Volume 4

UIJ Volume 4 2011

Vol. 4 Issue 6: December 2011 - Download the Complete Issue

Subscribers are invited to download the complete December issue (Vol. 4 Issue 5) in one .pdf file.

A β3 Agonist, Mirabegron for the Treatment of Overactive Bladder

ABSTRACT

Overactive bladder syndrome (OAB) has a negative impact on quality of life and social functioning. Although antimuscarinic drugs are the first line of treatment for OAB, adverse effects and the limitations of efficacy hinder their use. β-adrenoceptors are found in the bladder body and mediate relaxation to noradrenalin. Stimulation of β3-adrenoceptor subtypes has been shown to relax bladder smooth muscle in humans. Mirabegron, a novel selective β3-adorenoceptor agonist, is in development for the treatment of OAB. Phase II placebo-controlled clinical trials showed that mirabegron significantly improved the majority of variables when administered to patients with OAB. Mirabegron is well tolerated with significant efficacy in reducing the number of incontinence episodes and the mean micturition frequency. Commonly reported adverse effects were gastrointestinal adverse events and headache. The lower propensity of dry mouth and constipation while taking mirabegron may make it an attractive drug candidate.

Motoaki Saito, Fotios Dimitriadis, Fumiya Ohmasa, Seiya Inoue, Keisuke Satoh

Submitted: Oct 10, 2011 Accepted for Publication: October 27, 2011

KEYWORDS: Mirabegron; Adrenergic β3 receptor; Bladder; OAB (overactive bladder); LUTS (lower urinary tract symptoms)

CORRESPONDENCE: Fotios Dimitriadis, MD, PhD, Division of Molecular Pharmacology, Tottori University School of Medicine, 86 Nishimachi, Yonago 683-8503, Japan ( This email address is being protected from spambots. You need JavaScript enabled to view it. ).

CITATION: UroToday Int J. 2011 Dec;4(6):art 70. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.03

Acronyms and Abbreviations: ACh, acetylcholine; M1-4, muscarinic su types, 1-4 respectively; PLC, Phospholipase-C; IP3/DAG, Inositol 1,4,5 Trisphosphate/1,2-Diacylglycerol; NA, noradrenalin; AC, adenylyl cyclase; cATP, cyclic adenosine triphosphate

Ureteroscopic Management of Proximal Ureteric Calculi Using Stone Cone

ABSTRACT

Aim of the work: To assess the efficacy and safety of Stone Cone during ureteroscopic pneumatic lithotripsy of proximal ureteric calculi.

Setting and design: From June 2009 to June 2010, 119 patients were included and underwent ureteroscopic management of proximal ureteric calculi with the help of Stone Cone and pneumatic disintegration.

Material and method: Our patients were divided into 2 groups. Ureteroscopic management of proximal ureteric calculi with pneumatic lithotripsy was done in group 1, and ureteroscopic management of upper ureteric stones with the help of Stone Cone and pneumatic lithotripsy was done in group 2.

Results: Patients were divided into 2 groups. Group 1 included 62 patients that underwent standard ureteroscopic pneumatic lithotripsy without Stone Cone. Group 2 included 57 patients that underwent pneumatic lithotripsy using Stone Cone as ureteral occlusion during ureteroscopy. The success rate was 87% in group 1 and 94.7% in group 2. The complication rate ranged from 3.5 to 8%. There were 4 cases of haematuria (6.4%) and one case of ureteral perforation (1.6%) in group 1. In group 2, 2 cases (3.5%) of haematuria occurred. Operative time was highly significant in group 2 and not in group 1; it was 20 to 35 minutes in group 2 versus 30 to 50 minutes in group 1.

Conclusion: Stone Cone is an instrument used during ureteroscopi lithotripsy of proximal ureteric calculi. It can be considered a very effective instrument in blocking the upward migration of ureteric calculi, enabling its safe removal.

Ahmed Shelbaia, Sherif Abd ELRahman, Ali Hussein

Submitted June 15, 2011 - Accepted for Publication Sept 12, 2011

KEYWORDS: Proximal ureteric calculi; Stone Cone; Pneumatic lithotripsy; Ureteroscopy

CORRESPONDENCE: Ahmed Shelbaia, Urology Department, Cairo University Hospital, Borg El Atbaa, Faisal Street, Cairo, Egypt (ahmedshelbaia2007@hotmail)

CITATION: Urotoday Int J. 2011 Dec;4(6):art68. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.01

An Unusual Cause of Acute Scrotum in a 65-Year-Old Man

ABSTRACT

Testicular pain has several etiologies, including torsion, trauma, inflammation, and malignancy. Testicular torsion is a rare cause of scrotal pain in adult men. Few reports have commented on testicular torsion in the geriatric population. It is more common in young adults, and it usually develops as a consequence of certain congenital abnormalities in pediatric and adolescent patients. We report a case of a 65-year-old man who presented with left testicular pain and bilateral groin swelling for 5 days. Surgical exploration was performed and showed left testicular torsion with a right inguinal hernia. In conclusion, testicular torsion should be considered in the differential diagnosis of an acute scrotum regardless of the patient’s age. Our case report of testicular torsion in the elderly patient offers a contribution to literature regarding the presentation and management of adult onset testicular torsion.

Eng Hong Goh, Putera Mas Pian, Praveen Singam, Christopher Chee Kong Ho, Guan Hee Tan, Badrulhisham Bahadzor, Zulkifli Md Zainuddin

Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre

Submitted: May 12, 2011

Accepted for Publication: July 3, 2011

KEYWORDS: Testicular torsion; Elderly; Presentation

CORRESPONDENCE: Eng Hong Goh, Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur, 56000, Malaysia ( This email address is being protected from spambots. You need JavaScript enabled to view it. ).

CITATION: UroToday Int J. 2011 Dec;4(6):art 71. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.04

Congenital Renal Arteriovenous Malformation Is a Rare Cause of Hematuria and Ureteric Obstruction

ABSTRACT

Renal arteriovenous malformation (rAVM) is a rare benign cause of hematuria. We present a case of a 40-year-old female with hematuria and renal colic secondary to a rAVM, as well as a review of the literature. rAVM has a female-to-male ratio of 3 to 1 and can be categorized as either congenital or acquired. Congenital rAVM constitutes 25 to 30% of all rAVM. Acquired rAVM could be categorised as iatrogenic, traumatic, inflammatory, and malignant. The diagnostic and therapeutic option of choice is renal angiography and embolisation. rAVM embolisation allows the maximal preservation of nephrons. Post-rAVM embolisation, 40 to 61% of patients are at risk of post-embolisation syndrome. Total or partial nephrectomy is reserved for recalcitrant rAVMs. Additionally, it is the treatment of choice in centers without angiography.

Yeng Kwang Tay, Dan Spernat, Patrick J Page, Caroline Dowling

Submitted: August 11, 2011 - Accepted for Publication: September 23, 2011

KEYWORDS: Renal arteriovenous malformation; Renal AVM; Hematuria; Ureteric obstruction

CORRESPONDENCE: Yeng Kwang Tay, MD, Department of Urology, Monash Medical Centre, East Bentleigh, 3165, Victoria, Australia. ( This email address is being protected from spambots. You need JavaScript enabled to view it. )

CITATION: UroToday Int J. 2011 Dec;4(6):art 79. http://dx.doi.org/10.3834/uij. 1944-5784.2011.12.12

http://dx.doi.org/10.3834/uij.

Comparison of the Impact of Degarelix and Leuprolide on the Health-Related Quality of Life of Patients with Prostate Cancer: Results of a 12-Month Phase III Clinical Trial

ABSTRACT

Introduction: The objective of this study was to compare health-related quality of life (HRQoL) with degarelix (240 mg in month 1 and then 80 mg monthly, administered subcutaneously) or leuprolide (7.5 mg/month intramuscularly) in men with prostate cancer.

Methods: HRQoL was assessed at baseline and throughout a 12-month randomized, open-label, parallel-group clinical trial using standard SF-12 and EORTC QLQ-C30 questionnaires. HRQoL outcomes were compared between treatments using trend, change score, and response analyses.

Results: HRQoL data from 401 subjects were included in this analysis; 205 receiving degarelix 240/80 mg and 196 receiving leuprolide 7.5 mg. Over the 12-month treatment period, patients experienced worsening of most HRQoL domains except for bodily pain, general health (both SF-12), and diarrhea (QLQ-C30). No treatment group differences in HRQoL were noted at day 28 or 6 months. At 12 months, mean SF-12 scores for the mental component summary (p = 0.02) and mental health (p = 0.04) were significantly higher in degarelix- compared with leuprolide-treated patients. Treatment with leuprolide had a seemingly more favorable impact on insomnia (QLQ-C30; p = 0.04) and bodily pain (SF-12; p = 0.006) compared with degarelix. Patients with metastatic disease treated with degarelix reported significant improvements in the role-emotional domain (SF-12; p = 0.02), global health status (QLQ-C30; p = 0.04), and appetite loss (QLQ-C30; p = 0.02) at 12 months compared with leuprolide.

Conclusions: After 12 months of treatment, the HRQoL of patients with advanced prostate cancer treated with the GnRH antagonist degarelix is similar to that of patients treated with leuprolide. The study also indicates benefits with degarelix treatment in the metastatic population.

KEYWORDS: Degarelix; Gonadotropin-releasing hormone agonist; Gonadotropin-releasing hormone antagonist; Health-related quality of life; Leuprolide; Prostate

CORRESPONDENCE: Bo-Eric Persson, MD, Director, Medical Sciences, Urology/Oncology Global Marketing, Ferring International Center SA, Chemin de la Vergognausaz 50, 1162 St-Prex, Switzerland ( This email address is being protected from spambots. You need JavaScript enabled to view it. ).

CITATION: UroToday Int J. 2011 Dec;4(6):art 81. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.14

A Case of Bladder Melanosis Associated with Recurrent Urinary Tract Infections

ABSTRACT

Bladder melanosis is a very rare clinical entity that has reportedly been associated with a wide variety of urinary symptoms. Reports also exist of an association with bladder malignancy. We describe a case with a 58-year-old man under urological investigation following 2 urinary tract infections. Several flat, blackened areas within the bladder were observed at cystoscopy, which histology revealed was due to increased melanin deposits within bladder urothelial cells; i.e., melanosis. This finding is of uncertain significance, and regular cystoscopic follow-up was thought to be prudent. At 3 months, appearances were unchanged; however, at 6 months, the bladder’s appearance was entirely normal with resolved changes of melanosis.

KEYWORDS: Bladder melanosis; Melanosis vesica

CORRESPONDENCE: Sara Lightowlers, MB, BChir, West Suffolk Hospital, Bury St. Edmunds, Suffolk, United Kingdom, IP33 2QZ ( This email address is being protected from spambots. You need JavaScript enabled to view it. ).

CITATION: UroToday Int J. 2011 Dec;4(6):art 73. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.06

Scrotal Scintigraphy and Quantitative Imaging Approaches in the Evaluation of Patients with Acute Scrotal Pain

ABSTRACT

Introduction: Acute scrotal pain is an important clinical presentation that necessitates rapid and precise imaging techniques to differentiate between urgent surgical cases and non-surgical cases. Radioisotope testicular scintigraphy is a very helpful imaging modality to assess testicular blood flow. However, until now, all scrotal scintigraphy studies have no standard values to compare with the other testicle and increase its diagnostic accuracy. In this study we are going to find a standard fixed-comparison region of interest.

Methods: Scrotal scintigraphy was done for 40 patients with acute scrotal pain after intravenous technetium pertechnetate injection. Time-activity curve data was created and analyzed to create standard numeric data to calculate the ratio between the testicular radioactivity count rate/background radioactivity count rate.

Results: Forty male patients between the ages of 7 to 21 years (mean 13.5 ± 5.3) were included. Their main complaint was acute testicular pain. Twenty-four cases (60%) had left side pain and 16 cases (40%) had right side pain. Twenty-two cases (45%) had a past history of similar attacks. A history of trauma was encountered in 9 cases (22.5%), 9 cases (22.5%) had a past history of recurrent inflammatory processes proved by previous ultrasonography, 6 cases (18%) were known to have varicoceles, and 13 cases (32.5%) had testicular torsion after surgical exploration. The numeric data showed that there was a correlation and a significant critical cut-off ratio between the testicular radioactivity count. A background radioactivity count was determined by drawing symmetrical regions of interest at both the testis and the medial aspect of the ipsilateral thigh, with a cut-off figure of 1.45 for normal testicular radiotracer uptake and with a mean ratio of <1.2 (found in 12 cases) for acute testicular torsion in which impaired vascular flow to the testis and impaired testicular uptake of radioactivity was noticed. This correlated with the clinical sonographic data and operative data, as well as postoperative histopathological results (p.value = 0.00041). Via this technique, we conclude that the sensitivity of this technique reach was 92.3%, specificity was 96.4%, and diagnostic accuracy was 95.1%, in the diagnosis of acute testicular torsion.

Conclusion: Scrotal scintigraphy using quantitative imaging techniques is a highly significant tool with diagnostic accuracy of 95%, which indicates its importance as an emergency imaging modality in managing patients with acute scrotal pain.

Fouad Khalil, Alaa Hussein, Magdy El Tabie

Submitted: July 30, 2011

Accepted for Publication: October 12, 2011

KEYWORDS: Scrotal Scintigraphy; Acute testicular torsion imaging

CORRESPONDENCE: Dr. Alaa Hussein (MD,FEBU), Ahmed Maher Teaching Hospital, 241 Port Saied Street, 11441, Cairo, Egypt ( This email address is being protected from spambots. You need JavaScript enabled to view it. ).

CITATION: UroToday Int J. 2011 Dec;4(6):art 76. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.09

Urinary Incontinence, Overactive Bladder, and Enuresis in the Spanish Population: An Epidemiologic, Multicenter, and National Study

ABSTRACT

Introduction: Despite the growing interest on urinary incontinence (UI), nocturnal enuresis (NE), and overactive bladder (OAB), in Spain, there are no epidemiologic studies on the prevalence of these health problems in the different affected groups of the general population. The objective of the present study was to observe the prevalence of the signs and symptoms of UI, OAB, and NE in specific groups of the general population.

Methods: This is an epidemiologic, observational, multicenter, and national study. Data were collected by means of personal interviews in 5 representative areas from Spain and in 4 groups of the population: 1) workingwomen (25 to 64 years old), 2) workingmen (50 to 64 years old), 3) children attending primary school (6 to 11 years old), and 4) elderly, institutionalized subjects (over 65 years old) with no mental impairment. The Interview included 2 parts: 1) sociodemographic variables and clinical history, and 2) data about OAB and UI symptoms. The interview addressing children included sociodemographic variables and questions about liquid intake and urine control.

Results: The percentage of interview answers in the different groups varied between 79.7% and 98%. The prevalence of isolated OAB and UI in workingwomen (N = 3090) was 2.69% and 4.01%, respectively; in men (N = 1071) prevalence was 3.55% and 0.56%; in the elderly (N = 996) prevalence was 9.14% and 15.16%. In total, 9.94% (95% confidence interval [CI] = 8.9 to 11.04) of the women under study suffer 1 or both health problems. This percentage was 5.14% (95% CI = 3.89 to 6.63) in men and 53.71% (95% CI = 50.56 to 56.85) in the elderly. The prevalence of nocturnal enuresis in children (N = 1279) was 7.82% (95% CI = 6.62 to 9.17).

Conclusions: The prevalence of OAB and/or UI in Spain is nearly 10% of women between 25 and 64 years old, is around 5% in men between 50 and 64 years old, and it is over 50% in persons over 65 years. The prevalence of nocturnal enuresis in children between 6 and 11 years is around 8%.

Eduardo Martínez-Agulló, Luis Gómez-Pérez, Miguel Ramírez-Backhaus, Pablo Rebollo, Maite Pérez, José Chaves, The EPICC Cooperative Study Group

Submitted July 16, 2011 - Accepted for Publication September 2, 2011

KEYWORDS: Epidemiology; Overactive bladder; Urinary incontinence; General population; Prevalence

CORRESPONDENCE: Pablo Rebollo, MD, BAP Health Outcomes Research, Azcárraga, 33010 Oviedo, Spain ( This email address is being protected from spambots. You need JavaScript enabled to view it. ).

CITATION: Urotoday Int J. 2011 Dec;4(6):art78. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.11

An Unusual Intravesical Foreign Body

ABSTRACT

Foreign bodies of the urinary bladder may occur by self-insertion or migration from the neighbouring organs. An unusual foreign body in the urinary bladder in a clinical setting presents a diagnostic dilemma with a vague history. The patient usually presents with dysuria, intermittent urinary tract infection, or suprapubic pain. Here we report a case of an intravesical foreign body that was removed by cystoscopy.

Vedamurthy Pogula Reddy,¹ Madhurima Pothula,² Ravi Shankar Ganji³

¹Department of Urology and Renal Transplantation, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
²Department of Microbiology, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
³Department of Urology, Bollineni Hospital, Rajahmundry, Andhra Pradesh, India

Submitted: May 8, 2011 - Accepted for Publication: July 3, 2011

KEYWORDS: Urinary bladder; Foreign body

CORRESPONDENCE: Vedamurthy Pogula Reddy, MCh, Department of Urology and Renal Transplantation, Narayana Medical College, Chinthareddypalem, Nellore, India, 524002 ( This email address is being protected from spambots. You need JavaScript enabled to view it. ).

CITATION: UroToday Int J. 2011 Dec;4(6):art 72. http://dx.doi.org/10.3834/uij.1944-5784.2011.12.05

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