INTRODUCTION: A patient with a nonpalpable testis (NPT) is a diagnostic challenge. Use of ultrasonography (US) for the diagnosis of NPT is controversial. The purpose of the present study was to compare US with surgical findings.

METHODS: Between January 2000 and January 2007, 65 patients with a diagnosis of undescended testis (UDT) were evaluated. The 65 patients had 77 UDT. The patients had a physical examination that was followed by US and then surgery. All patients had a second physical examination in the operating room while under anesthesia

RESULTS: US localized 57 (74%) nonpalpable testes. Of these, 50 were in the inguinal region and 7 were in the abdomen. The sensitivity of US was 100% for the inguinal canal and 39% for intraabdominal viable testes.Enter text

CONCLUSION: All patients with presumed nonpalpable, undescended testes should be referred to a urologist for physical examination before receiving US. The authors recommend US as a first instrumental test for all patients with NPT. When US is negative, they advise laparoscopy.

KEYWORDS: Undescended testes; Ultrasonography; Cryptorchidism; Operative Finding

CORRESPONDENCE: Dr. Ahmed Al-ahnoumi, PO Box 16913, Sana’a Yemen ( This email address is being protected from spambots. You need JavaScript enabled to view it. ).

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INTRODUCTION: The transobturator approach was first described by Delorme in 2001. It has become the preferred approach for suburethral sling placement in many centers due to its efficacy and low morbidity. Nevertheless, complications have been associated with it.

METHODS: The authors describe management of a female subject with intractable groin pain after the insertion of an artisanal transobturator sling. The right side of the sling was removed.

RESULTS: The patient described significant but incomplete pain improvement at the time of hospital discharge. After one week, she had no pain but moderate stress urinary incontinence recurred.

CONCLUSION: The present case illustrates that a partial removal is not indicated for complete treatment. Time-related intractable groin pain may completely subside after sling tape removal. However, possible recurrence of urinary incontinence following intervention must be reinforced during patient counseling.

KEYWORDS: Synthetic slings; Transobturator; Groin pain

CORRESPONDENCE: Paulo Palma, MD, PhD, Division of Urology, Department of Surgery, Rua Jose Pugliesi Filho 265, Campinas, Sao Paulo, Brazil 13085-415 ( This email address is being protected from spambots. You need JavaScript enabled to view it. )

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Despite its long-standing history, surgical treatment of female stress urinary incontinence is still a developing medical field. Better understanding of its physiopathology has allowed the creation of novel approaches. Slings have become the mainstay of treatment. The authors provide a brief overview of the development and progress of sling techniques throughout the years.

KEYWORDS: Urinary stress incontinence; Sling; Transobturator tape; Synthetic slings; Mini slings

CORRESPONDENCE: Ricardo Miyaoka, M.D., State University of Campinas, Department of Urology, Rua Durval Cardoso, 172, Campinas, Sao Paulo, 13100-213, Brazil. Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

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INTRODUCTION: The aim of the investigation was to identify the diagnostic importance of peripheral zone sonographic findings in correlation with total prostatic specific antigen (tPSA) and pathological findings.

METHODS: Between January 2005 and January 2007, the transrectal biopsy records of 407 patients were reviewed for different prostatic indications. Echogenicity, calcific, and cystic changes of the peripheral zone were correlated with tPSA, total volume of the gland, digital rectal exam (DRE), and pathological findings.

RESULTS: The patients were divided into 3 groups (A, B, and C) according to tPSA: <4 ng="" ml="" n="159)," 4-10="" and="">10 ng/mL (n = 229), respectively. Heterogenicity was detected in 59.9% of cases and was higher when tPSA increased. Heterogenicity was found in the malignant biopsies of 78.7% of the patients (sensitivity = 78.78%; specificity = 44.6%). Calcific changes were found in 52% (n = 90) of group C (P < .05). Calcification was demonstrated in 41.4% (n=41) of malignant findings, but group comparisons were not statistically significant (sensitivity = 41.4%; specificity = 55.5%). Cystic changes were detected in 7.1% (n = 7) of malignant findings, but group comparisons were not statistically significant (sensitivity = 7.1%; specificity = 9.1%). However, 10.3% (n = 23) of patients with cystic peripheral zonal changes had high but not statistically significant PSA.

CONCLUSION: Heterogenicity of the peripheral zone is correlated with malignant pathology (positive predictor value = 31.9%) and high tPSA. Whenever a peripheral zone calcific change in prostatic sonography occurs, the urologist should suspect an increase of tPSA but without characteristic indicator of malignant anticipations (positive predictor value = 23.03%). Cystic changes in the peripheral zone are not specific findings and do not reflect any changes in tPSA or prostatic pathology.

KEYWORDS: Transrectal ultrasound; Echogenicity; Prostate calcification; Prostate cystic changes.

CORRESPONDENCE: El-Housseiny Ismail Ibrahiem (El- Zalouey) MD, Urology Department, Urology and Nephrology Center, Mansoura, Egypt. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

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INTRODUCTION: The purpose of the present investigation was to demonstrate the authors’ preliminary experience with the use of small intestine submucosa (SIS) as a suburethral sling in the treatment of stress urinary incontinence (SUI) in females.

METHODS: The participants were a carefully selected cohort of 17 women (mean age = 55 years; range, 44–63 years) with SUI based on clinical and urodynamic evidence. Patients with mixed incontinence, prior anti-incontinence, or transvaginal surgery were excluded. The SIS sling was placed as a midurethral sling via a transvaginal retropubic approach. Patients were followed up at 1 week and 3, 6, and 12 months after the procedure. Urodynamic evaluation was repeated at the last postoperative visit.

RESULTS: No adverse inflammatory reactions to the implanted sling or evidence of sling erosion or extrusion were noted in any patients throughout the follow-up period. No major complications were reported; however, minor complications were reported in 3 patients (17.6%). One year after the procedure, 14 patients (82.3%) were completely dry and 2 patients reported occasional episodes of leakage on more than usual daily exercise. The procedure failed to cure SUI in 1 patient, and 1 patient had persistent de novo urinary urgency requiring anticholinergic medication.

CONCLUSION: The preliminary results strongly support the feasibility of the use of SIS as a suburethral sling for treatment of SUI. However, long-term follow up is needed to confirm the durability of these encouraging initial observations.

KEYWORDS: Stress urinary incontinence; Suburethral slings; Small intestine submucosa (SIS).

CORRESPONDENCE: Yasser Farahat, Ph.D., Urology Department, Faculty of Medicine, Tanta University, 11 Ebn Elaas Str., Tanta, Ghr 31111, Egypt. Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

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INTRODUCTION: A kidney stone is a common urologic complaint. The association between hypercalciuria and bone mineral density (BMD) is well known. However, BMD reduction is also recognized among normocalciuric patients.

OBJECTIVE: Bone density in patients with stones was analyzed for the variables of age, sex, and stone configuration. Data were compared with a control group.

METHODS: Participants were 340 randomly chosen patients with upper urinary calcium stones. The control group included 340 healthy participants who were age and sex matched with the patient group. The quantitative variables included age, body mass index, T-score of bone densitometry in the lumbar vertebrae (L2-L4) and femoral neck, and the serum levels of uric acid, calcium, potassium, sodium, phosphor, alkaline phosphatase and parathyroid hormone. Furthermore, each patient’s 24-hour urine was studied for levels of creatinine, oxalate citrate, uric acid calcium, urea, and total volume.

RESULTS: The mean age of the patients was 43.22 years (SD =12.62); mean body mass index (BMI) was 27.44 kg/m2 (SD = 6.16). Lumbar vertebral bone densitometry bone mineral density (BMD) was normal in 144 patients (42.4%) and low normal in an additional 20 patients. One hundred forty patients (41.2%) had osteopenia and 56 (16.5%) were osteoporetic. Femoral neck BMD was normal in 188 patients (55.3%) and low normal in 28 patients. In comparison with the control group, lumbar and femoral BMD were significantly lower in patients with renal stones (P < .05). There were no significant differences among groups in quantitative variables, with the exception of serum uric acid level. There was a significant correlation between both lumbar T-score and femoral neck T-score with 24 hour urine uric acid. Lumbar T-scores increased in inverse relationship with age (P = .03).

CONCLUSION: The authors established that patients who form renal stones have a reduction in bone density. There was no significant difference in bone loss between hypercalciuric and normocalciuric patients, which indicates the existence of some interfering factors other than increased calcium loss. A low-calcium diet does not decrease stone formation, and it also leads to calcium imbalance and bone loss. Considering that the role of hypercalciuria in bone loss was not proven in this study and considering that a low-calcium diet has no proven role in renal stone prevention, the authors do not suggest low-calcium diets for renal stone formers.

KEYWORDS: Bone mineral density; Urolithiasis; Low-calcium diet; Hypercalciuria

CORRESPONDENCE: Dr. Mahmood Molaei, Department of Urology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran ( This email address is being protected from spambots. You need JavaScript enabled to view it. )

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INTRODUCTION: The purpose of the present study was to determine whether sitting or standing positions had an effect on voiding in patients with bladder outflow obstruction due to benign prostatic hyperplasia.

METHODS: The authors studied 100 male patients over the age of 45 years with benign prostatic hyperplasia. All underwent uroflowmetry and prevoiding and postvoiding estimation of the residual urine in standing and sitting positions. Patient group 1 had uroflowmetry maximum flow rate (Qmax) ≤ 10 mL/sec.; Group 2 had Qmax 10-15 mL/s. All parameters of uroflowmetry (eg, Qmax, average flow rate, time to maximum flow, and postvoiding residual) were compared for both groups in both positions.

RESULTS: Comparison of all parameters of uroflowmetry and postvoiding residual showed statistically significant differences in favor of sitting more than standing. This result was found for all patients and all variables except one: there was no statistically significant difference in the time to maximum flow in sitting and standing positions for patients in group 2.

CONCLUSION: Voiding in the sitting position in patients with benign prostatic hyperplasia is preferred due to a decrease in obstructive parameters shown by uroflowmetry and postvoiding residual urine volume. As a result, fewer complications such as UTI and bladder stone formation are expected.

KEYWORDS: Voiding Position; Uroflowmetry; Benign prostatic hyperplasia

CORRESPONDENCE: Dr. Mohamed Ali, Department of Urology, Faculty of Medicine, Suez Canal University, Ring Road, Ismailia 41115, Egypt ( This email address is being protected from spambots. You need JavaScript enabled to view it. ).

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INTRODUCTION: The purpose of the investigation was to conduct urodynamic evaluation on patients with chronic pelvic pain syndrome (CPPS) and thus define a specific urodynamic profile that might add to the pathophysiology of the syndrome. This profile may also aid definitive treatment.

METHODS: Participants were 34 men with mean age 34.2 (SD = 8.5; range, 24-45 years). All patients presented with symptoms of chronic prostatitis (eg, dysuria, frequency of micturition, burning perineal sensation, lower abdominal discomfort and/or suprapubic pain). They were classified as having CPPS after excluding prostatic infection by standard bacteriological methods. The patients were then evaluated with urodynamic measures including free-flow rate, filling (water) cystometry, a pressure -flow study of micturition, and electromyography of the external urethral sphincter.

RESULTS: Of the 34 total patients, 22 (64.7%) had a low mean Qmax of 10.4 ± 1.6 mL/s (range, 4-14 mL/s); 25 (73.5%) had a first sensation of filling and 27 (79.4%) a first desire to void at low volumes (<150 and="" 250="" respectively="" nine="" patients="" 26="" 5="" 7="" obstructed="" 2="" unobstructed="" had="" idiopathic="" detrusor="" overactivity="" regarding="" pressure-flow="" measures="" 25="" 73="" an="" obstructive="" pattern="" of="" micturition="" as="" defined="" by="" a="" low="" qmax="" 9="" 1="" 44="" ml="" s="" high="" intravesical="" pressure="" at="" maximum="" flow="" 87="" 4="" cmh2o="" increased="" opening="" 76="" the="" emg="" external="" sphincter="" was="" normal="" in="" all="" p="">

CONCLUSION: A significant proportion of the patients with CPPS had a particular urodynamic pattern of functional infravesical obstruction and sensory bladder deficit.

KEYWORDS: Urodynamic; Chronic pelvic pain syndrome

CORRESPONDENCE: Hashem Hafez, M.D., Department of Urology, Faculty of Medicine, Suez Canal University, Ring Road, Ismailia 41105, Egypt ( This email address is being protected from spambots. You need JavaScript enabled to view it. )

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INTRODUCTION: The purpose of the investigation was to evaluate the use of the two-wire technique for acute dilatation of the intramural ureter for ureteroscopy.

METHODS: Between April 2003 and April 2007, 400 consecutive ureteroscopic procedures were performed. There were 55 patients (40 male, 15 female) with a mean age of 28 years (range, 20-45 years). Patients had acute dilatation of the intramural ureter by the two-wire technique.

RESULTS: The mean operation time was 34 minutes (range, 20–70 minutes). All patients underwent successful ureteroscopy with a semirigid ureteroscope using the two-wire technique. Perforation or intramural false passage of the ureter did not occur. Patients were discharged from the hospital within 6–12 hours. The mean follow-up was 9.7 months (range, 6–18 months). Ultrasonography, intravenous urogram, and voiding cystourethrography were obtained at 3 and 6 months. Ultrasonography was done every 3 months until the end of the follow-up period. Follow-up imaging showed no distal-ureteral stricture or vesicoureteral reflux.

CONCLUSION: Acute dilatation of the intramural ureter by the two-wire technique is cost effective, easy, and time saving with no associated complications

KEYWORDS: Ureteroscopy; Ureteral dilatation; Two-wire technique

CORRESPONDENCE: Wael M Gamal, MD, Department of Urology, Sohag University, 31 el nasr Street, Sohag, Egypt ( This email address is being protected from spambots. You need JavaScript enabled to view it. ).

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We report a case of an adenoid cystic variant of basal cell carcinoma (BCC) of the prostate in a patient diagnosed following transurethral resection (TURP). A single focus of adenoid cystic carcinoma (ACC) was found. One year later the patient had an episode of hematuria, for which a second TURP was performed; the specimen showed diffuse ACC. The patient then underwent a total prostatectomy (TP). There was no remaining tumor. The patient has been followed for 6 years with no recurrence.

KEYWORDS: Adenoid cystic carcinoma; Basal cell carcinoma; Immunohistopathology; Prostate

CORRESPONDENCE: Mark S. Soloway, MD, Professor and Chairman, Department of Urology, University of Miami, Miller School of Medicine, P.O. Box 016960, Miami, FL 33101, USA. ( This email address is being protected from spambots. You need JavaScript enabled to view it. )

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