Hypoglycemia in Renal Cell Carcinoma: A Rare Paraneoplastic Syndrome A 65-year-old male adult foster care patient presented to the emergency room with altered mental status and respiratory depression which required intubation. The patient was also found to be hypoglycemic and hypertensive. He was admitted to the medical intensive care unit where a chronic type B aortic dissection and an exophytic superior pole right renal mass measuring 4.5 × 5.5 cm were discovered on CT scan (Figure 1). He continued experiencing recurrent episodes of hypoglycemia during his admission and was placed on double portion meals and intravenous glucose with dextrose 10% (D10) in water.
A Large Urinary Bladder Hemangioma Mimicking Urachal Cancer: A Case Report and Literature Review Urinary bladder hemangiomas are rare, especially in children and adolescents. We present a case of a 17-year-old young man with persistent gross hematuria for 1 month. Computed tomography revealed a 3.6-cm mass on the superior anterior wall of the urinary bladder, which was highly suspected as a urachal tumor. We carried out an en bloc resection of the urachus and bladder tumor. The pathological report indicated a cavernous hemangioma of the urinary bladder. No tumor recurrence or bleeding was found during the 2-year follow-up.
Herniated Kidney Postoperative incisional hernia is a relatively common complication following abdominal surgery. Herniation of the kidney is a less common entity and typically occurs as a congenital or acquired diaphragmatic defect, and rare case reports have demonstrated partial flank or lumbar herniation of the kidney. Herein we present a unique case of a postoperative incisional hernia containing the entire right kidney.
Post-prostatectomy lymphocoele presenting with renal failure Since its advent in 2001, robotic-assisted laparoscopic prostatectomy has become the gold standard treatment for the management of localised prostate cancer.Pelvic lymphocoele is most commonly found after gynaecological or renal transplant surgery or following extensive pelvic lymphadenectomy. Its formation following prostatectomy is not uncommon1 but it seldom causes major complications or morbidity.2We present a case of a 66-year-old man who presented with left sided abdominal pain, a palpable infra-umbilical mass, and renal failure.
Active Surveillance of Small Renal Masses Most renal masses in the United States are incidentally detected via abdominal imaging. This has led to an increase in the incidence of small renal masses (≤ 4 cm). Active surveillance is a feasible, oncologically safe option in slow growing and indolent tumors in other organs and has recently become more widely studied in small renal masses. Active surveillance for small renal masses is a feasible and safe option for select patients, particularly those who are more elderly or harbor significant comorbidities, especially cardiovascular disease.
Testosterone therapy for high-risk prostate cancer survivors: a systematic review and meta-analysis A systematic review and meta-analysis was performed to determine the relationship between testosterone therapy and risk of recurrence in testosterone-deficient survivors of curatively treated high-risk prostate cancer. Primary outcome was the risk of biochemical recurrence (BCR) in 109 high-risk patients in 13 included studies (1997-2017). Biochemical and symptomatic effects of therapy were also reviewed. The BCR rate was 0.00 (0.00-0.05), lower than the expected rate for high-risk prostate cancer survivors, suggesting that testosterone therapy may not increase their BCR risk.
Surgical Outcomes of Three vs Four Arm Robotic Partial Nephrectomy: Is the Fourth Arm Necessary? To compare the cost, efficacy, and safety of 3-arm versus 4-arm technique in robotic partial nephrectomy (RPN). Surgeons may either elect to utilize three versus four robotic instruments depending on preference. The purpose of this study is to compare the outcomes between the two techniques.
The History of Urology at the Minneapolis Veterans Affairs Health Care System The Veterans Health Administration (VHA) is the largest health care system in the United States, serving more than 8.9 million Veterans each year.1 It is estimated that sixty percent of all medical residents train within the 168 Veterans Affairs (VA) Medical Centers, making the VA the largest provider of healthcare training in the United States.1 Within the VA system, the Minneapolis VA Health Care System is one of the largest training programs. Many leaders in Urology have trained or served at the Section of Urology within the Minneapolis VA.
Reply by the Authors: Shock-wave Lithotripsy for Pediatric Patients: Which Nomogram Can Better Predict Postoperative Outcomes? The prediction of the success rate of SWL is an important issue, especially for pediatric patients. Therefore, clinicians should use these nomograms more often in daily practice to improve surgical planning. In our study, we compared the accuracy of the Onal and Dogan nomograms. We demonstrated that both nomograms are effective and independent predictors of stone-free rate. We used objective variables such as gender, age, stone size, number of stones, stone localization, and history of previous treatment.
Deputy Editor of Female Urology, Urodynamics, Incontinence, and Pelvic Floor Reconstructive Surgery: Craig Comiter Dr. Comiter received his undergraduate degree from Harvard College, and his medical degree from Harvard Medical School. He stayed in Boston for his residency, serving as resident in general surgery at the Brigham and Women's Hospital, and then completed his urology residency at the Harvard Program in Urology. In 1998, Dr. Comiter served as Clinical Instructor and Fellow in Neurourology and Urodynamics at the University of California in Los Angeles.
A Rare Case of Triplicate Ureter Ureter triplication is an extremely rare congenital anomaly of the urinary system with approximately 100 cases reported in medical literature since it was first described in 1870. It is classified into 4 types, and commonly associated with ipsilateral or contralateral urological anomalies. In this report, we present a case of a pediatric Type III- triplicate ureter associated with ipsilateral vesicoureteral reflux and contralateral idiopathic renal atrophy that was discovered during kidney transplant work-up.
Transurethral enucleation with bipolar energy (TUEB): AINU technique and Short-term Outcomes To present our TUEB technique, wherein the enucleated adenoma is resected while keeping it attached near the verumontanum avoiding the need of a morcellator. To evaluate the safety and short-term outcomes of our technique of TUEB for the treatment of symptomatic benign prostatic hypertrophy (BPH).
Antimuscarinic use in Men Treated with Bladder Outlet Obstruction Medication Therapy Approximately 50% of men with lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction (BOO) have urinary storage symptoms such as urgency, frequency, nocturia, and urinary incontinence.1,2 Based on recent randomized controlled trials, the American Urological Association (AUA) recommends the use of an antimuscarinic (AM) as an option, in addition to an alpha blocker (AB) in men with BOO and urinary storage symptoms without baseline excessive post-void urine residuals.3-9 These trials reported improvements in overactive bladder (OAB) symptoms in patients taking an AM in combination with an alpha-blocker compared to patients taking AB monotherapy.
Diagnostic accuracy of a rapid biparametric MRI protocol for detection of histologically proven prostate cancer Objective: To evaluate the performance of a rapid, low cost, non-contrast MRI examination as a secondary screening tool in detection of clinically significant prostate cancer.Methods: In this prospective single institution study 129 patients with elevated PSA levels or abnormal digital rectal examination findings underwent MRI with an abbreviated biparamatric MRI protocol consisting of high resolution axial T2- and diffusion weighted images. Index lesions were classified according to PI-RADS v2.0.
Pathologic Specimens at Time of Pyeloplasty: Frequency and Practice Patterns To assess national and regional practice patterns and rates of pathologic specimen identification sent at time of pyeloplasty, as well as project associated costs, we used a national administrative database. The rate at which the excised UPJ is sent for pathologic identification is variable, arguably without a clear clinical purpose.
Detection and Treatment of Primary Prostatic Melanoma Primary melanoma of the genitourinary (GU) tract is a very rare disease, representing less than 1% of all melanomas in men 1. The majority develop from the penis and distal urethra, with fewer cases of primary melanoma originating more proximally along the GU tract. Of the described cases of prostatic melanoma, most are of prostatic urothelial origin or secondary to metastatic disease 2. To our knowledge, only six cases of primary melanomas have been reported in the English literature to have unequivocally originated from the prostatic parenchyma (Table 1) (3-8).
Understanding the popcorn effect during holmium laser lithotripsy for dusting To assess low and high power settings for the popcorn technique, and relationship of laser fiber-to-stone distance and calyceal size on submillimeter fragmentation. Our in-vitro findings may help guide strategies to improve a dusting technique for ureteroscopy.
Locally Metastatic Ductal Adenocarcinoma of the Prostate: A Therapeutic and Prognostic Dilemma An asymptomatic 64-year-old male with an elevated prostate specific antigen (PSA) of 28.0ng/dL underwent transrectal ultrasound-guided prostate biopsy and was diagnosed with Gleason 8 (4+4) ductal adenocarcinoma in 8 of 12 cores sampled. Bone scan, chest x-ray, and abdominal CT scan were all radiographically negative for metastatic disease. He underwent curative intensity-modulated radiation therapy (IMRT) with 79.2 Gy in 44 fractions as well as adjuvant androgen deprivation (ADT) incorporating leuprolide, per American Urologic Assosciation (AUA) and National Comprehensive Cancer Network (NCCN) guidelines.
Acceptability of Mobile Health Technology for Promoting Fluid Consumption in Patients With Nephrolithiasis To evaluate kidney stone patients’ interest in lifestyle behavior modification and a variety of mobile health (mHealth) technologies to improve adherence to fluid consumption recommendations for the prevention of nephrolithiasis. Of particular interest was the acceptability of various intervention components for the design of a stone-specific mHealth technology.
Care Seeking Patterns for Women Requiring a Repeat Pelvic Organ Prolapse Surgery Due to Native Tissue Repair Failure Compared to a Mesh Complication To explore patient migration patterns in patients requiring repeat surgery after Pelvic Organ Prolapse (POP) repair as there is a limited understanding of care seeking patterns for repeat surgery after POP repair. We hypothesized that undergoing repeat surgery for a prolapse mesh complication would be associated with an increased incidence of migration to a new facility for care compared to those undergoing repeat surgery for recurrent POP.
Post TURBT Discovery of Urachal Remnant in a 62-Year-Old Man A 62-year-old male with a past medical history of cigarette smoking and laparoscopic repair of bilateral inguinal hernias using total extraperitoneal (TEP) mesh presented with persistent dysuria and perineal pain. Urine culture was negative, and he was treated with an extended course of antibiotics for a working diagnosis of prostatitis. His urinary symptoms improved but he returned with gross hematuria a few months later. CT urogram was concerning for a bladder tumor, with soft tissue thickening from the dome of the bladder extending to the abdominal wall and left inguinal region.
Variability of Retail Pricing of Generic Urologic Medications in a Major US Metropolitan Area Objective: To investigate retail pricing for generic urologic medications in the St. Louis area as a function of pharmacy type, zip-code, and median income.Materials and Methods: Pharmacies spanning 51 zip-codes were identified. From May-June 2017, pharmacies were inquired regarding cost, without insurance, for 30- and 90-tablet prices for finasteride 5mg, tamsulosin 0.4mg, oxybutynin 5mg, and oxybutynin ER 5mg and 10mg. Median income was determined using US census data.K-means clustering defined groupings based on zip-code, median income, and a combination of the two.
CURRENT STATE OF UROLOGIC MEDICAL SCHOOL EDUCATION: A SCOPING REVIEW To review current literature pertaining to the availability and implementation of urology-focused curricula, in an effort to highlight current approaches to urologic education at the medical school level.
Late Relapse of Nonseminomatous Germ Cell Tumor 24 Years Later A 60-year-old man with a history of coronary artery disease status-post coronary artery bypass graft, hypertension, type II diabetes, current every-day smoker, and testicular cancer presented with abdominal and left flank pain. A CT and PET scan was performed, revealing a PET-avid 5.5 × 4.4cm left para-aortic and renal hilar mass (Figs.1 and 2). Serum tumor markers were normal.
Bosniak Category III Renal Cysts Caused by Crizotinib in an Anaplastic Lymphoma Kinase Gene-Rearranged Non–Small Cell Lung Cancer Patient Bosniak category III renal cystic masses are often treated with surgical resection because of high risk of malignancy. Crizotinib is an anaplastic lymphoma kinase (ALK) inhibitor used to treat ALK gene-rearranged non–small cell lung cancer and reported to be associated with complex renal cyst formation. We herein report a case of Bosniak category III renal cysts occurred in a crizotinib-treated ALK gene-rearranged non–small cell lung cancer patients. The cysts regressed spontaneously after cessation of crizotinib and we could thus avoid unnecessary surgical resection.
Recurrent Unexplained Cystitis Due to an Ingested Foreign Body–An Extremely Rare Case We present the images of a 4-year-old male child with history of recurrent unexplained urinary tract infections which was found to be due to an ingested wooden foreign body which had perforated the small bowel into the posterior bladder wall. Such cases are very rare, usually due to domestic abuse or in patients with psychiatric illnesses. The adults usually report early but in children these cases go un-noticed. These patients may present with features of bowel obstruction, perforation,or hematochezia.
A Case of an Invisible Ureteral Stent A 35-year-old female presented to the emergency department with fevers and flank pain and was found on computed tomography to have a retained ureteral stent that was placed during emergent ureteral repair eight years prior. The stent was only faintly visible on computed tomography and was completely radiolucent on fluoroscopy. We believe that the stent's radiopaque coating degraded and was lost after years of exposure to urine. This case suggests that a stent may become undetectable on standard imaging if left in place for a long enough period of time.
Three-Dimensional Printing in Urology: History, Current Applications, and Future Directions To review the history, current applications, limitations, and future directions of three-dimensional (3D) printing within the field of urology. 3D printing is an additive manufacturing process in which a 3D model is created using a computer-generated image. This technology is applied by companies to create and test new drugs, design and manufacture instrument prototypes, and create patient-specific models of organs for surgical teaching and planning. A literature review was performed within the Web of Science and PubMed databases from January 2008 to May 2018 using keyword phrases “3D printing” and “urology.” A total of 46 relevant publications were included.
The Editors solicited many contributors from a wide range of esteemed, well-respected and experienced urologic laparoscopic and/or robotic surgeons to discuss the difficult situations one may encounter during a certain operation, and also offer tips and tricks on how to handle these circumstances and respective trouble-shooting approaches. There are many gems within the text, and thus is a good reference book for urologic residents and fellows—as the authors mentioned, the materials discussed in a certain chapter could enable a practicing urologist or the assistants to confront and resolve dilemmas before even entering the operating theatre.
Hydronephrosis After Pyeloplasty: “Will It Go Away?” To identify attributes of pediatric patients with hydronephrosis due to ureteropelvic junction obstruction and of their surgical encounters which are predictive of resolution of dilatation in order to provide more effective counseling about expected outcomes. This study was inspired by the suggestion in recent literature that greater than 20% improvement in anteroposterior diameter (APD) of the renal pelvis after pyeloplasty is indicative of resolution of obstruction. The remaining dilatation, however, is often distressing to caregivers, and there are no data to guide clinicians in counseling about its likelihood to resolve.
Re: Granieri et al.: Robotic Y-V Plasty fpr Recalcitrant Bladder Neck Contracture (Urology 2018;117:163-165) In the recent July 2018 edition of Urology, Granieri et al report their innovative and well described technique for robotic bladder neck reconstruction of recalcitrant “bladder neck contracture.”1 The authors performed this technique on mixed cohort of etiologies postradical prostatectomy (RP) and transurethral procedures (TUR). In this series, robotic bladder neck reconstruction at a median follow-up of 8 months appears to be a safe and efficacious treatment for this uncommon and challenging method to treat patient population.
Retroperitoneal Paraganglioma Involving the Renal Hilum: A Case Report and Literature Review A 27-year-old female with past medical history of hypertension presented to Urology clinic for evaluation of a right renal mass discovered incidentally by her Obstetrician on renal ultrasound obtained for work-up of her refractory hypertension. Her hypertension was uncontrolled despite being on a low-sodium diet, hydrochlorothiazide 50mg daily and lisinopril 10mg daily. Review of systems was notable for occasional headaches and blurry vision. She had regular annual physicals and negative pap smear with her Obstetrician, and reported no prior surgical history.
Recommendations for Safe and Efficient Morcellation After Endoscopic Enucleation of the Prostate Background:After EEP (HoLEP, ThuLEP, GreenLEP or bipolar) the enucleated tissue is removed through a process of mechanical morcellation. Morcellation is the last, and very important, step in EEP procedures. It introduces additional time, and the possibility for complications exists. Although this is not a difficult procedure, it requires a learning curve that can pose a challenge for inexperienced surgeons. There are two types of morcellation systems: oscillating and reciprocating (depending on blade movement).
Radiation effect on male spermatogenesis and fertility – the science and ethical consideration of the Oregon and Washington radiation experiments on prison inmates Since x-ray was discovered and studied in the late 1800s, there was extraordinary excitement in the promise and peril of nuclear energy. As the development of atomic energy proliferated, so did the concerns over the effects of ionizing radiation on those who might be exposed. This led to thousands of human radiation experiments conducted at hospitals, government facilities, and universities to understand the potential harmful effects of radiation on humans.1 This also became the context for two controversial experiments on the effects of x-ray irradiation on male fertility using prison inmates.
Comparison of RENAL, PADUA, CSA, and PAVP Nephrometry Scores in Predicting Functional Outcomes after Partial Nephrectomy To evaluate the accuracy of Radius, Exophytic/endophytic, Nearness to collecting system/sinus, Anterior/posterior, and Location relative to polar lines (RENAL), Preoperative Aspects and Dimensions Used for Anatomical classification (PADUA), Contact Surface Area (CSA), and Pre-operative Assessment of Volume Preservation (PAVP) nephrometry scores in predicting post-operative renal functional outcomes after partial nephrectomy (PN). Few studies have compared the accuracy of tumor complexity systems directly in the same set of PN patients.
Could Nonenhanced-Computer Tomography Suffice as the Imaging Study of Choice for the Screening of Asymptomatic Microscopic Hematuria? To compare the diagnostic accuracy of the noncontrast and contrast-enhanced phases of computed tomographic urography for detection of upper urinary tract findings in adults undergoing initial evaluation of newly diagnosed asymptomatic microscopic hematuria to determine if less-intensive noncontrast imaging has the potential to become a suitable imaging alternative in the work-up of this common condition.
Congenital Duplication of the Urogenital Sinus in an Adult Female A 28-year-old female presented to the emergency room with symptoms of left pyelonephritis. She was admitted and was found on imaging study to have left hydronephrosis and duplicated bladder. A left nephrostomy tube was placed, and urology was consulted for management of her infections in context of her anatomy. During her evaluation, the patient reported 3-4 urinary tract infections or episodes of left pyelonephritis per year, as well as recurrent left flank pain and mixed urinary incontinence for several years.
Isolated Shotgun Injury to the Ureter: The Importance of Clinical Suspicion Traumatic ureteral injuries are rare and account for less than 1% of all urological traumas. Associated abdominal injuries are almost always present. We present a rare case of isolated shotgun injury to the ureter where clinical suspicion was of paramount importance.
Increasing Body Mass Index Steepens the Learning Curve for Ultrasound-guided Percutaneous Nephrolithotomy To define how the learning curve for success in ultrasound-guided percutaneous nephrolithotomy (PCNL) is impacted by body mass index (BMI). Previous research has shown ultrasound-guided PCNL to be an effective method of nephrolithiasis treatment comparable to fluoroscopy-guided PCNL. A common concern for the ultrasound-guided approach is potential imaging difficulty in the obese patient population.
Has the Age of Cytoreductive Nephrectomy Come to an End? The CARMENA (Cancer du Rein Metastatique Nephrectomie et Antiangiogéniques) trial1 was a prospective, multicentre, open-label, phase-3 trial that randomly assigned patients with Memorial Sloan Kettering Cancer Center (MSKCC) intermediate- or poor-risk metastatic renal cell carcinoma (mRCC) to undergo cytoreductive nephrectomy (CNx) followed by sunitinib or to sunitinib alone without nephrectomy. The study was designed to test the noninferiority of sunitinib alone with respect to the primary endpoint overall survival (OS).
Giant Ureteric Calculus in a Patient With Bladder Exstrophy We report a case of giant ureteric calculus in an adult male with bladder exstrophy who presented with urinary incontinence and recurrent urinary tract infection. Investigations revealed a 16-cm ureteric calculus, a vesical calculus and a left staghorn renal calculus. Ureteric stone was removed by open ureterolithotomy.
Robotic Partial Nephrectomy for Complex Hilar Tumors: Tips and Tricks To report our step-by-step technique and provide tips and tricks for robotic partial nephrectomy (RPN) in a highly complex renal mass. Robotic surgery has widened the indications of the conservative treatment for renal masses. With increasing experience, larger deeply infiltrative tumors, or tumors involving the renal hilum can be treated with robotic partial nephrectomy.
Diagnosis and Treatment of Urethrocavernous Fistula Presenting As Urethral Bleeding Urethrocavernous fistula is rarely reported, though should be considered within the differential diagnosis for men who present with urethral bleeding, particularly at time of erection. Ultrasonography with concomitant intracavernosal injection can be considered to confirm the diagnosis. Here we report a case of urethrocavernous fistula in a 48 year old man without preceding traumatic event.
High catastrophizing in subjects with painful mesh complications have worse outcomes To identify the rate of catastrophizing in a cohort of subjects with chronic pain after self-reported mesh complications and identify interactions of catastrophization with other patient factors, such as age, number of pelvic surgeries, and intent to sue. Catastrophizing has been shown to be a risk factor for chronicity of pain, disability, and depression.
Use of Google Trends to Track Online Behavior and Interest in Kidney Stone Surgery To explore internet search trends data as a unique resource for monitoring online health information-seeking behavior. We utilized Google Trends to sample population interest and search inquiries into surgical treatment options of kidney stones, and we examined the relative frequency of searches across the United States.
ASSOCIATION BETWEEN EXSTROPHY-EPISPADIAS COMPLEX AND CONGENITAL ANOMALIES: A GERMAN MULTICENTER STUDY To further investigate associated anomalies in EEC patients CURE-Net database was systematically screened. In literature the exstrophy-epispadias complex (EEC) comprises a spectrum of anomalies, mainly occurring “isolated” without additional congenital defects. Nevertheless, previous epidemiological studies indicated a higher association with renal, anorectal and lower neurotubular anomalies, which may originate from the same developmental morphogenetic fields.
Functional Parenchymal Volume-based Spectrum Score is Able to Quantify Ischemic Injury After Partial Nephrectomy To externally validate the Spectrum Score (SS) using a modified calculation based on functional parenchymal volumes (FPVs) instead of renal scans. The SS quantifies acute ischemic injury in the ipsilateral kidney after partial nephrectomy. However, this metric requires renal split function assessment via renal scans, which may be unavailable in routine practice.
Chronic Prostatitis and/or Chronic Pelvic Pain as a Psychoneuromuscular Disorder—A Meta-analysis To evaluate effectiveness of physical therapy, biofeedback, and/or cognitive behavioral therapy for chronic prostatitis/chronic pelvic pain syndrome (CP and/or CPPS). This symptom complex has resisted resolution from conventional urologic treatment of the prostate, which includes antibiotics, alpha-blockers, and analgesics. Beginning in 1995, a new paradigm was introduced viewing CP and/or CPPS as a psychoneuromuscular disorder driven by protective pelvic floor guarding and psychosocial stress.
Determinants of Active Surveillance in Patients with Small Renal Masses To evaluate trends in the utilization of active surveillance (AS) in a nationally representative cancer database. AS has been increasingly recognized as a strategy for patients with small renal masses (SRM), but little is known about national usage patterns.
Younger Men With Prostate Cancer Have Lower Risk of Upgrading While on Active Surveillance: A Meta-analysis and Systematic Review of the Literature Active surveillance has become a popular option for patients with low risk prostate cancer. Our objective was to examine the correlation between age and the risk of Gleason upgrading and biopsy progression. A systematic search was conducted. Eight studies met our eligibility criteria including 6522 patients with a median age of 65.8 (41-86) years. Per decade decrease in age, the pooled odds ratio and hazard ratio (CI 95%) for Gleason upgrading were 0.83 (0.73-0.94) and 0.87 (0.82-0.92), and for biopsy progression were 0.80 (0.74-0.86) and 0.88 (0.79-0.99), respectively.
Urologic Complications Following Pelvic Radiotherapy Radiotherapy is widely used as a curative treatment for pelvic malignancies. The location of these organs leads to unavoidable exposure of the bladder, urethra, and distal ureters to radiation and may cause subsequent development of radiation cystitis, fistulae, strictures, and secondary malignancy. As cancer survival improves, an ever-increasing number of patients is living with the long-term complications of radiotherapy. Symptoms are not only debilitating for the patient but also pose a treatment challenge to the urologist.
Translabial Ultrasound Evaluation of Pelvic Floor Structures and Mesh in the Urology Office and Intraoperative Setting Translabial ultrasound (TUS) can provide an inexpensive alternative imaging modality for evaluating pelvic floor structures and synthetic slings as mesh can be difficult to identify on pelvic exam or cystoscopy, patients may be unable to provide an accurate history of previous pelvic surgery, and cross-sectional imaging with computed tomography and magnetic resonance imaging can be inadequate for evaluating synthetic slings.
Single-stage Abdominoplasty Using Groin Flaps Without Osteotomies: Management of Exstrophy-epispadias Complex The optimal treatment for children born with exstrophy-epispadia complex is still a matter of debate.1,2,3 We demonstrate the Single-Stage Abdominoplasty using Groin Flap technique to close the abdominal wall of children with classic bladder exstrophy (CBE) without osteotomy neither radical soft tissue mobilization. Advantages over current techniques are less risk of penile tissue loss and avoidance of osteotomies.
The Prognostic Value of PIK3CA Copy Number Gain in Penile Cancer To determine whether phosphatidylinositol-4,5-bisphosphate 3- kinase, catalytic subunit alpha (PIK3CA) copy number gain in penile cancer has prognostic value and association with histopathological parameters, human papillomavirus (HPV), and clinical outcome.
Urine Xanthine Crystals in Tumor Lysis Syndrome Urine xanthine crystals are remarkably rare but can be observed by routine urine microscopy. We report the results of a 67-year-old man with T-cell-prolymphocytic leukemia whose urine contained xanthine crystals after chemotherapy and prophylactic administration of febuxostat. Accumulation of xanthine was due to tumor lysis syndrome causing a massive release of DNA. The metabolized DNA caused an increase of xanthine, which was not readily converted to uric acid by xanthine oxidase because of febuxostat inhibition of this enzyme.
A Bilateral Metachronous Mesothelioma of the Tunica Vaginalis This is a unique case of bilateral metachronous testicular mesothelioma of the tunica vaginalis. Testicular mesothelioma is a rare entity found in patients with or without asbestos occupational exposure. The tumor most commonly presents as a unilateral testicular mass. More rare presentations include bilateral synchronous or metachronous tumors. Treatment is with surgical resection and prognosis is not generally favorable. The benefits of adjuvant therapy with radiation or chemotherapy remain unknown and further studies are needed.
Holmium Laser Endoureterotomy With the Lovaco Technique for the Treatment of Ureterointestinal Stenosis: Tips and Tricks To describe holmium laser endoureterotomy with the Lovaco technique for the treatment of ureterointestinal stenosis. This common problem after cystectomy represents a surgical challenge, with endourological techniques being useful in this context. We present a technique that has been described before, but which we consider useful and decisive. The key points and difficult aspects of the technique are shown, along with our experience with it.
Localized Inflammatory Myofibroblastic Tumor Involving the Genitourinary System: Adolescent Case Series and Review We describe four adolescent cases of inflammatory myofibroblastic tumor involving the genitourinary system. Two patients with masses of the urinary bladder presented with gross hematuria. The third patient presented with left flank pain and a mass encasing the left ureter causing hydronephrosis. The fourth patient presented with a painless, growing palpable mass of the left hemiscrotum. Currently, no standards exist for the management of inflammatory myofibroblastic tumors. Herein, we discuss the work-up and treatment approaches taken in each case.
A Case of Fatal Clostridial Necrotizing Fasciitis After Radical Prostatectomy A 70-year-old Caucasian male with pT3aN1Mx G3+4 prostate cancer underwent an open radical retropubic prostatectomy with lymphadenectomy without surgical complications. He experienced a slightly prolonged postoperative hospitalization (3 days) secondary to a reaction to an anesthesia study drug (tachycardia and drowsiness) that resolved after discontinuation of said drug and was subsequently discharged. Two weeks later, he was brought to the emergency department after the sudden onset of an acutely severe right groin pain and swelling that began that afternoon.
Abdominal Radiography With Digital Tomosynthesis: An Alternative to Computed Tomography for Identification of Urinary Calculi? To compare the accuracy of plain abdominal radiography (kidneys, ureter, and bladder [KUB]) with digital tomosynthesis (DT) to noncontrast computed tomography (NCCT), the gold standard imaging modality for urinary stones. Due to radiation and cost concerns, KUB is often used for diagnosis and follow-up of nephrolithiasis. DT, a novel technique that produces high-quality radiographs with less radiation and/or cost than low-dose NCCT, has not been assessed in this situation.
National Trends in Active Surveillance for Prostate Cancer: Validation of Medicare Claims-based Algorithms To better describe the real-world use of active surveillance. Active surveillance is a preferred management option for low-risk prostate cancer, yet its use outside of high-volume institutions is poorly understood. We created multiple claims-based algorithms, validated them using a robust clinical registry, and applied them to Medicare claims to describe national utilization.
Assessing the Learning Curve of Holmium Laser Enucleation of Prostate (HoLEP). A systematic review We systematically assessed the learning curve of Holmium laser enucleation of the prostate using the available literature to identify, as our primary outcome, the average number of cases required to reach competency. A computerized search of PubMed and Scopus for articles published from inception through to January 2018 was performed including 24 studies with a total of 5173 patients. Even though different outcome measures require varying case-loads to reach a plateau, Holmium laser enucleation of prostate has an acceptable learning curve with a proposed figure approximating 25-50 cases, with a structured mentorship programme aiding for faster progress.
Whole Exome Sequencing of a Consanguineous Turkish Family Identifies a Mutation in GTF2H3 in Brothers With Spermatogenic Failure In this case report we describe our investigation into the genetic cause of infertility due to idiopathic nonobstructive azoospermia in a consanguineous Turkish family. We extracted DNA from blood and applied whole exome sequencing on 4 infertile brothers in this family diagnosed with oligo- and azoospermia. Standard bioinformatics analysis pipelines were run including alignment to the reference genome, variant calling, and quality control filtering. Potentially pathogenic variants were identified and prioritized using genetic variant annotation software and public variant frequency databases, followed by validation with Sanger sequencing.
Ureteroscopic Management of Large ≥ 2 cm Upper Tract Urothelial Carcinoma: A Comprehensive Twenty-three Year Experience To evaluate the effectiveness of ureteroscopy (URS) with laser ablation as an alternative treatment for UTUC lesions larger than 2 cm. Traditionally, patients with large upper tract urothelial carcinoma (UTUC) are treated with radical nephroureterectomy (RNU). However, in patients with pre-existing renal disease, a solitary kidney, or those who decline RNU, management of UTUC may prove challenging
A Review of the FAERS Data on 5-Alpha Reductase Inhibitors: Implications for Postfinasteride Syndrome To quantify reports made to the Food and Drug Administration Adverse Event Reporting System (FAERS), create a demographic of patient reports, and examine the cluster of symptoms to correlate consistency of postfinasteride syndrome (PFS) complaints. PFS is a provisional diagnosis encompassing a cluster of sexual, physical, and psychological and/or neurologic symptoms associated with 5-alpha reductase inhibitor use that emerge or continue after discontinuation of medication.
Lynch Syndrome-associated Upper Tract Urothelial Carcinoma A 63-year-old female with known history of Lynch syndrome (LS) with MSH2 gene deletion presented to the emergency department with left flank and epigastric pain worsening over 1 week. She had a 3-year history of intermittent gross hematuria, with no masses or hydronephrosis on non-contrast abdominal and pelvic computed tomography (CT) scan 2.5 years prior. Review of systems was otherwise negative. Patient reported previously negative evaluation with cystoscopy and repeat urinalysis for gross hematuria by outside urologist.
Adrenal Cyst in Pregnancy: A Surgical Emergency A 41-year-old pregnant woman at 22 weeks of gestation was evaluated for sudden and progressive abdominal distension and increasing pain. Pregnancy showed a normal evolution, routine obstetric ultrasound performed 3 days before, has resulted normal, and laboratory tests were within normal ranges. Obstetric evaluation was normal but abdominal ultrasound (US) showed a huge cyst surrounding the uterus (Fig.1). A magnetic resonance (MR) was performed and showed a retroperitoneal cyst of 23.12 cm × 18.64cm, filled with blood and clots (Fig.
Single-session Transvesical Laparoendoscopic 1-Port Removal of 2 Bladder Diverticula in a Female Patient Bladder diverticula are usually encountered in males, and they are a rarity in women, especially in the absence of obstruction. Open surgery, as well as laparoscopic or robotic, or single-port surgery have been applied successfully to remove bladder diverticula.1-3 To the best of our knowledge, no single-port diverticulectomies have been performed in women.
Reply by the Authors We appreciate the comments provided by the readers on our submitted article in which we evaluated the effects of intercostal nerve block and nephrostomy tract infiltration on postoperative pain control after tubeless percutaneous nephrolithotomy.1 Below are our responses to the issues which they raised.
Hemorrhagic Cystitis Associated With Gefitinib Treatment: A Case Report Gefitinib is an oral anticancer agent that inhibits the intracellular phosphorylation of numerous tyrosine kinases associated with transmembrane cell surface receptors and then blocks cancer progression.1 Its efficacy for advanced non-small-cell lung cancer (NSCLC) has been proved in randomized, double-blind, phase III trials.2,3 Common side effects of gefitinib include diarrhea, rash, acne, dry skin, nausea, hepatic dysfunction, and vomiting.1 We describe the rare case of a patient treated with gefitinib, who later presented with hemorrhagic cystitis as a drug-related side effect.
Cognitive Versus Software Fusion for MRI-targeted Biopsy: Experience Before and After Implementation of Fusion To compare the diagnostic performance of the 2 most common approaches of magnetic resonance imaging targeted biopsy (TB)—cognitive registration targeted biopsy (COG-TB) and software fusion targeted biopsy (FUS-TB)—we assessed our institutional experience with both methods. TB has emerged to complement systematic template biopsy (SB) in prostate cancer (PCa) diagnosis; however, which magnetic resonance imaging targeting methodology is diagnostically better remains unclear.
Polypoid Endometriosis Presenting as a Renal Cortical Tumor A 41-year-old female patient presented with left-sided flank pain and gross hematuria temporally unrelated to her menstrual cycle. Abdominal computed tomography scan showed a large left-sided solid, enhancing kidney mass radiographically consistent with renal cell carcinoma. Following surgical resection, histopathological examination revealed polypoid endometriosis. Polypoid endometriosis is rare and mimics a neoplasm clinically, radiographically, and on gross examination. Patients with polypoid endometriosis often present with symptoms related to mass effect rather than classic endometriosis hallmark symptoms such as dyspareunia, dysmenorrhea, and cyclic abdominal pain.
Osteomyelitis of the Pubic Symphysis After Transrectal Biopsies of the Prostate We report a rare complication of magnetic reasonance imaging targeted transrectal biopsy of the prostate. Patient developed severe pain in the right hip and groin area after which he was admitted to the hospital. There was an interval of 2 months between the onset of the symptoms and the diagnosis. Our report is the first to describe osteomyelitis of the pubic symphysis in combination with abscess formation in the surrounding soft tissues due to MRI-guided transrectal biopsy of the prostate.
The Urology Match and Post-Interview Communication To understand the frequency and nature of post-interview communication as it relates to the rules and regulations of the American Urological Association (AUA) Urology Residency Matching, as well as the impact of such communication on the outcomes of the match.
Oral Propranolol in a Child With Infantile Hemangioma of the Urethra Infantile hemangiomas (IH) are the most common in the head and neck region.1 They can occur anywhere in the skin, however, urethral hemangiomas are very rare. We describe a case report of a 3-year-old boy with extensive lesions of IH in the anterior urethra. Urethral IH were disappeared during 1 year of oral administration of propranolol though it brought on urinary retention. This is the first report about oral propranolol treatment in a child with urethral IH. Oral administration of propranolol may be effective for urethral IH and beneficial especially for lesions requiring extensive surgical resection and reconstruction.
Complications of Delivery Among Mothers with Spina Bifida : To determine rates and types of peripartum morbidity among delivering women with spina bifida (SB) compared to those without SB. The rates of pregnancy and delivery among women with SB have been significantly increasing. Current knowledge of peripartum outcomes for these women is limited.
Cowper's Gland Syringocele Cowper's gland syringoceles are rare cystic dilations of the Cowper's gland duct. They are typically diagnosed in childhood but occasionally occur in adults. We report the case of a 28-year-old man who presented with a painful perineal and inferior scrotal mass and was found to have a large Cowper's gland syringocele extending into the scrotum associated with a scrotal abscess. Treatment consisted of surgical excision. The magnetic resonance imaging findings of this case are described.
Robot-assisted Vesico-vaginal Fistula Repair: A Compilation Vesico-vaginal fistulae (VVF) are the most common type of urinary tract fistulae.1 These fistulae represent a complication that generally occurs after an iatrogenic injury during hysterectomy and lower segment cesarean section, obstructed labor, radiation necrosis, pelvic malignancies as well as other radical pelvic surgery.1 The incidence varies between 0.3% and 2%.2 Due to its iatrogenic nature, and symptomatology VVF is associated with considerable emotional and psychologic distress.1, 3 This may be expressed as anger, resentment, and disappointment on the part of the patient toward the treating physician.
Paradoxical Examination and Imaging Findings in a Case of Paratesticular Cutaneous Angioyxoma Angiomyxomas are rare soft tissue neoplasms rich in myxoid matrix and blood vessels that typically present as nodules on the trunk, head, and limbs in adults. They are classified as either cutaneous or aggressive based on histological findings and extent of local growth. There are less than 150 reported cases in the literature. In this case report we describe the first paratesticular case of a cutaneous angiomyxoma in a pediatric patient, who presented with a transilluminating paratesticular mass consistent with a hydrocele, but showed solid and vascular features on ultrasound.
Nephrolithiasis in a 17-Year-Old Male With Seckel Syndrome and Horseshoe Kidneys: Case Report and Review of the Literature We report the case of a 17-year-old male with Seckel syndrome and horseshoe kidneys which had a 7 mm kidney stone in the lower pole calyx of the right moiety. The patient had a history of rotoscoliosis with 60° dextroconvex curvature and hepatic steatosis. Attempted ureteroscopy was unsuccessful due to stone location and anatomy. Percutaneous nephrolithotomy was ultimately required. This case highlights the difficulties of endoscopic treatments of renal calculi in patients with abnormal renal anatomy and dysmorphia.
Aggressive Renal Angiomyolipoma in a Patient With Tuberous Sclerosis Resulting in Pulmonary Tumor Embolus and Pulmonary Infarction Renal angiomyolipoma (AML) is the most commonly encountered mesenchymal tumor of the kidney which can present spontaneously or in association with tuberous sclerosis complex. Rarely, renal AMLs may demonstrate aggressive features such as renal vein invasion. This common entity and its uncommon complications are diagnosed based on physical examination and computed tomography results. Here we report imaging findings of a renal AML with renal vein and inferior vena cava invasion resulting in pulmonary tumor embolus and pulmonary infarction.
Wilms Tumor After Orthotopic Liver Transplant in a Patient With Alagille Syndrome We present a case of Wilms Tumor in a patient with Alagille syndrome 10 months after liver transplant. We explore a suggested genetic connection between these 2 diseases. In children with Wilms Tumor, we propose a pathoembryologic explanation for not just the tumor, but also for the cause of associated benign ureteral and renal parenchymal aberrancies that are commonly seen in the Alagille population. We also discuss the diagnostic and therapeutic challenges that can arise in a liver transplant patient with Alagille syndrome who subsequently develops a renal mass.
Renal Pelvic Hemangioma in a 3-Year-Old Boy: A Rare Pediatric Case Report Renal pelvic hemangioma is a rare benign tumor that is difficult to diagnose preoperatively. In the past, there are rarely reported cases in children. Here, a case of left renal pelvic hemangioma in a 3-year-old boy managed by nephrectomy is reported.
Growing Teratoma Syndrome of Testicular Origin A 20-year-old Hispanic male semi-professional soccer player with no prior medial history presented to the emergency department with one month of abdominal distension, and four days of left lower extremity swelling. During initial interview, the patient offered that his testicle had been enlarged for approximately 4-6 years, without any workup or intervention. A firm non-tender abdomen, enlarged left hemi-scrotum, and left lower extremity swelling was noted on physical examination. A left supraclavicular lymph node was also palpable.
Extra-adrenal Pheochromocytoma Associated With Segmental Renal Artery Compression and Pseudostenosis Classically, pheochromocytomas and paragangliomas result in hypertension secondary to an excess release of catecholamines. However, when the tumor arises near the renal hilum, hypertension may also be secondary to renal artery stenosis, which can occur via several purported mechanisms. We describe an unusual case of a hereditary, extra-adrenal pheochromocytoma causing right lower pole renal artery pseudostenosis, pertinent radiologic signs, relevant surgical findings, and subsequent resolution after extirpative surgery.
Bladder Agenesis and Associated Pelvic Arterial Anomaly in Two Female Pediatric Patients Bladder agenesis is an extremely rare congenital anomaly of the genitourinary tract. Two female patients with known diagnoses of bladder agenesis presented for pre-renal transplant evaluation and neobladder creation. Similar unique pelvic arterial malformations were identified through pre-operative imaging and intraoperative examination. With these similar findings, it could be proposed that such anatomical variants are products of the same insult or involve a causal relationship, with vascular aberrancies potentially provoking pelvic organ maldevelopment.
The Application of Suctioning Flexible Ureteroscopy with Intelligent Pressure-Control in Treating Upper Urinary Tract Calculi on Patients with a Solitary Kidney The position of the end of the ureteral sheath during surgery should be determined based on the location of the stone and the range of flexible motion of the ureteroscope at the time of lithotripsy. In lithotripsy for ureteral calculus, the sheath should be as close as possible to be beneath the ureteral calculus; in lithotripsy for kidney stones, the front end of the sheath should be as close as possible to the outlet of the renal pelvis but should not limit the moving activity of the bendable part of the flexible ureteroscope.
Retrograde Ureteral Catheterization: A Possible New Treatment for Renal Fungal Balls in Very Low Birth Weight Infants Invasive candidiasis is a serious pathogen of late-onset sepsis in very low birth weight infants. Kidney is the most common organ involved, and it causes morbidity and mortality, especially when fungal balls are formed. We report a 34-day-old female infant (born at 28 weeks' gestation, 1152 g) with systemic fungal infection complicated obstructive uropathy. On sonography, the fungal balls filled the entire pelvis without hydronephrosis. Percutaneous nephrostomy was not feasible. In addition to systemic antifungals, we successfully performed cystoscopy-assisted retrograde ureteral catheterization to decompress the pelvis, which also provided a route for local amphotericin B irrigation to achieve therapeutic concentration without nephrotoxicity.
Photoselective Vaporisation of the Bladder for the Management of Radiation Cystitis – Technique and Initial Outcomes. ObjectiveTo describe our technique utilising photoselective vaporisation of the bladder (PVB) for the management of haemorrhagic cystitis and initial results of 12 patients.Materials and MethodAn audit of theatre records of a single surgeon was performed to identify patients who had undergone PVB for management of radiation-cystitis. Technique: Rigid cystoscopy was performed. Ureteric catheters were placed and active bleeding sites targeted to optimise vision. Ablation was commenced using the vaporize function.
The Role of Imaging in Prostate Cancer Care Pathway: Novel Approaches to Urologic Management Challenges Along 10 Imaging Touch Points We map out a typical prostate cancer care pathway through discussion of updates on modern imaging. Multiparametric magnetic resonance imaging is the most sensitive and specific imaging tool for diagnosis and local staging, but transrectal ultrasound remains the most widely used technique for prostate biopsy guidance. Computed tomography and bone scan are useful in initial staging and recurrence detection. Novel imaging techniques in ultrasound elastography and multiparametric magnetic resonance imaging allow for increased lesion detection sensitivity and have the potential to enhance biopsy, while the development of new positron emission tomography radiotracers has great promise for improved detection of local and metastatic disease in patients with biochemical recurrence.
Case Report: Nephron-sparing Surgery in a Patient With Bilateral Multifocal Wilms Tumor We present a case of bilateral multifocal Wilms tumor in a nonsyndromic 12-month-old male. Our management approach included 12 weeks of preoperative chemotherapy for maximal tumor shrinkage and, despite the central location of the tumors, successful staged bilateral nephron-sparing surgery. We advocate for a broader application of nephron-sparing surgery in Wilms tumor cases with the goal of preserving renal function without compromising oncologic outcomes.
Efficacy and Safety of Ureteroscopy for Stone Disease in a Solitary Kidney: Findings From a Systematic Review Management of stone disease in solitary kidney remains a difficult treatment entity for the urologist. The challenge exists to deliver high clearance while maintaining strong safety profile. Twelve eligible studies were included, comprising a total of 693 patients with a male:female ratio of 2:1. Overall, 114 (16.4%) complications were reported. No fatalities were reported in any of the studies. Clavien III complications were recorded in less than 0.5% of the patients. This review confirms the effectiveness, safety, and reliability of this technique for this unique cohort of patients.
Pediatric Robotic Prostatectomy and Pelvic Lymphadenectomy for Embryonal Rhabdomyosarcoma We present the first published case of a pediatric robot-assisted prostatectomy and pelvic lymphadenectomy for refractory prostatic embryonal rhabdomyosarcoma. The patient is a 7-year-old male who had been treated with 3 cycles of chemotherapy and radiation, who underwent prostatectomy and lymphadenectomy for a recurrent mass. Surgery was uncomplicated and yielded negative surgical margins. We highlight the surgical technique and feasibility of utilizing robotic surgery for pediatric prostatectomy.
What Is the Role of α-Blockers for Medical Expulsive Therapy? Results From a Meta-analysis of 60 Randomized Trials and Over 9500 Patients Use of α-blockers for medical expulsive therapy (MET) has been the subject of huge debate in urology. Moreover, there have been a number of randomized controlled trials with differing results. We conducted a systematic review and meta-analysis of randomized controlled trials investigating the efficacy of α-blockers for MET. This review confirms there is a role for α-blockers in MET for ureteric stones specifically in stones >5 mm and distal ureteric stones, which is associated with improved stone expulsion.
Successful Conservative Management of Bilateral Renal Mucormycosis Our patient is a 56-year-old man with medical history of poorly controlled insulin-dependent diabetes, bipolar disorder, and polysubstance abuse. Before presentation at our institution, he had been evaluated at several regional hospitals over the course of the preceding month. His symptoms were recurrent flank pain, fevers, and passage of long filamentous grey strings of material in his urine, which he described as “sea snakes.” Despite several negative urine cultures, he had been diagnosed with presumed pyelonephritis and treated with multiple courses of antibiotics including ceftriaxone, cephalexin, metronidazole, piperacillin-tazobactam, and ciprofloxacin, without any clinical improvement.
A Rare Case of Pediatric Vaginal Yolk Sac Tumor A 14-month-old girl was evaluated for intermittent vaginal bleeding. Vaginoscopy revealed a friable tumor, and biopsy results confirmed a yolk sac tumor. Alpha-fetoprotein was elevated (1386 ng/mL) at diagnosis but quickly normalized with chemotherapy. The patient remained tumor-free 12 months after diagnosis without the need for radical surgery. Although rare, malignant tumors of the vagina must be included in the differential diagnosis of prepubertal girls who present with vaginal bleeding. Primary yolk sac tumor of the vagina is seen in girls less than 3 years of age and is treated with chemotherapy with or without surgical excision.
Metastatic Pheochromocytoma in an Asymptomatic 12-Year-Old With von Hippel-Lindau Disease Pheochromocytoma is a rare chromaffin cell tumor that may be associated with a genetic predisposition, such as von Hippel-Lindau (VHL) disease. VHL is an autosomal dominant disorder that is characterized by a predisposition to multiple tumors, including retinal and central nervous system hemangioblastomas, renal cell carcinoma, and pheochromocytomas. The classic presentation of pheochromocytoma is episodic hypertension, headaches, palpitations, and diaphoresis. In the pediatric population, 40% of pheochromocytomas have a hereditary basis.
A Homeopathic Alternative to Potassium Citrate in Patients With Recurrent Nephrolithiasis The patient is a 55-year-old man with a history of Crohn's disease requiring multiple small bowel resections and a history of uric acid stones. He developed bilateral staghorn calculi and underwent numerous interventions including 3 left percutaneous nephrolithotomies (PCNLs), 2 right PCNLs, and multiple ureteroscopies with holmium laser lithotripsy (URS-HLL). His most recent procedure performed at our institution was a right PCNL in 2013.
Spermatic Vein Thrombosis A 36-year-old man was transferred from a freestanding emergency department to a nearby tertiary referral center for evaluation of an acute scrotum. He initially experienced midline back and right-sided flank pain in the preceding 24 hours while performing housework, but presented to the outside facility with acute-onset right-sided inguinal and scrotal pain that woke him from sleep. This pain was associated with right hemiscrotum swelling, self-limited gross hematuria, and passage of a small blood clot per urethra.
Impact of Statin Intake on Kidney Stone Formation To determine whether statin intake affects nephrolithiasis risk, and whether higher lipid levels correlate with stone risk. Dyslipidemia is a known independent risk factor for urolithiasis, and emerging evidence suggests common biological pathways. Previous work has suggested that statins protect against new stone formation, but these findings have not been verified by other investigators.
Dual Pathology Causing Congenital Bladder Outlet Obstruction Anterior urethral syringocele is an uncommon congenital deformity characterised by cystic dilatation of bulbo-urethral gland ducts and is usually asymptomatic. We present a case on 4-day-old male neonate who presented with bilateral antenatal hydroureteronephrosis and renal impairment and found to have urethral syringocele and posterior urethral valves (PUV).
Author Reply The comments of the editor truly reflect the findings of our study on the surgical treatment of giant penoscrotal lymphedema. All the 19 patients described in the study were to be treated by surgery. Eight patients, however, defaulted, possibly because of their belief in alternative traditional herbal medicine and or financial constraint, because health insurance schemes are yet to be fully established in our environment.
TEMPORARY REMOVAL: New Approach to Guide Target Prostate Biopsy: Technique and Initial Experience The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
WITHDRAWN: Stented or Unstented Distal Hypospadias Repair The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2017.04.057. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
WITHDRAWN: Editorial Comment on “Abnormal Expression of Sg I is Closely Related to Seminal Vesiculitis” The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2015.08.052. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
WITHDRAWN: Reply The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2015.08.053. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
WITHDRAWN: Editorial Comment The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.urology.2013.02.086.The duplicate article has therefore been withdrawn.
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