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   Table of Contents - Current issue
Coverpage
October-December 2022
Volume 33 | Issue 4
Page Nos. 159-214

Online since Thursday, December 1, 2022

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EDITORIAL  

Editorial p. 159
Yao-Chi Chuang
DOI:10.4103/UROS.UROS_102_22  
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REVIEW ARTICLE Top

The cancer behavior and current treatment strategy for upper urinary tract cancer p. 161
Hao-Lun Luo, Tzu-Shuang Chen, Wen-Jeng Wu
DOI:10.4103/UROS.UROS_58_22  
Upper urinary tract urothelial carcinomas (UTUCs) are rare diseases, accounting for only 5%–10% of all urothelial cancers. Radical nephroureterectomy (RNU) with bladder cuff excision remains the standard care modality of UTUCs. However, the prognosis is poor and the recurrence is high in patients with advanced UTUC treated with RNU currently. Therefore, identifying cancer behavior for UTUC is an important guide for clinical practice. Herein, we provide an overview of cancer behavior of UTUCs, including prognostic factors and clinical cancer courses. We also discuss the appropriate management of patients with UTUC, such as diagnosis, surgical management, and systemic therapies. Due to the rarity of UTUC, strong evidence of management is often lacking. Therefore, further prospective trials are needed, and regular follow-up after interventions is mandatory.
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ORIGINAL ARTICLES Top

Efficacy and safety of Pulsed Electromagnetic Field (PEMF) stimulation in the treatment of urinary symptoms in women with urinary incontinence p. 170
Ali Hamidi Madani, Fatemeh Mohammadalizadeh Chafjiri, Samaneh Esmaeili, Zahra Hamidi Madani, Ehsan Kazemnejad Leili
DOI:10.4103/UROS.UROS_123_21  
Purpose: There are different approaches to the treatment of urinary incontinence (UI), including pharmacological, nonpharmacological, and surgical methods. Pulsed electromagnetic field (PEMF) stimulation is a nontraditional and noninvasive type of treatment, which is gaining increasing popularity in healthcare departments for UI treatment. Materials and Methods: In this quasi-experimental study, women (age ≥21 years) with lower urinary tract symptoms (LUTS) were assigned to three groups regarding the UI type (urgency, stress, and mixed UI). The Bristol Female LUTS (BFLUTS) questionnaire was used to evaluate the UI severity. The patients were treated with PEMF stimulation twice per week up to 6 weeks. The results were evaluated at three and 6 months posttreatment. Results: Ninety women completed 6 months of follow-up in this study. The mean age of the participants was 58.5 ± 13.9 years. Of 90 patients, 61 (67.8%) had mixed UI, 22 (24.4%) had urge UI, and 7 (7.8%) had stress UI. There were significant differences between the groups regarding the frequency of leakage from baseline to 3 and 6 months after treatment; the reduction of leakage severity was only nonsignificant in the stress UI group (P = 0.368). Based on the results, the number of used pads reduced from 4.18 ± 3.00 to 1.08 ± 2.03 (P < 0.001); this reduction was also significant in each of the groups. The mean BFLUTS score reduced from 7.42 ± 2.53 at baseline to 5.56 ± 2.37 and 3.00 ± 2.33 at 3 and 6 months after treatment, respectively (P < 0.001). No significant complications were detected in the groups. Conclusion: The PEMF stimulation is a safe and effective approach for reducing the symptoms of patients with UI. The best response to treatment was reported at 6 months posttreatment. Therefore, it is recommended to use PMEF stimulation as a noninvasive treatment along with routine therapies.
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Using a rat model to translate and explore the pathogenesis of ketamine-induced cystitis p. 176
Ying-Che Huang, Wei-Chia Lee, Yao-Chi Chuang, Cheng-Nan Tsai, Chun-Chieh Yu, Hung-Jen Wang, Chia-Hao Su
DOI:10.4103/UROS.UROS_128_21  
Purpose: Ketamine abusers may develop severe ulcerative cystitis along with irritative bladder symptoms. A reliable animal model may benefit the understanding of pathophysiologies and the development of therapeutic strategies for ketamine-induced cystitis (KIC). We used a popular rat model of KIC to validate the micturition behavior, functional brain images, and possible molecular mechanisms of this model. Materials and Methods: Female Sprague–Dawley rats were distributed to control (saline) and ketamine-treated rats (25 mg/kg/day for 28 days). Functional magnetic resonance imaging (fMRI), metabolic cage study, and cystometry were evaluated. Potential bladder transcripts involved in KIC were screened by using next-generation sequencing. Results: In contrast to the control, the ketamine-treated rats developed bladder overactivity accompanied by enhanced fMRI signals in periaqueduct and caudal putamen areas. Alterations in bladder transcripts, including eleven genes involving in regulating NF-κB signaling of bladder inflammation, and Crhr2 gene overexpression associating with vascular endothelial growth factor signaling of bladder ischemia were found in ketamine-treated rats. Both categories could be attributed to neurogenic inflammation induced by the direct toxicity of urinary ketamine and its metabolites. Conclusion: Our study results suggest this animal model could mimic irritative bladder symptoms associated with central sensitization in KIC. Through the bladder transcripts analysis, we highlight the neurogenic inflammation underlying the pathophysiologies of KIC in rats.
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Impact of COVID-19 pandemic on urological service: Experience at a Taiwanese tertiary center p. 182
Chang-Ho Chiang, Wei-Jen Chen, I-Shen Huang, Eric Yi-Hsiu Huang, Hsiao-Jen Chung, William J Huang
DOI:10.4103/UROS.UROS_119_21  
Purpose: The Taiwan Central Epidemic Command Center raised the coronavirus disease 2019 (COVID-19) pandemic alert to level 3 throughout the nation since May 19, 2021, and asked hospitals to reduce patient intake. Surgical departments were the worst affected. The aim of this study is to share experiences of urological practice adjustment in a tertiary medical center during the pandemic and to evaluate the impact of the COVID-19 pandemic on the urological service in Taiwan under a level 3 epidemic alert. Materials and Methods: This observational study was conducted from June 1, 2021, to June 31, 2021, when a level 3 pandemic alert was declared. Data of patients visiting the urology department at the Taipei Veterans General Hospital were recorded and compared with data 1 year before the COVID-19 outbreak in Taiwan (June 1, 2020, to June 31, 2020). Data included outpatient visits, elective surgeries, emergent surgeries, functional urological examinations, and diagnostic procedures in outpatient settings. Results: There was no significant decrease in all types of uro-oncological surgeries, except bladder urothelial carcinoma (UCB)-related procedures. The total number of UCB-related procedures showed 66.67% reduction. Stone-related surgeries were reduced by 45.7%. Only 12% of all transurethral prostate resections were performed in the pandemic. There was a significant decrease in all types of functional urology and andrology procedures. More than 30% reduction was noted in the number of patients visiting the urology department in June 2021 compared to that in June 2020. Conclusion: Our data provide a reference of how the urological service was affected during the level 3 pandemic alert in Taiwan. We postponed most elective surgeries and outpatient visits or diagnostic outpatient examinations procedures according to prioritization guidelines. Uro-oncology-related service was less affected because oncology patients have a stronger motivation for treatment. Benign urological condition-related procedures were significantly influenced. After the epidemic slowdown, the backlog should be gradually managed based on priority.
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Post hysterectomy vesicovaginal fistula repair without vaginal vault closure - A simple laparoscopic extravesical repair approach p. 187
Samir Swain, Suresh Kumar Rulaniya, Vishal Kumar Neniwal, Praveen Kumar Yadav, Piyush Agarwal, Shweta Bhalothia, Kishor Maroti Tonge, Zaid Ahmad Khan
DOI:10.4103/UROS.UROS_17_22  
Purpose: The purpose of this study is to describe a simple extravesical laparoscopic approach for supratrigonal vesicovaginal fistula (VVF) repair without cystotomy and closer of the vaginal vault. Materials and Methods: This retrospective observational study reviewed data of 36 patients from January 2015 to January 2020. In our technique, the fistula tract was identified without cystotomy with the help of preplaced ureteric catheter in VVF tract. After meticulous extravesical dissection of the fistula tract, the bladder wall was closed in a single layer using polyglactin 2.0 sutures. The omental flap was approximated over the vaginal vault without primary closer of the vault. Results: In most of the patients the fistula opening were located 2 cm away from ureteric orifice while in 4 patients it located within 2 cm of orifice. The mean operative time was 86 min (65–125) and estimated blood loss was 94 ml (40–130). The mean size of fistula was 7.1 mm (5–15 mm). Omental flap was approximate over vaginal opening in most of the patients. The average hospital stay of patients was 5 days. In all patients, Foley catheter was removed on day 14 after cystogram. The mean follow-up of patients was 4.2 months (3–7). All patients remained continent and symptom free during the follow-up periods. Conclusion: Our technique without suturing of the vaginal vault in laparoscopic VVF repair is safe in a simple supratrigonal fistula with good results and avoiding added suturing.
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Complications of robotic-assisted laparoscopic radical prostatectomy: Experience Sharing from 2000 cases involving a single surgeon p. 192
Chin-Heng Lu, Yen-Chuan Ou, Yi-Sheng Lin, Li-Hua Huang, Wei-Chun Weng, Chao-Yu Hsu, Min-Che Tung
DOI:10.4103/UROS.UROS_173_20  
Purpose: Sharing experiences of complications with robotic-assisted laparoscopic radical prostatectomy (RALP) in 2000 patients treated by a single surgeon. Materials and Methods: We retrospectively reviewed 2,000 prostate cancer patients who underwent RALP (Group I, cases 1–1,000; Group II, cases 1001–2000) from December 2005 to September 2020 to compare the complications of the first 1000 patients with those of the latter 1000. All procedures were performed by the same experienced surgeon. Perioperative surgical complications were classified using the Clavien–Dindo classification. Complications were classified as minor (Clavien–Dindo Grades I–II) and major (Clavien–Dindo Grades III–IV), respectively. There was no Grade V complication. Results: Seventy-two cases developed complications in Group I: 26 with Clavien–Dindo Grade I, 29 with Grade II, 12 with Grade III, and 4 with Grade IV. The cases that developed complications in Group II, however, were lower at 48 cases: 15 with Clavien–Dindo Grade I, 17 with Grade II, 15 with Grade III, and 1 with Grade IV. Cases with minor Clavien–Dindo Grade (I–II) complications decreased significantly from Group I to Group II, at 55–32 patients (P = 0.0416). The transfusion rate was 1.1% in Group I, which was significantly higher than that in Group II at 0.1% (P = 0.0151). Conclusion: The assessment of the two groups indicated that the surgeon's learning curve for RALP improved with significantly fewer minor Clavien–Dindo Grade (I–II) group complications after 1000 surgeries.
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Comparing concentration of urinary inflammatory cytokines in interstitial cystitis, overactive bladder, urinary tract infection, and bladder cancer p. 199
Michael B Chancellor, Laura E Lamb, Elijah P Ward, Sarah N Bartolone, Alexander Carabulea, Prasun Sharma, Joseph Janicki, Christopher Smith, Melissa Laudano, Nitya Abraham, Bernadette M M. Zwaans
DOI:10.4103/UROS.UROS_26_22  
Purpose: We sought to determine if urinary cytokine concentration profiles were different between various bladder conditions. Materials and Methods: Participants at three clinical sites completed a demographics survey and provided a urine sample in a collection cup containing a room-temperature urine preservative. Participants were divided into the following categories based on physician-documented diagnosis: asymptomatic control, nonulcerative interstitial cystitis (IC), overactive bladder with incontinence (OAB wet), urinary tract infection (UTI), and bladder cancer. Urinary cytokines were measured through Luminex multiplex assay. Results: Two hundred and seventy-seven urine samples were collected from three clinical sites. Urinary pro-inflammatory cytokines had an increasing trend in bladder disease versus control, with a significant increase for chemokine (C-X-C) ligand 1 growth-regulated protein alpha CXCL1 (GRO). Further analyses demonstrated that patients with UTI had significantly higher levels of GRO and interleukin-8 (IL-8) in comparison to control, nonulcerative IC, OAB wet, and bladder cancer. Both are chemokines that stimulate chemotaxis resulting in the rapid accumulation of immune cells such as neutrophils. IL-6 levels overall were at the lower limit of assay range but were significantly increased in urine of UTI patients versus IC patients. MCP-1 (CCL2) had the least separation among the control group and the various bladder diseases. Conclusion: Urinary concentrations of GRO were higher in disease state compared to control. Specifically, levels of GRO and IL-8 were higher in urine samples from patients with UTI compared to controls and other bladder conditions. Comparing and contrasting urinary cytokines may help improve our understanding of these important bladder diseases with great unmet needs.
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The effect of intraurethrally applied anatolian propolis extract on urethral healing in a rat model p. 205
Reha Girgin, Emine Yilmaz Can, Gökhan Çeker, Esin Kaymaz, önder Çinar, Necmettin Aydin Mungan
DOI:10.4103/UROS.UROS_158_21  
Purpose: Urethral stricture may cause irreversible results, as it prevents normal voiding. Although various endoscopic and open surgical options are available, the results are not always satisfactory so the main purpose is to prevent the formation of urethral scar. Our purpose was to examine the effects of intraurethrally administered Anatolian propolis on healing after an experimental urethral injury. Materials and Methods: A total of 40 Wistar male rats were used. Rats were divided into five equal groups: healthy control (Group 1), urethral damage/pathology (Group 2), solvent control (Group 3), 1-week propolis treatment (Group 4) and 3-week propolis treatment (Group 5). Urethral damage was performed with a 29G needle. Intraurethral, 50% ethanol, was administered in the solvent control group and 30% propolis was administered intraurethrally to the rats in Groups 3 and 4. Penile tissues were taken under deep anesthesia and examined under a light microscope. Results: Irregularities and luminal narrowing in the urethral epithelium and connective tissue were found in Group 2, except for one rat. Similarly, hyperemia-bleeding was observed in all rats except for one rat. Irregularities and hyperemia in the urethral epithelium and connective tissue were found in Group 3, except for two rats. Total improvement was observed in one rat, and more than 50% of fibrosis was observed in four rats in Groups 2 and 3. In Group 4, irregularity was observed in the urethral epithelium in four rats, while no inflammation was found in five rats. All of the rats had <50% fibrosis. In Group 5, six rats had complete recovery and <30% fibrosis. Conclusion: Anatolian propolis applied into the urethra seems to accelerate recovery after urethral trauma and reduces the formation of fibrosis.
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LETTER TO THE EDITOR Top

Long COVID: Information for urology health-care professionals p. 213
Zohreh Jadali
DOI:10.4103/UROS.UROS_39_22  
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