1 and a clinical stage T1c/T2a. There are several stricter protocols that have been developed and tested for AS. The Epstein criteria of ≤2 positive cores, <50% core involvement, and PSA density <0.15 ng/ml/cm3 carries 10 years rates of overall survival, cancer-specific survival, and metastasis-free survival of 94%, 99.9%, and 99.4%, respectively. Importantly, at 15 years, oncological outcomes such as metastasis-free survival and cancer specific survival change little (10). In Canada, specifically Klotz and collaborators have reported on single-arm cohorts of low-risk patients (Gleason score ≤6 and serum PSA level ≤10 ng/mL) and favorable intermediate-risk patients (serum PSA ≤15 ng/mL or a Gleason score of 7 [3+4]). The investigators reported 10and 15-year metastasis-free survival rates of 96% and 95% vs 91% and 82% for low vs. intermediate Vol. 45 (2): 210-214, March April, 2019
{"title":"Super active surveillance for low-risk prostate cancer | Opinion: Yes","authors":"L. Reis, D. L. Andrade, F. J. Bianco Jr.","doi":"10.1590/S1677-5538.IBJU.2019.02.02","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.02.02","url":null,"abstract":"Prostate cancer is the most common solid tumor in men in western countries. Notwithstanding, its high incidence, most patients survive their prostate cancer diagnosis and die from other causes (1). This low cancer death event rate poses remarkable challenges for both patients and their treating physicians. Fundamentally the “overs”, meaning overdiagnosis and overtreatment (2). Both particularly important as significant issues for patients arise as consequences of treatment. Distastefully, urinary incontinence and erectile dysfunction, among other, both exerting substantial impact in quality of life (3). This decade has witnessed results from three randomized trials. These robust studies clearly pointed to a limited benefit of definitive intervention such as surgery or radiation vs. surveillance modalities. The lack of differences in all cause survival and the relative low rate of metastasis 10 and 15 years after diagnosis have changed dramatically our knowledge on what is best to do when a man presents with a newly diagnosed prostate cancer (4-6). Not surprisingly, active surveillance (AS) has become a definitive alternative and common option. This strategy of management certainly decreased the morbidity rates associated to radical surgery or radiation (7). Specifically, AS is now a preferred option for many men with low-risk prostate cancer, gaining worldwide adoption due to robust data and is currently highlighted by many guidelines as the best treatment strategy for men with low risk (8, 9). What constitutes the best approach to AS is an open question, as many protocols currently exists. However, to the patient selection questions, the field of urology sets the tone in low risk PSA <10 ng/ml, WHO GG1 and a clinical stage T1c/T2a. There are several stricter protocols that have been developed and tested for AS. The Epstein criteria of ≤2 positive cores, <50% core involvement, and PSA density <0.15 ng/ml/cm3 carries 10 years rates of overall survival, cancer-specific survival, and metastasis-free survival of 94%, 99.9%, and 99.4%, respectively. Importantly, at 15 years, oncological outcomes such as metastasis-free survival and cancer specific survival change little (10). In Canada, specifically Klotz and collaborators have reported on single-arm cohorts of low-risk patients (Gleason score ≤6 and serum PSA level ≤10 ng/mL) and favorable intermediate-risk patients (serum PSA ≤15 ng/mL or a Gleason score of 7 [3+4]). The investigators reported 10and 15-year metastasis-free survival rates of 96% and 95% vs 91% and 82% for low vs. intermediate Vol. 45 (2): 210-214, March April, 2019","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"63 1","pages":"210 - 214"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80184719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1590/S1677-5538.IBJU.2019.02.01
L. Favorito
The March-April 2019 issue of the International Braz J Urol presents original contributions with a lot of interesting papers in different fields: Prostate Cancer, Renal stones, Renal Cell Carcinoma, Bladder Cancer, Uretrhal Strictures, Trauma, Prostate Biopsy, Kidney Transplant, neurogenic Bladder and Penile Cancer. The papers come from many different countries such as Brazil, USA, Turkey, China, Italy, Iran, Argentina, Spain, South Korea, and United Kingdon, and as usual the editor’s comment highlights some papers. We decided to comment the paper about a very interesting topic: The treatment of the inguinal lymph nodes in penile cancer. Doctor Meneses and collegues from Brazil performed on page 325 an interesting study about the Video Endoscopic management of inguinal lympadenectomy in penile cancer. The authors described the initial experience with this method and analyzed the post-surgical complications in 11 patients with penile cancer (stages T2 or T3). They observed the bleeding, drainage time, cellulitis, lymphocele, cutaneous necrosis, miocutaneous necrosis and hospitalization time. The results of the paper shows that no patient showed intrasurgical complications, bleeding > 50 mL or conversion. The global complication rate was 33.2% (27.2% were lymphatic). No patient showed cutaneous necrosis. The authors concluded that video endoscopic management of inguinal lympadenectomy in penile cancer is a safe and easy technique with lower incidence of complications. Malignant neoplasm of the penis is a rare disease, being more common in regions with low socioeconomic levels, accounting for approximately 2% of malignancies in man, with squamous cell carcinoma (SCC) being the most common type (1, 2). Considering that tumor dissemination is preferentially done lymphatic (initially for superficial inguinal lymph nodes and later for deep inguinal and pelvic lymph nodes), the presence of metastases in the inguinal lymph nodes is the main variable capable of affecting the survival in these patients (3). In this way, bilateral inguinal lymphadenectomy represents the only procedure capable of identifying and treating inguinal micrometastases early, although its prophylactic indication is controversial in the literature (4-6). The following are the main indications of lymphadenectomy: tumors > 2 cm, high-grade tumors (histopathological grade II or III), advanced local staging (T2-T4), lymphovascular microscopic invasion, palpable inguinal lymph nodes after antibiotic therapy, palpable inguinal lymph nodes that appeared in the follow-up without evidence of distant disease and unsatisfactory clinical evaluation (obese, inguinal surgery) (4). Inguinal lymphadenectomy represents an important stage of treatment. However, it should be noted that about 50% of patients submitted to open Vol. 45 (2): 208-209, March April, 2019
2019年3 - 4月出版的《国际膀胱杂志》在不同领域发表了许多有趣的原创论文:前列腺癌、肾结石、肾细胞癌、膀胱癌、尿道狭窄、创伤、前列腺活检、肾移植、神经源性膀胱和阴茎癌。这些论文来自许多不同的国家，如巴西、美国、土耳其、中国、意大利、伊朗、阿根廷、西班牙、韩国和英国，和往常一样，编辑的评论突出了一些论文。我们决定评论一个非常有趣的话题:阴茎癌腹股沟淋巴结的治疗。来自巴西的Meneses医生和他的同事在325页上做了一个有趣的研究，关于视频内窥镜下治疗阴茎癌的腹沟淋巴结切除术。作者描述了使用这种方法的初步经验，并分析了11例阴茎癌(T2或T3期)的术后并发症。观察出血、引流时间、蜂窝织炎、淋巴囊肿、皮肤坏死、微皮坏死及住院时间。本文结果显示，无一例患者出现术中并发症、出血> 50ml或转化。总并发症发生率为33.2%(27.2%为淋巴并发症)。无患者出现皮肤坏死。结论:视频内镜下治疗阴茎癌腹股沟淋巴结切除术是一种安全、简便、并发症发生率低的技术。阴茎恶性肿瘤是一种罕见的疾病，多见于社会经济水平较低的地区，约占男性恶性肿瘤的2%，其中鳞状细胞癌(SCC)是最常见的类型(1,2)。考虑到肿瘤的播散优先通过淋巴(最初为腹股沟浅淋巴结，后来为腹股沟深淋巴结和盆腔淋巴结)，腹股沟淋巴结转移的存在是影响这些患者生存的主要变量(3)。因此，双侧腹股沟淋巴结切除术是唯一能够早期识别和治疗腹股沟微转移的手术，尽管其预防适应症在文献中存在争议(4-6)。以下是淋巴结切除术的主要适应症:肿瘤> 2cm，肿瘤级别高(组织病理学分级为II级或III级)，局部分期晚期(T2-T4)，淋巴血管镜下浸润，抗生素治疗后可触及腹股沟淋巴结，随访中出现无远处病变证据且临床评价不理想的腹股沟淋巴结(肥胖，腹股沟手术)(4)。腹股沟淋巴结切除术是治疗的重要阶段。然而，应该注意的是，大约50%的患者提交了open Vol. 45 (2): 208-209, March - April, 2019
{"title":"The future of inguinal Lymphadenecotmy in penile cancer: laparoscopic or robotic?","authors":"L. Favorito","doi":"10.1590/S1677-5538.IBJU.2019.02.01","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.02.01","url":null,"abstract":"The March-April 2019 issue of the International Braz J Urol presents original contributions with a lot of interesting papers in different fields: Prostate Cancer, Renal stones, Renal Cell Carcinoma, Bladder Cancer, Uretrhal Strictures, Trauma, Prostate Biopsy, Kidney Transplant, neurogenic Bladder and Penile Cancer. The papers come from many different countries such as Brazil, USA, Turkey, China, Italy, Iran, Argentina, Spain, South Korea, and United Kingdon, and as usual the editor’s comment highlights some papers. We decided to comment the paper about a very interesting topic: The treatment of the inguinal lymph nodes in penile cancer. Doctor Meneses and collegues from Brazil performed on page 325 an interesting study about the Video Endoscopic management of inguinal lympadenectomy in penile cancer. The authors described the initial experience with this method and analyzed the post-surgical complications in 11 patients with penile cancer (stages T2 or T3). They observed the bleeding, drainage time, cellulitis, lymphocele, cutaneous necrosis, miocutaneous necrosis and hospitalization time. The results of the paper shows that no patient showed intrasurgical complications, bleeding > 50 mL or conversion. The global complication rate was 33.2% (27.2% were lymphatic). No patient showed cutaneous necrosis. The authors concluded that video endoscopic management of inguinal lympadenectomy in penile cancer is a safe and easy technique with lower incidence of complications. Malignant neoplasm of the penis is a rare disease, being more common in regions with low socioeconomic levels, accounting for approximately 2% of malignancies in man, with squamous cell carcinoma (SCC) being the most common type (1, 2). Considering that tumor dissemination is preferentially done lymphatic (initially for superficial inguinal lymph nodes and later for deep inguinal and pelvic lymph nodes), the presence of metastases in the inguinal lymph nodes is the main variable capable of affecting the survival in these patients (3). In this way, bilateral inguinal lymphadenectomy represents the only procedure capable of identifying and treating inguinal micrometastases early, although its prophylactic indication is controversial in the literature (4-6). The following are the main indications of lymphadenectomy: tumors > 2 cm, high-grade tumors (histopathological grade II or III), advanced local staging (T2-T4), lymphovascular microscopic invasion, palpable inguinal lymph nodes after antibiotic therapy, palpable inguinal lymph nodes that appeared in the follow-up without evidence of distant disease and unsatisfactory clinical evaluation (obese, inguinal surgery) (4). Inguinal lymphadenectomy represents an important stage of treatment. However, it should be noted that about 50% of patients submitted to open Vol. 45 (2): 208-209, March April, 2019","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"1 1","pages":"208 - 209"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90219411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1590/S1677-5538.IBJU.2019.0267
M. Bandini, S. Sekulovic, N. Stanojevic, B. Spiridonescu, V. Pesic, S. Sansalone, M. Slavković, A. Briganti, A. Salonia, F. Montorsi, R. Djinovic
ABSTRACT Introduction: Pubic hypertrophy, defined as an abnormal and abundant round mass of fatty tissue located over the pubic symphysis, is frequently underestimated in patients with hypospadias. We examined the prevalence of this condition, as well as the outcomes associated with its surgical treatment. Material and methods: Within 266 hypospadias patients treated at our clinic, we assessed the prevalence of pubic hypertrophy, and we schematically described the surgical steps of pubic lipectomy. Multivariable logistic regression (MLR) tested for predictors of pubic hypertrophy. Finally, separate MLRs tested for predictors of fistula and any complications after pubic lipectomy. Results: Of 266 hypospadias patients, 100 (37.6%) presented pubic hypertrophy and underwent pubic lipectomy. Patients with pubic hypertrophy more frequently had proximal hypospadias (44 vs. 7.8%), disorders of sex development (DSD) (10 vs. 0.6%), cryptorchidism (12 vs. 2.4%), and moderate (30°-60°) or severe (>60°) penile curvature (33 vs. 4.2%). In MLR, the location of urethral meatus (proximal, Odds ratio [OR]: 10.1, p<0.001) was the only significant predictor of pubic hypertrophy. Finally, pubic lipectomy was not associated with increased risk of fistula (OR: 1.12, p=0.7) or any complications (OR: 1.37, 95% CI: 0.64-2.88, p=0.4) after multivariable adjustment. Conclusions: One out of three hypospadias patients, referred to our center, presented pubic hypertrophy and received pubic lipectomy. This rate was higher in patients with proximal hypospadias suggesting a correlation between pubic hypertrophy and severity of hypospadias. Noteworthy, pubic lipectomy was not associated with increased risk of fistula or any complications.
{"title":"Prevalence and surgical management of pubic hypertrophy in hypospadias patients: results from a high-volume surgeon","authors":"M. Bandini, S. Sekulovic, N. Stanojevic, B. Spiridonescu, V. Pesic, S. Sansalone, M. Slavković, A. Briganti, A. Salonia, F. Montorsi, R. Djinovic","doi":"10.1590/S1677-5538.IBJU.2019.0267","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0267","url":null,"abstract":"ABSTRACT Introduction: Pubic hypertrophy, defined as an abnormal and abundant round mass of fatty tissue located over the pubic symphysis, is frequently underestimated in patients with hypospadias. We examined the prevalence of this condition, as well as the outcomes associated with its surgical treatment. Material and methods: Within 266 hypospadias patients treated at our clinic, we assessed the prevalence of pubic hypertrophy, and we schematically described the surgical steps of pubic lipectomy. Multivariable logistic regression (MLR) tested for predictors of pubic hypertrophy. Finally, separate MLRs tested for predictors of fistula and any complications after pubic lipectomy. Results: Of 266 hypospadias patients, 100 (37.6%) presented pubic hypertrophy and underwent pubic lipectomy. Patients with pubic hypertrophy more frequently had proximal hypospadias (44 vs. 7.8%), disorders of sex development (DSD) (10 vs. 0.6%), cryptorchidism (12 vs. 2.4%), and moderate (30°-60°) or severe (>60°) penile curvature (33 vs. 4.2%). In MLR, the location of urethral meatus (proximal, Odds ratio [OR]: 10.1, p<0.001) was the only significant predictor of pubic hypertrophy. Finally, pubic lipectomy was not associated with increased risk of fistula (OR: 1.12, p=0.7) or any complications (OR: 1.37, 95% CI: 0.64-2.88, p=0.4) after multivariable adjustment. Conclusions: One out of three hypospadias patients, referred to our center, presented pubic hypertrophy and received pubic lipectomy. This rate was higher in patients with proximal hypospadias suggesting a correlation between pubic hypertrophy and severity of hypospadias. Noteworthy, pubic lipectomy was not associated with increased risk of fistula or any complications.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"150 1","pages":"1238 - 1248"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75777669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-01DOI: 10.1590/S1677-5538.IBJU.2019.02.03
S. Ghodoussipour, A. Lebastchi, P. Pinto, André Berger
Prostate cancer (PCa) is diagnosed in over 170,000 men in the United States each year (1). While this makes PCa one of the most common solid malignancies in men, the mortality is low and most men die from unrelated causes (1). In fact, almost half of men with screening detected and localized PCa are considered candidates for deferred treatment or active surveillance (AS) (2). To decrease the morbidity associated with definitive therapy, many providers recommend AS for those with very-low (VLR), low risk (LR) disease and in selected favorable, intermediate risk (IR) PCa (3-5). The use of AS has been steadily increasing and is supported by large cohort studies showing 98-100% PCa specific survival rates (6, 7). While the recommended follow-up for AS varies, safety is predicated on close surveillance with predefined thresholds for treatment based on identification of cancer progression yet still curable disease. In the largest published AS cohort of 993 men with median follow-up of 6.4 years, 10-year cancer specific survival (CSS) was 98.1%. However, 27% of these patients ultimately underwent surgery for indications ranging from prostate specific antigen (PSA) progression, biopsy Gleason score progression or patient preference. While this cohort included mostly younger men with LR disease (Age <70, cT1/T2a disease, PSA <10ng/ml), they also included patients older than 70 with Gleason 3+4=7 or lower disease, such that 20% had IR (6). A separate analysis of this cohort by Musunuru et al. showed that while only 3% of patients developed metastases, metastasis free survival (MFS) was significantly lower in the IR as compared to the LR group (84% vs 95%, p=0.001) (8). Another separate cohort analysis by Yamamoto et al. showed a significantly higher risk of 15-year PCa mortality (PCM) for higher Gleason score disease (HR of 4.0 for Gleason 3+4=7 vs Gleason 3+3=6 and HR 10.5 for Gleason 4+3=7 vs Gleason 3+3=6) (9). The PROTECT trial randomized 1643 patients with localized PCa into AS (n=545), definitive treatment with radical prostatectomy (RP; n=553) or radiation therapy (RT; n=545). There was no difference in PCM amongst the 3 groups (p=0.48), however, of those 17 patients who passed away, 8 were in the AS group (5/8 with IR disease), 5 in the RP group and 4 in the RT group. The rate of disease progression and development of metastases was significantly higher in the AS group as compared to RP or RT (112 vs 46 vs 46 men, respectively; p<0.001) (10). Despite a certain subset of patients who seem to do worse on AS, concerns with morbidity from definitive treatment have led experts to recommend a broadening of the indications for AS and to include selected patients with low volume IR disease (3, 5, 11, 12). As the indications for AS expand, certain patients may wish to be even more “active” in their surveillance. In 2018, Bloom et DiffereNce Of OpiNiON Vol. 45 (2): 215-219, March April, 2019
诊断前列腺癌(PCa)是在美国每年超过170000人(1),这使得PCa最常见的固体男性恶性肿瘤之一,死亡率很低,大多数人死于不相关的原因(1)。事实上,几乎一半的男性筛查检测和局部PCa是延迟治疗或候选人积极监测()(2)。减少发病率与明确的治疗,许多供应商建议对于那些极低(VLR)”,低风险(LR)疾病和选择有利的中风险(IR) PCa(3-5)。AS的使用一直在稳步增加，并得到大型队列研究的支持，显示PCa特异性生存率为98-100%(6,7)。虽然推荐的AS随访时间各不相同，但安全性是基于密切监测和预定义的治疗阈值，这些阈值是基于确定癌症进展但仍可治愈的疾病。在已发表的最大的AS队列中，993名男性，中位随访6.4年，10年癌症特异性生存率(CSS)为98.1%。然而，这些患者中有27%最终因前列腺特异性抗原(PSA)进展、活检Gleason评分进展或患者偏好等适应症接受了手术。虽然该队列主要包括患有LR疾病的年轻男性(年龄<70岁，cT1/T2a疾病，PSA <10ng/ml)，但他们也包括年龄大于70岁的Gleason 3+4=7或更低疾病的患者，因此20%患有IR(6)。Musunuru等人对该队列的单独分析显示，虽然只有3%的患者发生转移，但与LR组相比，IR中的无转移生存率(MFS)显着降低(84% vs 95%)。p=0.001)(8)。Yamamoto等人的另一项单独队列分析显示，Gleason评分较高的疾病15年PCa死亡率(PCM)的风险明显更高(Gleason 3+4=7 vs Gleason 3+3=6的HR为4.0,Gleason 4+3=7 vs Gleason 3+3=6的HR为10.5)(9)。PROTECT试验将1643名局限性PCa患者随机分为AS (n=545)，最终治疗是根治性前列腺切除术(RP;n=553)或放射治疗(RT;n = 545)。3组间PCM无差异(p=0.48)，但17例死亡患者中，AS组8例(5/8合并IR疾病)，RP组5例，RT组4例。与RP或RT相比，AS组的疾病进展和转移率明显更高(分别为112人vs 46人vs 46人;p < 0.001)(10)。尽管有一部分患者在接受AS治疗后表现更差，但考虑到最终治疗的发病率，专家们建议扩大AS的适应症，并选择包括低容量IR疾病的患者(3,5,11,12)。随着As适应症的扩大，某些患者可能希望在他们的监测中更加“积极”。In 2018, Bloom et DiffereNce Of OpiNiON Vol. 45 (2): 215-219, March April, 2019
{"title":"Super active surveillance for low-risk prostate cancer | Opinion: No","authors":"S. Ghodoussipour, A. Lebastchi, P. Pinto, André Berger","doi":"10.1590/S1677-5538.IBJU.2019.02.03","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.02.03","url":null,"abstract":"Prostate cancer (PCa) is diagnosed in over 170,000 men in the United States each year (1). While this makes PCa one of the most common solid malignancies in men, the mortality is low and most men die from unrelated causes (1). In fact, almost half of men with screening detected and localized PCa are considered candidates for deferred treatment or active surveillance (AS) (2). To decrease the morbidity associated with definitive therapy, many providers recommend AS for those with very-low (VLR), low risk (LR) disease and in selected favorable, intermediate risk (IR) PCa (3-5). The use of AS has been steadily increasing and is supported by large cohort studies showing 98-100% PCa specific survival rates (6, 7). While the recommended follow-up for AS varies, safety is predicated on close surveillance with predefined thresholds for treatment based on identification of cancer progression yet still curable disease. In the largest published AS cohort of 993 men with median follow-up of 6.4 years, 10-year cancer specific survival (CSS) was 98.1%. However, 27% of these patients ultimately underwent surgery for indications ranging from prostate specific antigen (PSA) progression, biopsy Gleason score progression or patient preference. While this cohort included mostly younger men with LR disease (Age <70, cT1/T2a disease, PSA <10ng/ml), they also included patients older than 70 with Gleason 3+4=7 or lower disease, such that 20% had IR (6). A separate analysis of this cohort by Musunuru et al. showed that while only 3% of patients developed metastases, metastasis free survival (MFS) was significantly lower in the IR as compared to the LR group (84% vs 95%, p=0.001) (8). Another separate cohort analysis by Yamamoto et al. showed a significantly higher risk of 15-year PCa mortality (PCM) for higher Gleason score disease (HR of 4.0 for Gleason 3+4=7 vs Gleason 3+3=6 and HR 10.5 for Gleason 4+3=7 vs Gleason 3+3=6) (9). The PROTECT trial randomized 1643 patients with localized PCa into AS (n=545), definitive treatment with radical prostatectomy (RP; n=553) or radiation therapy (RT; n=545). There was no difference in PCM amongst the 3 groups (p=0.48), however, of those 17 patients who passed away, 8 were in the AS group (5/8 with IR disease), 5 in the RP group and 4 in the RT group. The rate of disease progression and development of metastases was significantly higher in the AS group as compared to RP or RT (112 vs 46 vs 46 men, respectively; p<0.001) (10). Despite a certain subset of patients who seem to do worse on AS, concerns with morbidity from definitive treatment have led experts to recommend a broadening of the indications for AS and to include selected patients with low volume IR disease (3, 5, 11, 12). As the indications for AS expand, certain patients may wish to be even more “active” in their surveillance. In 2018, Bloom et DiffereNce Of OpiNiON Vol. 45 (2): 215-219, March April, 2019","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"16 1","pages":"215 - 219"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81884253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-29DOI: 10.1590/S1677-5538.IBJU.2018.0843.1
Diogo Benchimol de Souza, Gabriela F. Buys-Gonçalves
Herbal medicine is as old as the history of mankind, and is still a topic of interest in current days. The article of Haghmorad et al. (1) reports promising results with two herbal extracts for improving fertility parameters. Both herbs showed positive results when used individually, but (what was more interesting) a synergic effect seems to occur when used together. The extract of Tribulus terrestris were more prominent in raising LH and Testosterone levels (which was already reported (2,3)) while Anacyclus pyrethrum showed more impressive results in raising FSH and improving sperm parameters. Thus, the combined use may improve fertility parameters by two different endocrine ways. One limitation not raised by the authors is that the extracts improved fertility parameters in control animals, in which a normal testicle, hypothalamus-pituitary-gonadal axis and fertility parameters are assumed. Future studies investigating if these herbal extracts can also improve fertility parameters in infertile/subfertile models are warranted. The mechanisms of action of these phytotherapics are poorly understood, especially for the less-studied Anacyclus pyrethrum. This herb has been proposed for different conditions (from local anesthetic to anticancer (4,5)), although no clinical study was conducted focusing on male reproductive or endocrine systems. It seems that most phytotherapeutic study focuses only on the final specific effects, putting aside the search for knowledge on the basic mechanisms of the extracts. Since the ancient Greece Hippocrates advocated the principle of primum non nocere which should be always applied when proposing any therapy, including herbal therapies. When studying any treatment for a specific condition, is important to have a more global perspective, evaluating potential side-effects of the proposed medication. Specifically, for Tribulus terrestris, our group recently showed this herb leads to arterial blood pressure increase and renal morphology alteration with glomerular loss (6). This kind of study may add information for the physician, helping evaluating the pros and cons of each prescription for each patient. EDITORIAL COMMENT Vol. 45 (5): 1055-1056, September October, 2019
{"title":"Editorial Comment: Improvement of fertility parameters with Tribulus Terrestris and Anacyclus Pyrethrum treatment in male rats","authors":"Diogo Benchimol de Souza, Gabriela F. Buys-Gonçalves","doi":"10.1590/S1677-5538.IBJU.2018.0843.1","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2018.0843.1","url":null,"abstract":"Herbal medicine is as old as the history of mankind, and is still a topic of interest in current days. The article of Haghmorad et al. (1) reports promising results with two herbal extracts for improving fertility parameters. Both herbs showed positive results when used individually, but (what was more interesting) a synergic effect seems to occur when used together. The extract of Tribulus terrestris were more prominent in raising LH and Testosterone levels (which was already reported (2,3)) while Anacyclus pyrethrum showed more impressive results in raising FSH and improving sperm parameters. Thus, the combined use may improve fertility parameters by two different endocrine ways. One limitation not raised by the authors is that the extracts improved fertility parameters in control animals, in which a normal testicle, hypothalamus-pituitary-gonadal axis and fertility parameters are assumed. Future studies investigating if these herbal extracts can also improve fertility parameters in infertile/subfertile models are warranted. The mechanisms of action of these phytotherapics are poorly understood, especially for the less-studied Anacyclus pyrethrum. This herb has been proposed for different conditions (from local anesthetic to anticancer (4,5)), although no clinical study was conducted focusing on male reproductive or endocrine systems. It seems that most phytotherapeutic study focuses only on the final specific effects, putting aside the search for knowledge on the basic mechanisms of the extracts. Since the ancient Greece Hippocrates advocated the principle of primum non nocere which should be always applied when proposing any therapy, including herbal therapies. When studying any treatment for a specific condition, is important to have a more global perspective, evaluating potential side-effects of the proposed medication. Specifically, for Tribulus terrestris, our group recently showed this herb leads to arterial blood pressure increase and renal morphology alteration with glomerular loss (6). This kind of study may add information for the physician, helping evaluating the pros and cons of each prescription for each patient. EDITORIAL COMMENT Vol. 45 (5): 1055-1056, September October, 2019","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"56 1","pages":"1055 - 1056"},"PeriodicalIF":0.0,"publicationDate":"2019-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77214474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-29DOI: 10.1590/S1677-5538.IBJU.2019.0026
F. Mrad, Alana de Medeiros Nelli, M. Alvaia, Heros Aureliano Antunes da Silva Maia, Carina Oliveira Silva Guimarães, E. Carvalho, C. Gomes, J. M. Netto, J. B. Bessa Júnior
ABSTRACT Introduction Evidence indicates an increase in the prevalence of enuresis in individuals with sickle cell disease. The present study aims to evaluate the prevalence and impact of enuresis on quality of life in individuals with sickle cell disease. Materials and Methods This cross-sectional study evaluated individuals with sickle cell disease followed at a reference clinic, using a questionnaire designed to evaluate the age of complete toilet training, the presence of enuresis and lower urinary tract, and the impact on quality of life of these individuals. Results Fifty children presenting SCD (52% females, mean age ten years) were included in the study. Of those, 34% (17/50) presented as HbSC, 56% with HbSS (28/50), 2% Sα-thalassemia (1/5) and 8% the type of SCD was not determined. The prevalence of enuresis was 42% (21/50), affecting 75% of subjects at five years and about 15% of adolescents at 15 years of age. Enuresis was classified as monosymptomatic in 33.3% (7/21) and nonmonosymptomatic in 66.6% (14/21) of the cases, being primary in all subjects. Nocturia was identified in 24% (12/50), urgency in 20% (10/50) and daytime incontinence 10% (5/50) of the individuals. Enuresis had a significant impact on the quality of life of 67% of the individuals. Conclusion Enuresis was highly prevalent among children with SCD, and continues to be prevalent throughout early adulthood, being more common in males. Primary nonmonosymptomatic enuresis was the most common type, and 2/3 of the study population had a low quality of life.
{"title":"Prevalence of enuresis and its impact in quality of life of patients with sickle cell disease","authors":"F. Mrad, Alana de Medeiros Nelli, M. Alvaia, Heros Aureliano Antunes da Silva Maia, Carina Oliveira Silva Guimarães, E. Carvalho, C. Gomes, J. M. Netto, J. B. Bessa Júnior","doi":"10.1590/S1677-5538.IBJU.2019.0026","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0026","url":null,"abstract":"ABSTRACT Introduction Evidence indicates an increase in the prevalence of enuresis in individuals with sickle cell disease. The present study aims to evaluate the prevalence and impact of enuresis on quality of life in individuals with sickle cell disease. Materials and Methods This cross-sectional study evaluated individuals with sickle cell disease followed at a reference clinic, using a questionnaire designed to evaluate the age of complete toilet training, the presence of enuresis and lower urinary tract, and the impact on quality of life of these individuals. Results Fifty children presenting SCD (52% females, mean age ten years) were included in the study. Of those, 34% (17/50) presented as HbSC, 56% with HbSS (28/50), 2% Sα-thalassemia (1/5) and 8% the type of SCD was not determined. The prevalence of enuresis was 42% (21/50), affecting 75% of subjects at five years and about 15% of adolescents at 15 years of age. Enuresis was classified as monosymptomatic in 33.3% (7/21) and nonmonosymptomatic in 66.6% (14/21) of the cases, being primary in all subjects. Nocturia was identified in 24% (12/50), urgency in 20% (10/50) and daytime incontinence 10% (5/50) of the individuals. Enuresis had a significant impact on the quality of life of 67% of the individuals. Conclusion Enuresis was highly prevalent among children with SCD, and continues to be prevalent throughout early adulthood, being more common in males. Primary nonmonosymptomatic enuresis was the most common type, and 2/3 of the study population had a low quality of life.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"179 1","pages":"974 - 980"},"PeriodicalIF":0.0,"publicationDate":"2019-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88783575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-29DOI: 10.1590/S1677-5538.IBJU.2019.0176
A. Aggarwal, Manoj Kumar, Siddharth Pandey, Samarth Agarwal, S. Sankhwar
ABSTRACT Objectives To compare and assess various outcomes and success of buccal mucosal graft urethroplasty (BMGU) in patients with CKD versus patients having normal renal function. Material and Methods This was a retrospective, single centre study, during period 2013 to 2017. Patients were grouped into two groups. Group 1 had patients with estimated Glomerular Filtration Rate (eGFR)>60mL/min/1.73m2 while group 2 had patients with eGFR <60mL/min/1.73m2. eGFR was calculated according to the MDRD equation. The two groups were compared with regard to various outcomes like length, location of stricture, technique of graft placement, intra-operative blood loss (haemoglobin drop), duration of hospital stay, post-operative complications and recurrence. Results A total of 223 patients were included in study with group 1 had 130 patients and group 2 had 93 patients. Mean age of patients with CKD were higher (47.49 years versus 29.13 years). The mean follow-up period was comparable between both groups (23.29 months and 22.54 months respectively). Patients with CKD had more post-operative Clavien Grade 2 or higher complications (p=0.01) and a greater recurrence rates (p<0.001) than in non-CKD patients. On multivariate analysis, age and CKD status was significant predictor of urethroplasty success (p=0.004) (OR= 14.98 (1.952-114.94, 95% CI). Conclusions CKD patients are more prone to post-operative complications in terms of wound infection, graft uptake and graft failure and higher recurrence rates following BMGU.
{"title":"Assessment of long term outcomes after buccal mucosal graft urethroplasty: the impact of chronic kidney disease","authors":"A. Aggarwal, Manoj Kumar, Siddharth Pandey, Samarth Agarwal, S. Sankhwar","doi":"10.1590/S1677-5538.IBJU.2019.0176","DOIUrl":"https://doi.org/10.1590/S1677-5538.IBJU.2019.0176","url":null,"abstract":"ABSTRACT Objectives To compare and assess various outcomes and success of buccal mucosal graft urethroplasty (BMGU) in patients with CKD versus patients having normal renal function. Material and Methods This was a retrospective, single centre study, during period 2013 to 2017. Patients were grouped into two groups. Group 1 had patients with estimated Glomerular Filtration Rate (eGFR)>60mL/min/1.73m2 while group 2 had patients with eGFR <60mL/min/1.73m2. eGFR was calculated according to the MDRD equation. The two groups were compared with regard to various outcomes like length, location of stricture, technique of graft placement, intra-operative blood loss (haemoglobin drop), duration of hospital stay, post-operative complications and recurrence. Results A total of 223 patients were included in study with group 1 had 130 patients and group 2 had 93 patients. Mean age of patients with CKD were higher (47.49 years versus 29.13 years). The mean follow-up period was comparable between both groups (23.29 months and 22.54 months respectively). Patients with CKD had more post-operative Clavien Grade 2 or higher complications (p=0.01) and a greater recurrence rates (p<0.001) than in non-CKD patients. On multivariate analysis, age and CKD status was significant predictor of urethroplasty success (p=0.004) (OR= 14.98 (1.952-114.94, 95% CI). Conclusions CKD patients are more prone to post-operative complications in terms of wound infection, graft uptake and graft failure and higher recurrence rates following BMGU.","PeriodicalId":13674,"journal":{"name":"International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology","volume":"14 1","pages":"981 - 988"},"PeriodicalIF":0.0,"publicationDate":"2019-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82504893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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