Introduction: The Human Papilloma Virus (HPV) is the most prevalent sexually transmissible disease. The treatment of Condyloma Accuminatum is a great challenge because of the high recurrence rate and of the lack of any drug efficient in its elimination. Objective: To assess the efficacy of the treatment with Imuno BCG (Bacillus Calmette-Guérin) for bearers of condylomas recurrent for more than 2 years. Patients and Methods: Patients with age between 18 and 60 years, having a history of more than 2 years of genital warts, were included, attended as from 01-08-2011; bearers of serious diseases, immunodeficiency or users of immune-suppressors, being excluded. The procedure adopted began with a biopsy of the wart(s) with local anesthetic, followed by the electro-coagulation of all the warts and bases of the biopsies, a solution with 80 mg of Imuno BCG dissolved in 2 ml of saline solution 0.9% was applied to all the genital area, including the cauterized areas. The area was covered with plastic for 2 hours and afterwards washed with water. The local application of Imuno BCG was repeated for 8 consecutive weeks. At the end of the second month the cases were re-assessed. When there was clinical recurrence a new procedure with the same drug was undertaken, but with 3 weekly applications made by the patient himself for 8 weeks. Result: Sixteen patients completed 2-year follow-up. The cure rate was of 62.5%. Of the 10 patients cured, 6 (37.5%) used one series of Imuno BCG, 1 (6.25%) used 2 series, and 3 (18.75%) used 3 series. Of the 6 patients who were not cured, there was a reduction in the number of cauterizations from 5.5 times (over an average period of the disease of 51.6 months) to 2.4 cauterizations (over an average follow-up period of 52.3 months) after the use Imuno BCG. The collateral effects of the use of Imuno BCG were insignificant. Conclusion: Topical BCG is a good option for the treatment of recurrent condylomas, with minimal collateral effect. It may be used even on PPD-negative patients. However, this result must be confirmed with larger sample populations and control-group studies.

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2015PD5-04 CAN WE PREDICT WHICH PATIENTS WILL PRESENT RESOLUTION OF DETRUSOROVERACTIVITY (DO) AFTER TRANSURETHRAL RESECTION OF THE PROSTATE (TURP)? Alexandre Iscaife, Sabrina T. Reis, Aline Albertini, Marco A. Nunes, Antonio M. Lucon, Willian C. Nahas, Miguel Srougi, and Alberto A. Antunes Alexandre IscaifeAlexandre Iscaife More articles by this author , Sabrina T. ReisSabrina T. Reis More articles by this author , Aline AlbertiniAline Albertini More articles by this author , Marco A. NunesMarco A. Nunes More articles by this author , Antonio M. LuconAntonio M. Lucon More articles by this author , Willian C. NahasWillian C. Nahas More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , and Alberto A. AntunesAlberto A. Antunes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.303AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detrusor overactivity (DO) is one of the most frequent consequences of bladder outlet obstruction (BOO) due to BPH. The aim of the present study is to determine which clinical and urodynamic variables may be related to the persistence of DO after transurethral resection of the prostate. METHODS Analysis of 46 patients with BOO due to BPH who underwent TURP from 2011 to 2012. All patients underwent urodynamic analysis pre and post operatively after 12 months. The clinical and urodynamic variables in the preoperative were correlated with the resolution of DO in the postoperative period. RESULTS Patients with DO in the preoperative period were older (65.2 vs 61.1 years; p = 0.041), had higher IPSS score (25.2 vs 19; p = 0.014) and higher maximum flow rates (8.6 vs 6.6 ml/s; p = 0.039). Patients who persisted with DO were statistically older than those with resolution (69 vs 63 years; p = 0.043 ng/ml). Among patients with a MCC under 250 ml, 63.6% persisted with DO against only 20% among those with a MCC over 250 ml (p = 0.024). Analyzing urodynamic variables together, we found that patients presenting a MCC < 250 ml and a amplitude of DO over 40 cmH2O resulted in a 66.7% chance of persistence of DO (p = 0.041). When the patient has these characteristics associated with an early DO, the chance of persistence of DO reached 83.3% (p = 0.013) (Table). CONCLUSIONS Advanced patient age together with a low MCC and an early and high amplitude of DO are the most important predictors for persistence of DO after relief of BOO. Analysis of urodynamic variables grouped as predictor of persistence of DO after TURP Resolution Persistence p Low MCC+High BCI absent 81.30% 18.8% 0.004 present 22.20% 77.80 Low MCC+High amplitude absent 75.00% 25.0% 0.041 present 33.30% 66.70% Low MCC+High amplitude+High BCI absent 76.50% 23.50% 0.014 present 25.00% 75.00% High amplitude+early DO absent 75.00% 25.00% 0.041 present 33.30% 66.70% Low MCC+high amplitude+early DO absent 73.70% 26.30% 0.013 present 16.70% 83.30% multiple and early DO absent 60.00% 40.00% 1.00 present 60.00% 40.00% © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e93 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandre Iscaife More articles by this author Sabrina T. Reis More articles by this author Aline Albertini More articles by this author Marco A. Nunes More articles by this author Antonio M. Lucon More articles by this author Willian C. Nahas More articles by this author Miguel Srougi More articles by this author Alberto A. Antunes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Context: The phenotype of familial pheochromocytoma (PHEO) associated with germline TMEM127 mutations (TMEM127-related PHEO) has not been clearly defined.Objective: This study aimed to investigate the penetrance, full phenotypic spectrum and effectiveness of clinical/genetic screening in TMEM127-related PHEO.Design, Setting, and Participants: Clinical and genetic screening, and genetic counseling were offered to 151 individuals from a six-generation family carrying a TMEM127 germline mutation in a referral center.Intervention and Main Outcome Measures: TMEM127 genetic testing was offered to at-risk relatives and clinical surveillance for pheochromocytoma was performed in mutation-positive carriers.Results: Forty seven individuals carried the c.410-2A>C TMEM127 mutation. Clinical data were obtained from 34 TMEM127-mutation carriers followed up for 8.7 +/- 8.1 years (range, 1-20 y). Pheochromocytoma was diagnosed in 11 carriers (32%) at a median age of 43 years. In nine patients, symptoms started at 29 years (range, 10-55 y) and two cases were asymptomatic. Tumors were multicentric in five (45%) and bilateral in five (45%) patients. Six patients (54%) had at least one adrenomedullary nodule less than 10 mm. No paragangliomas, distant metastases, or other manifestations were detected. Cumulative penetrance of pheochromocytoma was 0% at 0-20 years, 3% at 21-30 years, 15% at 31-40 years, 24% at 41-50 years, and 32% at 51-65 years. The youngest case was diagnosed at 22 years and the earliest symptoms were reported at age 10.Conclusions: Tumor multicentricity, nodular adrenomedullary hyperplasia, and the occurrence of symptoms more than a decade earlier than the age at diagnosis are novel findings in TMEM127-related PHEO. The high penetrance of pheochromocytoma in this condition validates the benefits of genetic testing of at-risk relatives. We thus recommend that TMEM127 genetic testing should be offered to at-risk individuals at age 22 years and mutation carriers should undergo clinical surveillance annually.

PURPOSE:We determined which clinical and urodynamic variables may be related to persistent detrusor overactivity after transurethral resection of the prostate.MATERIALS AND METHODS:We studied 46 patients with bladder outlet obstruction due to benign prostatic hyperplasia who were treated with transurethral prostate resection from 2011 to 2012. All patients underwent urodynamic analysis preoperatively and 12 months postoperatively. Clinical and urodynamic variables in the preoperative period were correlated with the resolution of detrusor overactivity postoperatively.RESULTS:Patients with detrusor overactivity in the preoperative period were older (65.2 vs 61.1 years, p = 0.041) and had a higher I-PSS (International Prostate Symptom Score) (25.2 vs 19, p = 0.014) and higher maximum flow rate (8.6 vs 6.6 ml per second, p = 0.039). Patients with persistent detrusor overactivity were statistically older than those with resolution (69 vs 63 years, p = 0.043). Detrusor overactivity persisted in 63.6% of patients with maximum cystometric capacity less than 250 ml compared to 20% of those with greater than 250 ml (p = 0.024). When analyzing urodynamic variables together, we found a 66.7% chance of persistent detrusor overactivity in patients with maximum cystometric capacity less than 250 ml and detrusor overactivity amplitude greater than 40 cm H2O (p = 0.041). When these characteristics were associated with early detrusor overactivity, the chance of persistent detrusor overactivity was 83.3% (p = 0.013).CONCLUSIONS:Advanced patient age together with low maximum cystometric capacity, and early and high detrusor overactivity amplitude are the most important predictors of persistent detrusor overactivity after relief of bladder outlet obstruction.

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Interstitial Cystitis1 Apr 2014PD9-10 PROSPECTIVE LONG-TERM FOLLOW-UP STUDY OF PATIENTS WITH REFRACTORY INTERSTITIAL CYSTITIS TREATED WITH CYCLOSPORINE A Jamil Chade, Daher Chade, Antonio M. Lucon, Homero Bruschini, and Miguel Srougi Jamil ChadeJamil Chade More articles by this author , Daher ChadeDaher Chade More articles by this author , Antonio M. LuconAntonio M. Lucon More articles by this author , Homero BruschiniHomero Bruschini More articles by this author , and Miguel SrougiMiguel Srougi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.792AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Interstitial Cystitis (IC) is a challenging disease of the urinary bladder. Although several different types of medical treatment have been used, none of them has been significantly successful and therefore a standard of care is still debatable. We sought to analyze the impact of a 5-year therapy of cyclosporine A (CYA) on clinical and urodynamic findings for interstitial cystitis METHODS Two male and 43 female patients who fulfilled the NIDDKD (National Institute for Diabetes and Digestive and Kidney Diseases) criteria for the diagnosis of IC were included in this study. Diagnosis was confirmed by cystoscopic examination, biopsy of the bladder, urodynamic evaluation and voiding diary. The symptoms were measured using O'Leary-Sant interstitial cystitis symptoms index (ICSI) and problem index (ICPI) before and after the proposed treatment. Quality of life (QoL) was assessed by AUA QoL index. All patients had been treated with at least 2 other drugs previously, unsuccessfully. After signing the informed consent, they received 1.5 mg/kg of cyclosporine A, twice a day, for 5 years. The patients were evaluated for the symptoms (ICSI) and by urodynamics before, during and after treatment. RESULTS All patients had ICSI of 36 and ICPI above 8 prior to treatment. The mean ICSI score decreased from 36 to 21.6 at 6 months, and to 8.4 at 5 years (p<0.001) of treatment. Mean initial filling sensation increased from 103mL before receiving CYA to 170mL after treatment (p<0.001). Mean bladder capacity prior to CYA was 207mL and 318mL after treatment (p<0.001). Mean AUA QoL index went from 4.8 to 1.3 with CYA use. All 45 patients had ICPI above 8 before treatment, but only 22% of patients remained in this group after CYA. All the patients had biochemical analysis before and after the treatment, and no significant abnormalities were found for liver and renal function. CONCLUSIONS Long term Cyclosporine A therapy is an effective alternative treatment for refractory IC. Our data suggest beneficial results and clinically significant improvement, despite failure to multiple previous treatments. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e215 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jamil Chade More articles by this author Daher Chade More articles by this author Antonio M. Lucon More articles by this author Homero Bruschini More articles by this author Miguel Srougi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery I1 Apr 2014PD3-02 CADAVERIC ORGAN-SPECIFIC ACELLULAR MATRIX FOR URETHRAL RECONSTRUCTION IN HUMANS: LONG TERM RESULTS Leopoldo Ribeiro-Filho, Arnaldo Fazoli, Marco Antonio Arap, Anuar Mitre, Renato Falci, Jose Luis Chambo, Antonio Marmo Lucon, Hiroaki Shiina, Mikio Igawa, Rajvir Dahiya, Emil Tanagho, William Nahas, and Miguel Srougi Leopoldo Ribeiro-FilhoLeopoldo Ribeiro-Filho More articles by this author , Arnaldo FazoliArnaldo Fazoli More articles by this author , Marco Antonio ArapMarco Antonio Arap More articles by this author , Anuar MitreAnuar Mitre More articles by this author , Renato FalciRenato Falci More articles by this author , Jose Luis ChamboJose Luis Chambo More articles by this author , Antonio Marmo LuconAntonio Marmo Lucon More articles by this author , Hiroaki ShiinaHiroaki Shiina More articles by this author , Mikio IgawaMikio Igawa More articles by this author , Rajvir DahiyaRajvir Dahiya More articles by this author , Emil TanaghoEmil Tanagho More articles by this author , William NahasWilliam Nahas More articles by this author , and Miguel SrougiMiguel Srougi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.147AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Over the last nine years, our group has performed 156 urethral reconstructions with human cadaveric acellular matrix grafts. We utilize both urethral (n = 65) and bladder (n= 91) acellular matrix grafts for this purpose. In the present study, we report the long-term outcomes of the 44 initial patients treated with urethral acellular matrix grafts (UAMG) who had been followed-up for at least 24 months. METHODS Forty-four male patients (age 10 to 71 years) with long and complex urethral strictures (3 to 18 cm) and history of multiple urethral procedures (3 to 30 procedures/ patient)underwent ventral onlay UAMG procedures at our Institution between June 2004 and October 2011. Five patients had undergone more than one UAMG procedure (total number of procedures = 50). After been harvested from a cadaveric donor, the urethras (mucosa and corpus spongiosum) were enzymatically converted into UAMG in our lab. After dissection, the stenotic urethras were incised longitudinally and UAMG were placed with 4-0 PDS running sutures over a 14 Fr silicone Foley. The patients stayed with indwelling catheters and received antibiotics for 1 to 3 months. No immunosuppressors were prescribed. RESULTS Thirty-nine out of 44 patients (88%) were able to urinate after catheter removal. During follow-up (24 to 113 months, median 42 months) peak flow rates ranged from 5.4 to 25.2 ml/s (median 17.6 ml/s)in those patiens who were able to void. Cystoscopy performed in fourteen patients showed a vascularized neourethra covered by urothelium with a wide-open urethral lumen (the limits between the graft and the native urethra could not be determined). Only 2 patients (5%) presented graft infection 2 to 3 weeks after the surgery. They were treated conservatively with oral antibiotics and indwelling catheter for an extra month. Six patients (14%) needed an endoscopic urethrotomy to treat partial restenosis (0.5 to 1.0 cm long) 2 to 8 months after the UAMG reconstruction and have been presenting a stable flow rate over the last 24 months (8.6 to 17.2ml/s). Nine patients (including the two who had graft infection) had been requiring urethral dilations (20%). Complete restenosis of the graft occurred in 5 patients(11%), who were submitted to a new UAMG procedure. Two out of these five patients who underwent a UAMG salvage procedure were able to urinate, but they need urethral dilations. CONCLUSIONS UAMG urethroplasty is a simple, safe and easy technique with good long-term results that may represent one more option in the treatment of severe urethral stenosis. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e20 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Leopoldo Ribeiro-Filho More articles by this author Arnaldo Fazoli More articles by this author Marco Antonio Arap More articles by this author Anuar Mitre More articles by this author Renato Falci More articles by this author Jose Luis Chambo More articles by this author Antonio Marmo Lucon More articles by this author Hiroaki Shiina More articles by this author Mikio Igawa More articles by this author Rajvir Dahiya More articles by this author Emil Tanagho More articles by this author William Nahas More articles by this author Miguel Srougi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE:To develop and internally validate a prognostic score to predict the risk of metastases or recurrence in patients with adrenal cortical carcinomas (ACC).DESIGN:Clinical, laboratory and pathological data from 129 ACC patients, treated in a tertiary centre, were retrospectively reviewed.RESULTS:Using a multivariate binary logistic regression analysis, we developed a prognostic score with five covariates: a functional pattern other than isolated hyperandrogenism, a tumour size >7·5 cm, a primary tumour classified as T3/T4, the presence of microscopic venous invasion and a mitotic index >5/50 high-power fields. The prognostic score was calibrated according to the Hosmer-Lemeshow goodness-of-fit test (P = 0·9329) and exhibited excellent overall performance (Brier score = 0·0738). Finally, the discriminatory ability of the model, determined by the area under the ROC curve (AROC ), was near perfect (AROC , 0·9611; 95% CI, 0·92676-0·99552). The prediction model was internally validated with 200 bootstrap resamples and achieved excellent performance for estimating the risk of metastasis and recurrence in eight additional patients with apparently localized disease at diagnosis.CONCLUSION:We developed and internally validated a prognostic score based on the clinicopathological data that are readily available to any attending physician. Our model can be used to accurately estimate the risk of unfavourable outcomes in ACC patients. This score could be beneficial for both patient counselling and the identification of patients in whom adjuvant mitotane is justified.

CONTEXT: Renal artery pseudoaneurysm is a rare complication after renal injury but should be suspected whenever there is recurrent hematuria after renal trauma.CASE REPORTS: We present three cases of pseudoaneurysm after blunt renal trauma and a review of the literature. All patients underwent renal angiography. Two cases were diagnosed during the initial hospital stay due to hematuria, or in the follow-up period during recovery. One patient was hemodynamically unstable. Two patients successfully underwent coil embolization in a single session. In the other case, selective embolization was attempted, but was unsuccessful because artery catheterization was impossible. Procedural and medical success and complications were retrospectively assessed from the patients' records. The clinical presentation, treatment options and clinical decisions are discussed.CONCLUSIONS: Renal artery pseudoaneurysm may develop acutely or even years after the initial injury. Signs and symptoms may have a wide spectrum of presentation. Selective angiographic embolization is an effective treatment that reduces the extent of parenchymal infarction.

Objective: Acute urinary retention (AUR) is expected to occur in 2% to 39% men with benign prostatic hyperplasia. To date, no study has elucidated the effect of long-term use of indwelling bladder catheter on serum prostate specific antigen (PSA) levels and on the incidence of prostate cancer (CaP). The aim of the present study is to analyze the incidence of CaP in patients with long-term use of indwelling bladder catheter and determine some practice patterns on this issue.Materials and methods: The study comprised a retrospective analysis of data from 1,651 patients who had undergone transrectal ultrasound (TRUS)-guided prostate biopsy from July 2004 to June 2009. Among these patients, 198 (12%) were using an indwelling bladder catheter during the biopsy for at least 1 month. The incidence of CaP was recorded according to total PSA levels. Other variables such patient age, free/total PSA rate, PSA density, prostate volume, and duration of catheter use was also analyzed. Men with a digital rectal examination suspicious for cancer were not considered for analysis.Results: Median patient age was 71 years (37 to 89 years). Overall, 25% of patients presented a CaP diagnosis. CaP incidence according to the PSA levels was 0%, 18.9%, 24.5%, and 40.6% for patients with PSA <= 4.0, 4.1-10.0, 10.1-20.0, and >20.0 ng/ml, respectively. When prostate volume was analyzed together, we demonstrated that only 1 (2.4%) patient with PSA below 10.0 ng/ml and prostate volume >60 g had CaP. Median total PSA, PSA density, and prostate volume were statistically different between patients with and without CaP.Conclusions: Prostate biopsy should not be indicated for all patients with diagnosis of BPH and AUR who present an elevated PSA level. Patients with PSA below 10.0 ng/ml, and prostate volume >60 g should only undergo biopsy in selected cases. Patients with PSA >20.0 ng/ml and a prostate volume <= 60 g are at higher risk of CaP diagnosis. (C) 2012 Elsevier Inc. All rights reserved.

Background: A recent microarray study identified a set of genes whose combined expression patterns were predictive of poor outcome in a cohort of adult adrenocortical tumors (ACTs). The difference between the expression values measured by qRT-PCR of DLGAP5 and PINK1 genes was the best molecular predictor of recurrence and malignancy. Among the adrenocortical carcinomas, the combined expression of BUB1B and PINK1 genes was the most reliable predictor of overall survival. The prognostic and molecular heterogeneity of ACTs raises the need to study the applicability of these molecular markers in other cohorts.Objective: To validate the combined expression of BUB1B, DLGAP5, and PINK1 as outcome predictor in ACTs from a Brazilian cohort of adult and pediatric patients.Patients and methods: BUB1B, DLGAP5, and PINK1 expression was assessed by quantitative PCR in 53 ACTs from 52 patients - 24 pediatric and 28 adults (one pediatric patient presented a bilateral asynchronous ACT).Results: DLGAP5 PINK1 and BUB1B PINK1 were strong predictors of disease-free survival and overall survival, respectively, among adult patients with ACT. In the pediatric cohort, these molecular predictors were only marginally associated with disease-free survival but not with overall survival.Conclusion: This study confirms the prognostic value of the combined expression of BUB1B, DLGAP5, and PINK1 genes in a Brazilian group of adult ACTs. Among pediatric ACTs, other molecular predictors of outcome are required.

Laparoscopic procedures have usually been employed as an alternative to open surgery for the management of several urologic problems.1 Laparoscopic ureteroneocystostomy is rarely reported despite the description of different techniques.2-7 Ramalingam et al. described a 3‐case series of successful laparoscopic Boari flap ureteral reimplantations.8 Gao el al. also described a 3‐case series of laparoscopically ureteroplasties for the treatment of congenital obstructive megaureter with good results.9 Only one article considers ureteral tailoring and reimplantation, combining laparoscopic and conventional surgery to create an antireflux mechanism.10 We report, to our knowledge, the first case of laparoscopic ureteral reimplantation with intracorporeal tailoring for an obstructive megaureter in adults.

Urogenital tuberculosis is the second most frequent form of extrapulmonary tuberculosis. Starting with a pulmonary focus, 2 to 20% of patients develop urogenital tuberculosis through hematogenous spread to the kidneys, prostate, and epididymis; through the descending collecting system to the ureters, bladder, and urethra; and through the ejaculatory ducts to the genital organs. Urogenital tuberculosis occurs at all age ranges, but it is predominant in males in their fourth and fifth decades. It is a serious, insidious disease, generally developing symptoms only at a late stage, which leads to a diagnostic delay with consequent urogenital organ destruction; there are reports of patients with renal failure as their initial clinical presentation. Although the condition has been long recognized by nephrologists, urologists, and infectious disease specialists, urogenital tuberculosis is still largely unknown. Even when suggestive findings such as hematuria, sterile pyuria, and recurrent urinary infections are present, we rarely remember this diagnostic possibility. Greater knowledge of the features of urogenital tuberculosis then becomes relevant and should emphasize the importance of an early diagnosis.

We investigated the effects of the antioxidant N-acetylcysteine (NAC) on early outcomes of deceased donor renal transplantation. Between April 2005 and June 2008, adult primary graft recipients of deceased renal donors were assigned to treatment (n = 38) or control (n = 36) groups and evaluated for 90 days and one year after renal transplantation. The treatment group received NAC orally (600 mg twice daily) from day 0 to 7 postoperatively. Renal function was determined by serum creatinine, MDRD and Cockcroft-Gault estimated GFR (eGFR), delayed graft function (DGF) and dialysis free Kaplan-Meier estimate curve. Serum levels of thiobarbituric acid reactive substances (TBARS), were employed as markers of oxidative stress. The NAC group displayed a lower mean serum creatinine during the first 90 days (P = .026) and at 1 year after transplantation (P = .005). Furthermore, the NAC group showed a higher mean eGFR throughout the first 90 days and at 1 year. DGF was lower among the NAC group (P = .017) and these recipients required fewer days of dialysis (P = .012). Oxidative stress was significantly attenuated with NAC (P < .001). Our results suggested that NAC enhanced early outcomes of deceased donor renal transplantation by attenuating oxidative stress.

PURPOSE:Evaluation of the beneficial effect of nephrectomy of the atrophic kidney on blood pressure (BP) and renal function.MATERIALS AND METHODS:A retrospective study of 51 patients with renovascular hypertension (RVH), bearers of atrophic kidney due to severe stenosis or occlusion of the renal artery. Average age was 47.1 +/- 15 years, the median creatinine clearance was 54 mL/min, average systolic BP (SBP) 149.6 +/- 22.5 mm Hg, average diastolic BP (DBP) 90.8 +/- 17 mm Hg and the median number of hypotensors 3 (1 to 5) per patient per day. Blood pressure and serum creatinine were analyzed from 12 to 60 months after the nephrectomy.RESULTS:There was a significant improvement in the average SBP in the periods from 12 to 36 months (p < or = 0.028) and for the average DBP from 12 to 48 months after the nephrectomy (p < or = 0.045), accompanied by a significant reduction in the use of hypotensors from 12 to 48 months (p < 0.05). One year after the nephrectomy, there was a 69% improvement in blood pressure and 63.8% improvement in renal function of patients.CONCLUSION:The removal of atrophic kidney in patients with RVH is a safe procedure which presents benefits for the control of arterial hypertension and renal function in bearers of renovascular hypertension.

CONTEXTPrevious studies have shown that double RET mutations may be associated with unusual multiple endocrine neoplasia type 2 (MEN 2) phenotypes.OBJECTIVEOur objective was to report the clinical features of patients harboring a previously unreported double mutation of the RET gene and to characterize this mutation in vitro.PATIENTSSixteen patients from four unrelated families and harboring the C634Y/Y791F double RET germline mutation were included in the study.RESULTSLarge pheochromocytomas measuring 6.0-14 cm and weighing up to 640 g were identified in the four index cases. Three of the four tumors were bilateral. High penetrance of pheochromocytoma was also seen in the C634Y/Y791F-mutation-positive relatives (seven of nine, 77.7%). Of these, two cases had bilateral tumors, one presented with multifocal tumors, two cases had large tumors (>5 cm), and one case, which was diagnosed with a large (5.5 x 4.5 x 4.0 cm) pheochromocytoma, reported early onset of symptoms of the disease (14 yr old). The overall penetrance of pheochromocytoma was 84.6% (11 of 13). Development of medullary thyroid carcinoma in our patients seemed similar to that observed in patients with codon 634 mutations. Haplotype analysis demonstrated that the mutation did not arise from a common ancestor. In vitro studies showed the double C634Y/Y791F RET receptor was significantly more phosphorylated than either activated wild-type receptor or single C634Y and Y791F RET mutants.CONCLUSIONSOur data suggest that the natural history of the novel C634Y/Y791F double mutation carries a codon 634-like pattern of medullary thyroid carcinoma development, is associated with increased susceptibility to unusually large bilateral pheochromocytomas, and is likely more biologically active than each individual mutation.

Purpose: To assess the radiological findings of urogenital tuberculosis (UGT) in patients at different disease stages, for a better understanding of its pathophysiology.Patients and methods: We retrospectively reviewed the radiological exams of 20 men (median age 41 years; range: 28-65) with urogenital tuberculosis diagnosis. The patients were classified in the following groups: (1) bilateral renal tuberculosis with predominantly parenchymatous involvement; (2) unilateral renal tuberculosis; (3) unilateral renal tuberculosis with bladder tuberculosis and (4) bilateral renal tuberculosis with bladder tuberculosis.Results: One AIDS patient had multiple bilateral renal tuberculosis abscesses (group 1). Six patients had unilateral renal tuberculosis with hydronephrosis due to stenosis and thickening of the collecting system, without involvement of the bladder or contralateral kidney (group 2). Six patients had bladder tuberculosis with diffuse thickening of the bladder wall, with one very low or no function kidney while the other kidney was normal (group 3). Seven patients had bladder tuberculosis associated to a very low or no function kidney with the other kidney with high-grade vesicoureteral reflux-associated ureterohydronephrosis (group 4). In two patients, sequential exams showed evolution of tuberculosis from a unilateral renal and ureteral lesion to contracted bladder and dilatation of the contralateral kidney secondary to high-grade reflux.Conclusions: UGT may have variable radiological presentations. However, in two of our cases we have seen that tuberculosis involvement of the urinary tract may be sequential. Further evidences are necessary to confirm this hypothesis. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

CONTEXT: Ureteral stenosis and ureterohydronephrosis may be serious complications of aortoiliac or aortofemoral reconstructive surgery. CASE REPORT: A 62-year-old female patient presented with a six-month history of left lumbar pain. She was a smoker, and had mild chronic arterial hypertension and Takayasu arteritis. She had previously undergone three vascular interventions. In two procedures, Dacron prostheses were necessary. Excretory urography showed moderate left ureterohydronephrosis and revealed a filling defect in the ureter close to where the iliac vessels cross. This finding was compatible with ureteral stenosis, and the aortoiliac graft may have been the reason for this inflammatory process. The patient underwent laparotomy, which showed that there was a relationship between the ureteral stenosis and the vascular prosthesis. Segmental ureterectomy and end-to-end ureteroplasty with the ureter crossing over the prosthesis anteriorly were performed. There were no complications. The early and late postoperative periods were uneventful. The patient evolved well and the results from a new excretory urogram were normal. We concluded that symptomatic ureterohydronephrosis following aortoiliac graft is a real complication and needs to be quickly diagnosed and treated by urologists.

You have accessJournal of Urology1 Apr 2009THE FATE OF THE REMNANT KIDNEY AFTER NEPHRECTOMY DUE TO STONE DISEASE Alexandre Danilovic, Eduardo Mazzucchi, Fabio Y Tanno, Arthur H Brito, Elias Chedid, Fabio C Vicentini, Gustavo X Ebaid, Antonio M Lucon, and Miguel Srougi Alexandre DanilovicAlexandre Danilovic More articles by this author , Eduardo MazzucchiEduardo Mazzucchi More articles by this author , Fabio Y TannoFabio Y Tanno More articles by this author , Arthur H BritoArthur H Brito More articles by this author , Elias ChedidElias Chedid More articles by this author , Fabio C VicentiniFabio C Vicentini More articles by this author , Gustavo X EbaidGustavo X Ebaid More articles by this author , Antonio M LuconAntonio M Lucon More articles by this author , and Miguel SrougiMiguel Srougi More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)61465-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "THE FATE OF THE REMNANT KIDNEY AFTER NEPHRECTOMY DUE TO STONE DISEASE." The Journal of Urology, 181(4S), p. 519 © 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 4SApril 2009Page: 519 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Alexandre Danilovic More articles by this author Eduardo Mazzucchi More articles by this author Fabio Y Tanno More articles by this author Arthur H Brito More articles by this author Elias Chedid More articles by this author Fabio C Vicentini More articles by this author Gustavo X Ebaid More articles by this author Antonio M Lucon More articles by this author Miguel Srougi More articles by this author Expand All Advertisement PDF downloadLoading ...