Prostate cancer is one of the commonest types of cancer in men worldwide. The primary treatment option for localized prostate cancer is radical prostatectomy. Unfortunately, a considerable proportion of men may experience long-term post-surgical sequelae is to determine the effect of nursing interventions on urinary, bowel, and sexual dysfunction among post-radical prostatectomy patients. A quasi-experimental (one group, pre-test-post-test) research design. We included 30 post-radical prostatectomy patients in this study. Each patient was interviewed in five sessions. During these sessions, the information about the complications of RP, pelvic floor exercise training and sexual rehabilitation was given. International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF), The Revised Faecal Incontinence Scale (RFIS) and Sexual Health Inventory for Men (SHIM) were used to evaluate the effect of nursing interventions. The study results demonstrate that the incidence of urinary and sexual dysfunction is high among patients post-radical prostatectomy patients. Fortunately, urinary and sexual dysfunctions were improved post-implementation of nursing intervention with statistically significant differences (p-value < 0.05). The incidence of faecal incontinence was 16.7% while it was 13.3% post-nursing implementation with no statistically significant differences. Nursing intervention is effective in the management of urinary incontinence after radical prostatectomy within a short period time while the improvement in sexual dysfunction may need more time.

Introduction: There are no clinical guidelines for the manipulation of chronic indwelling ureteral stents. The goal of this study was to survey, through a simulated case, how urologists initially manage a patient with a chronic ureteral stent presenting with urosepsis. Methods: An online questionnaire was shared from July 1 to August 31, 2021, through social media (Twitter) and email lists. The scenario described a 50-year-old female, known for a chronic indwelling ureteral stent, presenting to the emergency department with fever, tachycardia, and flank pain. In the scenario, the stent was in adequate position and the last exchange had been performed one month prior. Respondents could choose between treating with antibiotics and keeping the same exchange schedule, urgent stent exchange, or an alternative management that they defined. P<0.05 was considered significant. Results: A total of 396 participants completed the survey. Responses from 48 countries were collected, with 135 (34.1%) respondents from Canada. Half (50%) of respondents had more than 10 years of experience. Most (79.3%) respondents opted for initial empiric antibiotic therapy, while 16.2% opted for urgent stent exchange. A total of 19 (4.9%) medical specialists completed the survey. Non-urologists opted more frequently than urologists (42.1% vs. 16.2%) for urgent stent exchange (p=0.0111). Conclusions: This questionnaire allowed us to explore the various managements proposed by urologists in a patient with urosepsis and chronic indwelling ureteral stent. Most urologists opted for initial medical management. Further clinical studies could help determine the necessity for ureteral stent manipulation in urosepsis, and, if present, its ideal timing.

OBJECTIVE:This pilot study aimed to objectively assess the osteoporotic effect caused by androgen deprivation therapy (ADT) in patients with prostate cancer and compare this effect in surgical versus medical castration, specifically with luteinizing hormone-releasing hormone (LHRH) antagonists.MATERIAL AND METHODS:The study included 60 patients with metastatic prostate adenocarcinoma treated with either bilateral orchidectomy (group I) or LHRH antagonist (Degarelix) injection (group II). The patients had a baseline bone mineral density (BMD) assessment before the start of ADT using dual energy X-ray absorptiometry (DEXA) scan and then follow-up assessment after 6 months. BMD was measured at the spine (lumbar vertebrae L2-L4), femur (total), and forearm (one-third radius).RESULTS:Group I included 33 patients and group II 27 patients. Both the groups showed significant reduction in BMD at the spine and femur after 6 months, whereas the forearm did not show a significant reduction. Spine BMD showed 5.9%±2.6% and 4.7%±2.6% reduction whereas the femur BMD showed 6%±7.4% and 6%±4.7% reduction in the orchiectomy and the Degarelix groups, respectively. There was no statistically significant difference between the groups at the 3 measured sites.CONCLUSION:Both surgical castration and LHRH antagonists were associated with significant accelerated osteoporotic effect at the spine and femur after 6 months without difference between both the methods. Assessment of osteoporotic risk together with preventive or management measures should be started early during ADT.

Objective To compare the outcomes and complications of planned percutaneous nephrolithotomy (PCNL) in patients with a prior urosepsis episode to those without. Patients and Methods We recorded patients who presented initially with obstructive urosepsis, as identified by systemic inflammatory response syndrome and obstructing kidney stones. We compared the surgical outcomes and complications among those patients who had planned PCNL after control of prior urosepsis with urgent decompression and antibiotics (Group A) to a group who presented for PCNL with no previous history of a septic presentations (Group B). A 1:1 matched-pair analysis was performed using four parameters (age, gender, body mass index, and American Society of Anesthesiologists classification) to eliminate potential allocation bias. Primary outcomes included were stone-free rate (SFR) and complication rate. Secondary outcomes included were operative time, estimated blood loss, and duration of postoperative hospital stay. Results A total of 80 patients underwent PCNL (48 male and 32 females) divided equally between both treatment groups, with a mean (interquartile range) age of 47 (19–75) years. There were no differences in demographic data or stone characteristics between both groups. Both groups had comparable SFRs (92.5% vs 97.5%, P = 0.212) and mean operative time (77 vs 74 min, P = 0.728) (Table 2). Patients in Group A had a significantly higher overall complications rate (35% vs 10%, P = 0.03) . There were no postoperative mortalities and the mean length of hospital stay was significantly longer in Group A patients compared to group B (4.2 vs 1.5 days, P = 0.042). Conclusions : Planned PCNL after decompression for urolithiasis-related sepsis has comparable operative time and SFR but higher complication rates and longer postoperative hospital stay. This is critical in counselling patients prior to definitive treatment of kidney stones after urgent decompression for urosepsis and for adequate preoperative planning and preparation. Abbreviations: ASA: American Society of Anesthesiologists; BMI: body mass index; ICU: intensive care unit; IQR: interquartile range; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; PCN: percutaneous nephrostomy; PCNL: percutaneous nephrolithotomy; SFR: stone-free rate; URS; ureteroscopy; US: ultrasonography

Objective: To present the first Egyptian clinical practice guideline for kidney transplantation (KT).Methods: A panel of multidisciplinary subspecialties related to KT prepared this document. The sources of information included updates of six international guidelines, and review of several relevant international and Egyptian publications. All statements were graded according to the strength of clinical practice recommendation and the level of evidence. All recommendations were discussed by the panel members who represented most of the licensed Egyptian centres practicing KT.Results: Recommendations were given on preparation, surgical techniques and surgical complications of both donors and recipients. A special emphasis was made on the recipient’s journey with immunosuppression. It starts with setting the scene by covering the donor and recipient evaluations, medicolegal requirements, recipient’s protective vaccines, and risk assessment. It spans desensitisation and induction strategies to surgical approach and potential complications, options of maintenance immunosuppression, updated treatment of acute rejection and chemoprophylactic protocols. It ends with monitoring for potential complications of the recipient’s suppressed immunity and the short- and long-term complications of immunosuppressive drugs. It highlights the importance of individualisation of immunosuppression strategies consistent with pre-KT risk assessment. It emphasises the all-important role of anti-human leucocyte antigen antibodies, particularly the donor-specific antibodies (DSAs), in acute and chronic rejection, and eventual graft and patient survival. It addresses the place of DSAs across the recipient’s journey with his/her gift of life.Conclusion: This guideline introduces the first proposed standard of good clinical practice in the field of KT in Egypt.Abbreviations: Ab: antibody; ABMR: Ab-mediated rejection; ABO: ABO blood groups; BKV: BK polyomavirus; BMI: body mass index; BTS: British Transplantation Society; CAN: chronic allograft nephropathy; CDC: complement-dependent cytotoxicity; CKD: chronic kidney disease; CMV: cytomegalovirus; CNI: calcineurin inhibitor; CPRA: Calculated Panel Reactive Antibodies; (dn)DSA: (de novo) donor-specific antibodies; ECG: electrocardiogram; ESWL: extracorporeal shockwave lithotripsy; FCM: flow cytometry; GBM: glomerular basement membrane; GN: glomerulonephritis; HIV: human immunodeficiency virus; HLA: human leucocyte antigen; HPV: human papilloma virus; IL2-RA: interleukin-2 receptor antagonist; IVIg: intravenous immunoglobulin; KT(C)(R): kidney transplantation/transplant (candidate) (recipient); (L)(O)LDN: (laparoscopic) (open) live-donor nephrectomy; MBD: metabolic bone disease; MCS: Mean channel shift (in FCM-XM); MFI: mean fluorescence intensity; MMF: mycophenolate mofetil; mTOR(i): mammalian target of rapamycin (inhibitor); NG: ‘not graded’; PAP: Papanicolaou smear; PCN: percutaneous nephrostomy; PCNL: percutaneous nephrolithotomy; PKTU: post-KT urolithiasis; PLEX: plasma exchange; PRA: panel reactive antibodies; PSI: proliferation signal inhibitor; PTA: percutaneous transluminal angioplasty; RAS: renal artery stenosis; RAT: renal artery thrombosis;:rATG: rabbit anti-thymocyte globulin; RCT: randomised controlled trial; RIS: Relative MFI Score; RVT: renal vein thrombosis; TB: tuberculosis; TCMR: T-cell-mediated rejection; URS: ureterorenoscopy; (CD)US: (colour Doppler) ultrasonography; VCUG: voiding cystourethrogram; XM: cross match; ZN: Ziehl–Neelsen stain

Objective: To compare bilateral orchidectomy, as the classical 'gold standard' androgen-deprivation therapy (ADT), and ADT using a luteinising hormone-releasing hormone (LHRH) antagonist (degarelix) for the treatment of metastatic prostate cancer regarding their short-term biochemical efficacy, testosterone castrate level, tolerability, and effect on health-related quality of life (HRQoL). Patients and methods: A total of 60 patients with newly diagnosed metastatic prostate cancer were managed by either bilateral orchidectomy or degarelix injection as ADT. Both groups were compared according to their prostate-specific antigen (PSA) nadir and testosterone level at the 6-month follow-up. HRQoL was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) after 12 months. Results: Bilateral orchidectomy and degarelix showed comparable results for PSA reduction, but there was a statistically significantly lower castrate level of testosterone in the bilateral orchidectomy group. Using the EROTC QLQC-30, bilateral orchidectomy was associated with better HRQoL, better global health status, and better functional status. Conclusion: Bilateral orchidectomy resulted in lower castrate levels of testosterone, which may be associated with better disease control, together with better HRQoL and general health status compared to LHRH antagonist (degarelix). These results indicate that we should consider revisiting bilateral orchidectomy as a valuable and effective treatment option for ADT.

INTRODUCTION:We compared retrograde extraperitoneal open radical cystoprostatectomy (REORC) and robot-assisted radical cystoprostatectomy with intracorporeal diversion (iRARC) and have reported the early perioperative outcomes. PATIENTS AND METHODS:REORC and iRARC were each performed at a different tertiary high-volume center in 2 countries. Men aged ≥ 18 years with precystectomy clinical stage T1-T3 disease were included. Patients with previous major pelvic and/or intra-abdominal surgery, those who had undergone previous pelvic and/or abdominal irradiation, women, and patients with clinical stage T4 disease were excluded. All cases were managed according to a standardized enhanced recovery after surgery protocol, and all the patients had undergone ileal conduit urinary diversion. Bowel recovery was one of the main endpoints; thus, the intervals to passing flatus, tolerating oral feeding, and bowel opening were determined. The operative time, estimated blood loss, intraoperative complications, length of hospital stay, postcystectomy tumor type, stage, margin status, lymph node yield, and 30- and 90-day complications were analyzed. RESULTS:We performed a retrospective analysis of prospectively collected data from October 2016 to December 2018 of 99 patients, 50 of whom had undergone REORC and 49 iRARC. The demographic data and preoperative parameters were comparable between the 2 groups. REORC resulted in a significantly shorter mean operative time (P < .001), significantly greater mean estimated blood loss (P < .001), and greater percentage of patients requiring blood transfusion (98% vs. 12.24%). No significant differences in the length of stay were observed (P = .412). The rate of prolonged postoperative ileus was 16% and 18.4% in the REORC and iRARC groups, respectively (P = .3). Differences in the interval to passing flatus, tolerating solid oral intake, and bowel opening were not statistically significant between the 2 groups (P = .423, P = .770, and P = .700, respectively). No statistically significant difference was observed in the postcystectomy pathologic outcomes and overall and major complications rates at 30 and 90 days. CONCLUSION:REORC resulted in quicker bowel recovery and a shorter length of stay compared with conventional open procedures, with advantages comparable to those realized with iRARC. Thus, REORC can be adopted as the preferred open approach at institutions without surgical robots available.

Objectives: To examine the safety and effectiveness of percutaneous nephrolithotomy (PCNL) as an outpatient procedure, as in most centres PCNL is performed as an inpatient procedure that necessitates postoperative hospital admission. Patients and methods: Our study included 186 patients undergoing PCNL for renal calculi. Only those who met strict inclusion criteria were discharged home on the same day. Preoperative eligibility criteria for outpatient management included no complex medical problem, normal renal function, and easy access to an emergency room. Patients were divided into two groups. The outpatient group (Group 1) included those patients discharged on the same day as the PCNL and the hospitalised group (Group 2) included those who were considered appropriate for outpatient management but needed to be hospitalised. Results: In all, 162 patients (87%) fulfilled the inclusion criteria for outpatient management and 146 of these patients (90.1%) planned for outpatient management were discharged on the same operative day (Group 1). The mean time to discharge home was 8.97 h. In all, 16 patients who opted for the outpatient approach subsequently required hospitalisation (Group 2). In the hospitalised group the mean operative time was longer, which was probably related to its higher stone burden. Conclusion: PCNL can be safely performed with excellent outcomes as an outpatient procedure. Outpatient PCNL offers several advantages including a more rapid patient convalescence, reduced healthcare expenditure, decreased postoperative nosocomial infections with no additional morbidity for the patient, and with no compromising of the stone-free rate.

You have accessJournal of UrologyStone Disease: Surgical Therapy V1 Apr 2016MP51-19 PERCUTANEOUS NEPHROLITHOTOMY AS AN OUTPATIENT PROCEDURE; Ahmed fahmy, Omer Algebaly, and Wael Sameh Ahmed fahmyAhmed fahmy More articles by this author , Omer AlgebalyOmer Algebaly More articles by this author , and Wael SamehWael Sameh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.474AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolithotomy (PCNL) has stood the test of time as the procedure of choice for large renal stones. In most centers, PCNL is performed as an inpatient procedure which necessitates postoperative hospital admission. Due to limited resources and funds in our health care system, large case volume of urolithiasis associated with refinement in PCNL technique and expertise, there is an ongoing shift toward decreasing length of hospital stay and performing PCNL as an outpatient procedure whenever possible. In this study, we examined the safety and efficacy of PCNL as an out patient procedure. METHODS Our study included 186 undergoing PCNL for renal calculi. All patients were considered for an outpatient PCNL procedure, but only those who met strict criteria were discharged home at the same day. Preoperative, intraoperative and postoperative data were prospectively collected and analyzed, with attention on the need for re-hospitalization, emergency room visit, perioperative complications and stone free rates. Follow up by phone call was done at 2nd day, one week and one month postoperatively for any deviation in postoperative course. RESULTS The mean patient age was 42 years ( range 16 – 68 years). The mean maximum stone diameter was 27 mm. The mean operative time was 86 minutes. There was no major introperative complication. Blood transfusion was need in 9 patients (4.8%) We succeeded to discharge 162 patients (87%) on the same operative day. The mean time to discharge home following discharge from recovery room was 10 hours and 42 minutes. Those who needed inpatient care were for hemorrhagic and /or infective complications (16 patients) or medical complications unrelated to the procedure (8 patients). 92% of patients were stone free. No patient required re-hospitalization. Four patients needed post operative assessment in the emergency room for hematuria which turned out to be not significance and was managed conservatively. Twelve casee of low grade fever and postoperative pain was managed conservatively upon follow up phone call CONCLUSIONS In the current study, we demonstrated that PCNL can be safely performed with excellent outcomes as an outpatient procedure. Outpatient PCNL offer several advantageses, including more rapid patient convalescence, cutting health care expenses, decrease postoperative nosocomial infection with no additive morbidity to the patient and without compromising stone free rate. Future studies on larger patient population are needed to examine whether PCNL as an outpatient procedure could potentially become the standard of care for patients with renal calculi © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e688 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ahmed fahmy More articles by this author Omer Algebaly More articles by this author Wael Sameh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Introduction: The aim of our work was to report our experience in managing cases with medium-sized adrenocortical carcinoma by the high retroperitoneal extra pleural approach.Methods: During the past 2 years, 10 patients with suspected adrenocortical carcinoma were managed by our technique: the high supra 10th rib, retroperitoneal extra pleural approach. We included cases with 5 to 10 cm adrenal masses, suspected as adrenocortical carcinoma.Results: The mean patient age was 38 years (range: 26-44), the median tumour volume was 7 cm (range: 5-8). Of the 10 patients, 7 were female. Of the patients, 6 had right-and 4 had left-sided tumours. Intraoperatively, all cases had proper surgical removal, with no apparent residual tumour tissue. No single patient required a chest tube or developed respiratory problems. There were no major vascular injuries during surgery. We did not compare our findings to the standard lateral or subcostal approaches, as in our institution we adopt this high lateral approach for medium-sized tumours, while managing larger tumours with transperitoneal subcostal approach and smaller tumours laparoscopically.Conclusion: The high supra 10th lateral retroperitoneal, extra pleural approach is a safe, doable technique, allowing easy access to medium-sized suprarenal tumours and its vasculature, for cases suspected to be adrenocortical carcinoma.

Objective: To evaluate the accuracy of 16-section multi-detector row computed tomography (MDCT) angiography in the preoperative evaluation of renal transplant donors in comparison with intra-operative findings.Patients and methods: In this prospective study 89 consecutive renal donors (69 men and 20 women) underwent 16-MDCT angiography followed by open surgical donor nephrectomy from January 2008 to March 2010. We reported the number and origin of renal arteries and the presence of early branching arteries. Renal venous anatomy was evaluated for the presence of major and minor venous anomalies. The renal calyces and ureters were assessed with delayed excretory phase images. On a 3D workstation, images were evaluated by the radiologist and the urologist. These CT angiography results were compared with surgical findings.Results: The mean age of the donors was 31 years. Open donor nephrectomy was performed on the left in 52 and on the right in 37 subjects. At surgery, accessory renal arteries were found in 14 kidneys (double arteries to 13 kidneys and triple arteries to one kidney). CT and surgical findings agreed in 92% of subjects. Seven small accessory renal arteries in seven donors were missed by radiology reviewers. Early branching of the renal arteries was shown in 5 arteries, and CT matched surgical findings in 88 cases (99%). Renal vein anomalies were present in six subjects, three of them were missed with the preoperative CT. The major shortcoming of MDCT angiography was noted in identifying minor venous anatomy. The presence of discrepancies between pre-operative MDCT and the findings at surgery did not affect the clinical outcome of transplantation, except in one case where intra-operative surgical distress was noted due to failure in identifying multiple major renal veins.Conclusions: 16-MDCT angiography is a good modality in the pre-operative evaluation of live renal donors. However, it provides suboptimal information on renal vascular anatomy, particularly complex venous patterns. Surgeons should not rely fully on pre-operative CT angiography while performing donor nephrectomy. (C) 2013 Production and hosting by Elsevier B.V. on behalf of Pan African Urological Surgeons' Association. Open access under CC BY-NC-ND license.

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 20121171 EVACUATION PATTERN AND QUALITY OF LIFE IN PATIENTS UNDERGOING DIUS DIVERSION AFTER LONG-TERM FOLLOW UP Tamer Abou Youssif, Wael Sameh, and Mohammed Atta Tamer Abou YoussifTamer Abou Youssif Alexandria, Egypt More articles by this author , Wael SamehWael Sameh Alexandria, Egypt More articles by this author , and Mohammed AttaMohammed Atta Alexandria, Egypt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1395AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureterosigmoidostomy is the first known continent urinary diversion. Initial reports were followed by unacceptable rate of morbidity and mortality due to ascending infection and obstruction as well as leakage of ureterointestinal anastomosis. Many technical modifications have been introduced to overcome these complications. One of these modifications is the Detubularized isolated ureterosigmoidostomy technique described in 1996 by Atta et al. This technique incorporated several principles to overcome the bad outcome of conventional ureterosigmoidostomy; mainly to improve the evacuation pattern and accordingly the life-style in those patients. This work provides an evaluation of the evacuation pattern and quality of life for patients underwent DIUS diversion after long-term follow up. METHODS Our database included 122 patients underwent DIUS following cystectomy. DIUS was done as previously described. Minimal follow up duration for these patients was six months after surgery. Frequency of evacuation, and continence during day and night times were recorded. Continence in this study means complete dryness without the use of any pads. The ability to discriminate between urine and stool were reported. Patients overall satisfaction was estimated according the following presumed score (score 1 to 5): score 1= never or rarely satisfied, 2= seldom satisfied, 3= occasionally satisfied, 4= often satisfied, and 5= highly or always satisfied. RESULTS Ninety five patients are available for the current evaluation. All patients were completely continent during day time and night. The average evacuation frequency was 3.9 times during day and 1.7 times during night. All patients were able to feel the desire to evacuate and to withhold evacuation after for an average time of 35 minutes. Fifty two patients (54.7%) could pass solid stools with minimal urine at the end once per day and the remaining evacuations consisting of clear urine only. The remaining 43 patients pass various degrees of urine and stools mixtures in most of their evacuants. Thirty two patients (33.7%) are able to differentiate between urine and stool sensation before going to evacuate.Satisfaction score revealed that 82 patients have score 5, none of the patients regretted the diversion or think of any form of undiversion. CONCLUSIONS DIUS provides a high rate of continence both day and night, with satisfactory evacuation habits. Patients with DIUS can tolerate full bowel comfortably as long as they wish without any leakage Patients with DIUS experience good discrimination of urine and stool evacuants. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e474-e475 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tamer Abou Youssif Alexandria, Egypt More articles by this author Wael Sameh Alexandria, Egypt More articles by this author Mohammed Atta Alexandria, Egypt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE To document, in an in vivo study, the pressure transmission from the urinary bladder to the upper tract through ureteric stents in human patients. Stents have acquired special importance in the urological armamentarium. Flank pain and hydronephrosis are associated with stenting in 50% and 18% of cases, respectively. Pressure transmission from urinary bladder to the upper tract through the stent is the logical explanation for loin pain and hydronephrosis.METHODS This study was conducted in a prospective manner. We did not select patients or modify their management; instead, we studied patients who, during the course of urological management of some upper tract disease, are left with both a ureteric stent and a nephrostomy tube. Twenty patients fulfilled our criteria. After written consent, a pressure-flow study was done monitoring pressure changes in the renal pelvis during different phases of bladder filling in sitting and recumbent positions.RESULTS Pressure-flow curves showed almost equal transmission of pressure from the bladder to the renal pelvis throughout all phases of bladder filling and emptying. Any voluntary and involuntary rise of pressure in the bladder was instantly and almost equally transmitted to the renal pelvis. A subgroup of patients with infravesical obstruction resulting from benign prostatic hyperplasia also showed equal transmission of the elevated intravesical pressure during voiding to the renal pelvis.CONCLUSION Pressure from the lower urinary tract is transmitted to the upper tract through the stent, posing a threat to the renal parenchyma and function. Stent placement, when indicated, should be used for the shortest period possible, in sterile urine. UROLOGY 79: 766-770, 2012. (C) 2012 Elsevier Inc.

Introduction: Approximately 70% of bladder cancer are superficial, and respond well to endoscopic transurethral resection. However, 70% of these patients experience tumor recurrence. As the propensity for local recurrence extends over the lifetime, these patients must undergo life-long surveillance. Combination of cystoscopy and urine cytology, is considered to be the "gold standard" for this survellance. However, the former is invasive and the latter has low sensitivity. Therefore, new non-invasive tests with high sensitivity and specificity that are easy to perform are needed for screening and surveillance for recurrent tumors. Aim of the Work: The aim of this work was to investigate the value of a combination assay of the three urinary proteins: survivin, calreticulin (CRT) and urokinase type plasminogen activator receptor (uPAR) as non invasive diagnostic tool in detection of bladder cancer recurrence. Patients and Methods: From march 2010 to October 2010, all patients with known history of NMIBC who are scheduled for follow-up cystoscopy in the Department of Urology, Alexandria University were prospectively included in this study. All patients underwent cystoscopy under general anaesthesia, and those who were found to have a definite or suspicious lesion(s) in the bladder underwent complete TURBT. Voided urine samples from all patients were taken before cystoscopy. Urinary survivin and uPAR concentrations were performed by ELISA technique while urinary CRT was estimated by western blot technique. Results: Sixty eight patients were eligible to our study. Thirty patients were found to have no recurrence of the disease and were considered as group I (recurrence-free group) while 38 patients had non-muscle-invasive recurrence and were considered as group II (recurrence group). There was significant increase of the three urinary proteins in the recurrence group compared to the recurrence-free group. The concomitant use of the three urinary markers revealed higher sensitivity for detection of bladder cancer recurrence (96.8%) than the use of each marker alone, but at the expense of lower specificity (80%). Combining these markers using a Logistic Regression Model resulted in higher specificity with maintained excellent sensitivity. A direct comparison between the diagnostic performance of the new logistic regression model, survivin alone and various combinations the three markers showed that the new model had the highest sensitivity (93.75%) with a 100.00% specificity. Conclusion: Combining more than one urinary marker is a logic step forward that improves the sensitivity of detection of bladder cancer recurrence. The use of this logistic regression model as a promising urinary marker for early detection of bladder cancer is recommended where the specificity remains 100.0% while the sensitivity is raised to 93.75%. However larger studies should be carried out to prove the usefulness of these marker combinations. [S Sharaf; A Ketat; I Diab; F Dwidar and W Sameh. Value of a Combination Assay of Urinary Survivin, Calreticulin and Urokinase Type-Plasminogen Activator Receptor as Non-Invasive Diagnostic Tool in NonMuscle-Invasive Bladder Cancer. Journal of American Science. 2012; 8(4):466-473]. (ISSN: 1545-1003). http://www.americanscience.org. 62

Introduction: Approximately 70% of bladder cancers are non-muscle-invasive (NMIBC), and respond well to endoscopic transurethral resection. However, 70% of these patients experience tumor recurrence. As the tendency for local recurrence and/or progression extends over the lifetime, patients with superficial bladder cancer must undergo life-long surveillance. Combination of cystoscopy and urine cytology is considered the "gold standard" for this surveillance. However, they suffer from drawbacks where cystoscopy is an invasive procedure and urine cytology shows limited ability to detect low grade bladder tumors. Therefore, new non-invasive tests with high sensitivity and specificity that are easy to perform are needed not only for initial diagnosis but also in surveillance for recurrent tumors.Objective: To investigate the magnitude investigate the magnitude of survivin expression in non-muscle-invasive bladder cancer and its possible value as a non invasive diagnostic tool.Patients and methods: From March 2010 to October 2010, 68 patients with known history of NMIBC who were scheduled for follow-up cystoscopy in the department of Urology, Alexandria University were included in this study prospectively. All patients underwent cystoscopy under general anaesthesia, and those who were found to have a definite or suspicious lesion(s) in the bladder underwent complete TURBT. Survivin expression was determined in urine and in bladder cancer tissue both by Western blotting and by ELISA.Results: The study included 68 patients. Tumor recurrence was detected in 38 patients, of whom, 24 had low grade recurrence. The urinary concentration of survivin was significantly higher in the recurrence group by both detection methods (U = 141, P = 0.018 and chi(2) = 10.46, P = 0.001 for ELISA and WB respectively). Survivin by ELISA showed higher sensitivity and specificity (84.4% and 100%) than that by WB (55.3% and 93.3%). In tumor tissue, by both methods, survivin was detected in higher levels than in urine but there was no significant correlation between urinary and tissue levels neither in the whole recurrence group nor in the low grade subgroup.Conclusion: Urinary survivin is a useful marker for non-invasive detection of non-muscle-invasive bladder cancer recurrence. Its detection is better using ELISA technique than WB and there is no correlation between its expression in tissue and urine. (C) 2012 Production and hosting by Elsevier B.V. on behalf of Pan African Urological Surgeons' Association.

Objectives: Recurrence rates for patients with locally advanced renal cell carcinoma (LARCC) remain high. To date the predictors of recurrence in those patients remain controversial. The aim of the present study was to assess the relapse pattern in those patients and identify predictors for recurrence.Patients and methods: We evaluated retrospectively 112 consecutive patients who underwent surgery for LARCC (T3-T4N0M0) between January 2000 and December 2010. Clinical and pathological data were collected from hospital medical records and compiled into a computerized database. Studied variables were age, mode of presentation, Tumour-Node-Metastasis (TNM) stage, Fuhrman nuclear grade, histological subtype, tumour size, venous thrombus level, collecting-system invasion and sarcomatoid differentiation. Recurrence- free survival (RFS) was estimated using the Kaplan-Meier method. Univariate and multivariate analyses were conducted.Results: Patients were followed for a mean and median follow- up of 33 and 24 months, respectively, after surgery. During the follow- up, recurrences (distant and/or local) were recorded in 58 patients, representing 52% of the cohort. The mean and median times to recurrence were 25 and 13 months, respectively. Sites of recurrence were multiple in 36 patients (62%), lung only in 14 (24%), and local in eight (14%). RFS rates at 1, 2, and 5 years were 50%, 43% and 34%, respectively, while the median RFS was 23.7 months. Using univariate analysis, RFS after nephrectomy was significantly shorter in patients aged < 70 years, symptomatic at presentation, with larger tumours, higher nuclear grade, collecting-system invasion, and/or sarcomatoid differentiation. After multivariate analysis, T-stage, nuclear grade and sarcomatoid differentiation retained their power as independent predictors of RFS (P = 0.032, < 0.001 and 0.003, respectively).Conclusions: For patients with LARCC, T-stage, grade and sarcomatoid differentiation independently dictate the risk of tumour recurrence. Considering these variables in the postoperative surveillance protocols and in the need for a multimodal therapeutic approach is highly recommended. (C) 2012 Arab Association of Urology. Production and hosting by Elsevier B.V. All rights reserved.

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion1 Apr 20121165 COMPARISON OF MANOMETRIC AND RADIOLOGIC FINDINGS IN SIGMA VS. DETUBULARIZED ISOLATED URETEROSIGMOIDOSTOMY (ATTA POUCH) Tamer Abou Youssif, Grgs Fawzy, Wael Sameh, and Mohammed Atta Tamer Abou YoussifTamer Abou Youssif Alexandria, Egypt , Grgs FawzyGrgs Fawzy Alexandria, Egypt , Wael SamehWael Sameh Alexandria, Egypt , and Mohammed AttaMohammed Atta Alexandria, Egypt View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1389AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detubularized Isolated Ureterosigmoidostomy (DIUS) involves detubularization of the rectum and sigmoid colon and refashioning into an isolated pouch with fixation of the new non-dismembered left colon stoma into posterior rectal wall facing the anal canal (Atta MA, J Urol, 1996). Improvement bowel evacuation pattern, and absence of urgency and nocturnal wetting was shown in a previous study. The present study provides rectodynamic as well as radiologic evidences for improved function following DIUS. METHODS This study was conducted on 20 patients divided into two groups: group(A) including ten patients scheduled for radical cystectomy and urinary diversion by DIUS, and group (B) including ten patients who had previously underwent radical cystectomy and urinary diversion by sigma rectum pouch (Mainz II). The rectal and anal pressures as well as the anorectal inhibitory reflex were measured preoperatively and repeated 6 months in both groups. Ascending pouchography was done postoperatively with incremental increase of the infused volume till 500 ml, and post-evacuation film was taken to confirm complete colon evacuation. Comparison of both groups was done using Student t-test. RESULTS In group A there was a statistical significant difference between preoperative and postoperative mean resting anal pressure, which was 71 ± 4.007 (66-80) cmH2O and 73.9 ± 4.42 (69-83) cmH2O respectively. There was no significant difference between post-operative mean resting anal pressure in group A and B. In group A the mean basal pouch pressure was 5 ± 3.33 (0-10) cmH2O, mean end pressure was 13.2 ± 4.42 (9-20) cmH2O and contraction waves were found in one patient with pressure up to 40 cmH2O. In group B the mean basal pouch pressure was 7 ± 2.58 (5-10) cmH2O, mean end pressure was 17.7 ± 6.11 (10-30) cmH2O and contraction waves were found in three patients with pressure up to 40 cmH2O The anorectal inhibitory reflex was lost in all patients of group A after surgery. All patients of group B showed preserved anorectal reflex. Pouchogram with a maximum infused volume of 500 ml showed no reflux to the colon or the ureters in group A, with full emptying on post evacuation films. In group B eight patients had reflux up to the transverse colon starting at 350 ml and became more evident at 500 ml in all patients, with failed emptying post evacuation films. CONCLUSIONS Detubularization of the rectum and sigmoid results in a capacious low pressure pouch with absent anorectal inhibitory reflex, consequently decreasing the frequency of evacuation without any urgency. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e472 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Metrics Author Information Tamer Abou Youssif Alexandria, Egypt More articles by this author Grgs Fawzy Alexandria, Egypt More articles by this author Wael Sameh Alexandria, Egypt More articles by this author Mohammed Atta Alexandria, Egypt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Purpose: To assess the effectiveness of a lithotripter (Modularis Vario; Siemens, AG Healthcare, Munich, Germany) in the management of renal and ureteric stones.Patients and methods: In all, 1146 adult patients with renal or ureteric stones were treated at one urological centre using the latest model of the Modularis Vario lithotripter. The effectiveness of lithotripsy and re-treatment rate were assessed. Data were obtained on stone location, stone size, shock wave usage, success rate, and complications.Results: Between May 2007 and November 2009, 698 patients with renal stones and 448 with ureteric stones underwent extracorporeal shock-wave lithotripsy (ESWL). The mean (SD) renal stone size was 12.8 (3.8) mm; a mean of 1.36 sessions was required, with a mean (SD) number of 3744 (1961) shocks delivered per renal stone. After 3 months, the success rate defined as the patient being stone-free or with residual fragments of < 4 mm; for renal stones the rate was 91.1%, with a 6.9% complication rate in the form of steinstrasse and severe renal colic. The mean (SD) ureteric stone size was 10.4 (2.7) mm. A mean of 1.37 sessions was required, with a mean (SD) of 4551 (2467) shocks delivered for each ureteric stone. The success rate for ureteric stones was 89.5%, with a 5.6% complication rate. The overall efficiency quotient was 0.66.Conclusion: The Siemens Modularis Vario lithotripter is a safe and effective machine for treating renal and ureteric stones. (C) 2011 Arab Association of Urology. Production and hosting by Elsevier B. V. All rights reserved.

Detubularized Isolated Ureterosigmoidostomy (DIUS) involves detubularization of the rectum and sigmoid colon and refashioning into an isolated pouch with fixation of the new non-dismembered left colon stoma into posterior rectal wall facing the anal canal (Atta MA, J Urol, 1996). Improved evacuation function after DIUS was previously shown. This work provides an evidence for this improvement of function.

Recurrence rates for patients with locally advanced renal cell carcinoma (LARCC) remain high. To date, the predictors of recurrence in those patients are still controversial. The aim of this work is to study the survival pattern of those patients and identify predictors for recurrences.