Complete Urological Evaluation Research Articles

Megacystis-microcolon-intestinal hypoperistalsis syndrome: don't forget the bladder.

Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) is a well described clinical condition, but reports are focused on microcolon and intestinal hypoperistalsis, while data on bladder management are scant. Aim of the study is to present urological concerns in MMIHS. Retrospective evaluation of clinical data on urological management of MMIHS patients treated in the last 10years. Six patients were enrolled (3 male, 3 female). Three girls had prenatal diagnosis of megacystis (1 vesicoamniotic shunt was placed). All patients had genetic diagnosis: 5 had ACTG2 gene mutations and 1 MYH11 mutation. All patients were addressed to our attention for urinary symptoms, such as urinary retention, urinary tract infections, acute renal injury. Two patients presented frequent stoma prolapses. All children underwent a complete urological evaluation, and then started a bladder management protocol (clean intermittent catheterization, via urethra or cystostomy-tube placement), with improvement of urinary infections, upper urinary tract dilation and stoma prolapses, if present. All patients had good renal function at last follow-up. We believe that MMIHS patients must be addressed soon and before onset of symptoms for a multidisciplinary evaluation, including an early assessment by a pediatric urologist expert in functional disorder, to preserve renal function at its best.

Does sacral ratio have any impact on success rate of biofeedback therapy in children with lower urinary tract dysfunction?

To evaluate the possible impact of patients' sacral ratios (SRs) on response to biofeedback (BF) therapy in pediatric patients with lower urinary tract dysfunction (LUTD). In this retrospective cohort conducted from 2016 to 2018 in our tertiary medical center, we included the medical records of all pediatric patients with LUTD who were nominated for BF due to having abnormal uroflowmetry patterns and simultaneous increase in electromyography (EMG) activity. Ten sessions of weekly animated BF were performed for each patient. All patients underwent a complete urological evaluation, uroflowmetry with simultaneous EMG and post-void residual measurement before and after treatment. SRs were calculated based on plain anteroposterior lumbosacral radiographs. Patients were then divided into normal SR (≥0.74) and low SR (<0.74) and outcomes were compared between them. Of the total 86 patients included in our study, 48 (55.8%) had a normal SR (≥0.74), while 38 (44.2%) had a low SR (<0.74). Our data revealed that BF therapy significantly improved maximum and average urinary flow rates, urine volume, daytime urinary incontinence, enuresis, urinary urgency and constipation; irrespective of the patients' SRs (all P<0.001). Our between-groups analyses showed that after the completion of BF, the SR≥0.74 group had significantly higher maximum urinary flow rate (mean difference [95%CI]: 7.7 [5.4, 10.0], P<0.001) (Figure) and urine volume (mean difference [95%CI]: 49.9 [19.5, 80.4], P=0.002) and significantly lower diurnal urinary incontinence (4.2% vs. 21.1%, P=0.020), enuresis (4.2% vs. 18.4%, P=0.040) and constipation (2.1% vs. 23.7%, P=0.004) compared to the SR<0.74 group. SR has been proposed as a reliable indicator of bony pelvis growth and subsequent lumbosacral neurodevelopment. Additionally, larger SR values are associated with better postoperative sphincter function in children with urological and anorectal malformations. Our results demonstrated that after completion of BF, the normal SR group had a significantly better improvement of some of the uroflowmetry indicators and LUTD-associated symptoms compared to the low SR group. Our findings implied that although BF therapy is an efficient treatment for children with LUTD, irrespective of their sacral development; children with enhanced sacral development may benefit from better clinical response, especially in terms of LUTD-associated symptoms.

The retinal neurovascular coupling is impaired in men with vasculogenic erectile dysfunction

The aim of this study was to study the retinal vessels in patients affected by vasculogenic erectile dysfunction (ED), using dynamic vessel analyzer (DVA). Patients with vasculogenic ED and control subjects were prospectively enrolled to undergo a complete urological and ophthalmologic evaluation, including DVA and structural optical coherence tomography (OCT). The main outcome measures were: (1) arterial dilation; (2) arterial constriction; (3) reaction amplitude (the difference between arterial dilation and constriction); and, (4) venous dilation. Thirty-five patients with ED and 30 male controls were included in the analysis. Mean ± SD age was 52.0 ± 10.8 years in the ED group and 48.1 ± 16.3 years in the control group (p = 0.317). In the dynamic analysis, the arterial dilation was lower in the ED group (1.88 ± 1.50%), as compared with the control group (3.70 ± 1.56%, p < 0.0001). Neither arterial constriction nor venous dilation differed between groups. The reaction amplitude was decreased in ED patients (2.40 ± 2.02%, p = 0.023), compared to controls (4.25 ± 2.20%). In the Pearson correlation analysis, the ED severity, was directly correlated with both reaction amplitude (R = .701, p = 0.004) and arterial dilation (R = .529, p = 0.042). In conclusion, subjects with vasculogenic ED are featured by a significant dysfunction of the retinal neurovascular coupling, which is inversely correlated with ED severity.

THULIUM:YAG LASER ENUCLEATION OF THE PROSTATE (ThuLEP) - OUR EXPERIENCE IN 246 PATIENTS.

New minimally invasive procedures to treat benign prostatic hyperplasia (BPH) have been developed in the last 20 years. With the introduction of laser enucleation techniques in prostate surgery, previous standard surgical procedures (open retropubic or transvesical adenectomy and transurethral resection of the prostate) have become less relevant, especially in case of very large prostates. The objective of this paper is to describe the experience and results of thulium:YAG laser application in BPH treatment in our department. In the last five years, 246 patients underwent thulium:YAG laser enucleation of the prostate (ThuLEP) due to BPH or lower urinary tract symptoms following complete urologic evaluation. The mean age of our patients was 73 (range 51-95) years and mean duration of surgery was 92 minutes. The mean weight of enucleated tissue was 73 grams. A low rate of intraoperative and early postoperative complications and short length of stay proved minimal invasiveness of this procedure, which results in significant improvements in urodynamic parameters and substantially reduces the post-void residual urine volume. The most important surgical and technical characteristics (enucleation and low-power laser application) make ThuLEP a safe and efficient surgical method not limited by the prostate volume. ThuLEP has a potential to displace the current standard surgical procedures to treat BPH.

2064. Incidence and Risk Factors for Microscopic Hematuria in a US Military HIV Cohort

Abstract Background Microscopic hematuria (MH) is a common finding on screening urinalyses in persons living with HIV (PLWH); however, a study in the pre-HAART era revealed that a complete urologic evaluation was generally non-diagnostic in young males with a benign history and normal renal function. Recent studies have shown a decreased incidence of hematuria in PLWH in the HAART era. We performed a nested case-control study in the prospectively enrolled US Military HIV Natural History Study (NHS) to evaluate characteristics of PLWH with and without MH. Methods We evaluated male participants diagnosed with HIV and enrolled in the NHS Jan 2007 to Dec 2019. MH cases were defined as having at least one urinalysis with ≥5 RBCs/hpf. We used descriptive statistics to compare cases and controls with respect to demographics, comorbidities, and laboratory findings to determine risk factors for MH. Cox regression models evaluated for independent associations with the development of MH since HIV diagnosis. Results Of 829 included participants, 142 (17.1%) had MH, of whom 87 (61.3%) had only one MH event. Cases had a shorter mean duration of study follow-up but more analyzable urinalyses per participant. There were no significant differences between cases and controls in demographics, CD4 count nadir, time from HIV diagnosis to HAART initiation, or inclusion of tenofovir disoproxil fumarate (TDF) in initial regimen. On univariate analysis, more cases had a history of urinary tract infection (UTI) or a hypertension diagnosis through the time of incident MH compared to controls, but were less likely to have proteinuria or pyuria at the time of MH. Cox regression models revealed that a history of UTI increased the hazard for MH (HR 2.07, p &amp;lt; 0.05). In contrast, the presence of proteinuria (HR 0.42, p&amp;lt; 0.01) and TDF use (HR 0.56, p&amp;lt; 0.05) decreased the hazard for MH compared to controls. Conclusion A history of UTI, though not concurrent pyuria, was associated with an increased hazard for MH. The use of TDF in the initial HAART regimen and the presence of proteinuria were protective against hematuria. Future studies are needed to clarify these findings; however, they provide reassurance that in a young, otherwise healthy cohort, MH is typically self-limited and unrelated to intrinsic renal pathology, comorbidity, or HIV-related factor. Disclosures All Authors: No reported disclosures.

Individual-risk-score for urinary tract malignancy in patients with microscopic hematuria.

To determine the patients who can be safely exempted from undergoing unnecessary diagnostic procedures for microscopic hematuria (MH) evaluation by using the developed individual-risk-scoring system. The patients who underwent a complete urological evaluation for MH were identified retrospectively. The risk factors for urinary malignancy which defined in the 2020 American Urological Association/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction guidelines were recorded for each patient. Multivariable logistic regression was performed to establish a predictive risk-scoring system. The odds ratios obtained as a result of the logistic regression analysis were scored. A total of 1461 patients who had undergone a complete urological evaluation for MH were identified. The urinary malignancy rate was 3.4% (50 of the 1461 patients). According to the odds ratios, age >40 was calculated as 1 point; male gender, 2 points; smoking history, 4 points; presence of occupational risk factor, 1 point; and presence of macroscopic hematuria, 2 points. For the cut-off risk score, 5 points was found to be the most appropriate score according to the sensitivity and specificity levels. The patients with risk scores of 5 points or lower were considered to be in the low-risk group for urinary tract malignancy. The patients with a risk score of 5 points or above require complete urological evaluation. The results of the present study may reduce the number of patients undergoing unnecessary urological evaluation.

Comparison of Microscopic Hematuria Guidelines as Applied in 1018 Patients With Microscopic Hematuria

ObjectiveTo compare the 2012 American Urological Association (AUA) and 2020 AUA/Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) microscopic hematuria (MH) guidelines as applied in 1,018 patients with MH, to confirm of risk groups and to investigate the natural history of patients with MH. Materials and MethodsPatients who had undergone a complete urological evaluation for MH according to the 2012 AUA MH guidelines were identified retrospectively. All the patients were then classified into low-, intermediate-, or high-risk for urinary tract malignancy according to the updated 2020 AUA/SUFU MH guidelines, for a second evaluation. The results of the first and second evaluations using the previous 2012 AUA and updated 2020 AUA/SUFU MH guidelines, respectively, were then compared. ResultsA total of 1018 patients with MH were identified. The urinary tract malignancy rate was 3.3% (34 of the 1,018 patients). According to the 2020 AUA/SUFU MH guidelines, there were 218 patients (21.4%) in the low-risk group, 447 patients (43.9%) in the intermediate-risk group, and 353 patients (34.6%) in the high-risk group. All the 34 patients with malignancy were from the intermediate- or high-risk group who require further urological evaluation. There was no patient with newly developed urinary tract malignancy at the median follow-up time of 28 months (12-58). ConclusionThe use of the updated 2020 AUA/SUFU MH guidelines may reduce the number of diagnostic procedures without compromising the diagnosis of life-threatening malignant lesions.

Complete urological evaluation including sperm DNA fragmentation in male systemic lupus erythematosus patients.

To evaluate sperm DNA fragmentation analysis in non-azoospermic male systemic lupus erythematosus (SLE) patients. Twenty-eight consecutive male SLE patients (American College of Rheumatology criteria) and 34 healthy controls were evaluated for demographic/exposures data, urological evaluation, hormone profile and sperm analysis (including sperm DNA fragmentation). Clinical features, disease activity/damage scores and treatment were also evaluated. The median age (33 (20-52) vs. 36.5 (25-54) years, P = 0.329) and frequency of varicocele (25% vs. 32%, P = 0.183) were similar in SLE patients and healthy controls. Sperm DNA fragmentation showed significantly higher levels of cells class III (44 (9-88) vs. 16.5 (0-80)%, P = 0.001) and cell class IV (10.5 (3-86) vs. 7 (0-36)%, P = 0.039) in SLE. The sperm DNA fragmentation index was also significantly higher in SLE patients (62 (31-97) vs. 25.5 (0-100)%, P < 0.001). Conventional sperm parameters (including sperm count, motility and morphology) were similar in both groups. In SLE patients no correlations were observed between sperm DNA fragmentation index and age, disease duration, Systemic Lupus Erythematosus Disease Activity Index 2000 and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index scores, and cumulative dose of prednisone, hydroxychloroquine, intravenous cyclophosphamide, methotrexate, azathioprine and mycophenolate mofetil ( P > 0.05). Further analysis of SLE patients treated with and without intravenous cyclophosphamide showed that total sperm motility was significantly lower in the former group (64% (15-83) vs. 72% (57-86), P = 0.024). The sperm DNA fragmentation index was alike in both groups (52.5 (31-95) vs. 67.5 (34-97)%, P = 0.185). To our knowledge, this is the first demonstration that male non-azoospermic SLE patients have increased sperm DNA fragmentation without evident gonadal dysfunction. Intravenous cyclophosphamide does not seem to be a major determinant for this abnormality. Future prospective study is necessary to determine the impact of this alteration in these patients' fertility.

Can female urethral calculus present with acute urinary retention?

Urethral calculus is a very rare cause obstructive uropathy. Incidence of urethral calculus is extremely rare, less often in females as compared to males. It is usually associated with genitourinary pathology. Primary or native urethral calculus, formed in situ in the urethra whereas secondary or migratory urethral calculi originate from the kidney or bladder and descend into urethra. Most of the primary urethral stones are formed in association with functional or anatomical pathology such as chronic stasis, urinary tract infection, urethral diverticulum, meatal stenosis, urethral stricture, periurethral abscess or fistulous tract. Diagnosis of urethral calculus is sometimes difficult due to its location, and failure of diagnosis may leads to urethral injury, urinary incontinence or renal insufficiency. We present a case of 50 years old woman with acute retention of urine. On genital examination stone was visible at the urethral meatus. On cysto-urethroscopy, no urethral abnormality was detected. On further ultrasound evaluation, no stone was visualised in the kidney or the bladder. Our case is distinct because no anatomic abnormalities were detected after complete urological evaluation.

Importance of Different Grades of Abdominal Obesity on Testosterone Level, Erectile Dysfunction, and Clinical Coincidence.

The aim of the current study was to investigate the influence of different grades of abdominal obesity (AO) on the prevalence of testosterone deficiency syndrome (TDS), erectile dysfunction (ED), and metabolic syndrome (MetS). In a cross-sectional descriptive study, a total of 216 males underwent a complete urological, internal, and hormonal evaluation. Males were divided according to waist circumference into five groups: less than 94 cm (Grade [G] 0), 94 to 101 cm (G1), 102 to 109 cm (G2), 110 to 119 cm (G3), and more than 120 cm (G4). Incidence of ED, TDS, and MetS was compared in these groups and in participants without AO. Some degree of ED was identified in 74.7% of males with AO. In G1, there were 61% of males with ED, in G2 68%, in G3 83%, and in G4 87%. A strong correlation between testosterone (TST) level and AO was identified. Ninety-eight out of 198 (49.5%) males with AO and 1/18 (5.5%) males without AO had TDS. There were significant differences between individual groups. In the group of males with AO G4 (more than 120 cm), 87.1% had TDS. MetS was diagnosed in 105/198 (53.0%) males with AO, but in G4, 83.9% of males with AO had MetS. Males older than 40 years of age with AO have a higher incidence of ED, TDS, and MetS. Dividing males into five groups according to waist circumference seems to be reasonable. With growing AO, there were significantly more males with ED, TDS, and MetS.

Papel de la cistouretrografía miccional en el protocolo de trasplante renal: ¿reemplaza al urólogo?

Introduction and objectivesThere is no consensus on the different clinical tests used for kidney pre-transplant urological evaluation. The protocols vary according to the experience of each transplant group, with no clear guidelines for these protocols. The experience is presented from a high volume kidney transplant center in Colombia, where voiding cystourethrography (VCU) is used as part of the protocol prior to renal transplantation. Materials and methodsA total of 331 kidney transplants were performed from January 2009 to December 2012 in Hospital Pablo Tobon Uribe. The study included the evaluation of 233 clinical records and 223 voiding cystourethrographs (VCU). Results and discussionThere were 39 abnormal VCU (17.4%), 19 (4 bilateral and 15 unilateral) vesicoureteral reflux, 5 with reduced bladder capacity, one with benign prostate hyperplasia, and one due to increased bladder capacity. ConclusionAlthough a large proportion kidney pre-transplant patients have an abnormal VCU, this does not change clinical or surgical approached before transplantation. Instead of using urinary tract protocol tests, a complete urological evaluation should be considered.

Prospective External Validation of a Bladder Cancer Detection Model

Few studies have combined clinical prognostic factors with urinary biomarkers into risk profiles that can be used to predict the likelihood of bladdercancer. We previously developed and internally validated a bladder cancer detection nomogram that combines clinical features with the NMP22® BladderChek® test. To consider extensive use of the model the nomogram was tested in a prospective cohort of patients who presented with hematuria. Patients referred for hematuria evaluation were prospectively enrolled at 3 centers. Each patient underwent complete urological evaluation, including history, examination, cystoscopy, cytology and NMP22. Alogistic regression model to predict urothelial bladder carcinoma was also developed to compare the performance of clinical data with and without adding NMP22 and urinary cytology. The study included 381 patients (50.7% women) with a median age of 58years. Urothelial bladder carcinoma was detected in 23 patients (6%). It was associated with age greater than 65 (11.1% vs 4% of patients, p = 0.012), male gender (10.1% vs 2%, p = 0.003), white ethnicity (9.2% vs 3.1%, p = 0.016), gross hematuria (9.9% vs 2.5%, p = 0.005), positive NMP22 (37% vs 3.7%, p <0.001) and positive cytology (83.3% vs 3.9%, p <0.001). Predictive accuracy of the bladder cancer detection nomogram was 80.2%. The calibration plot indicated that the previously published nomogram was well calibrated in patients with aless than 15% predicted probability of urothelial bladder carcinoma. We prospectively validated a highly accurate tool that combines clinical factors and a urinary biomarker to detect bladder cancer. This tool can help prioritize urological referrals for patients with hematuria.

Diagnosis and Treatment of Bladder Cancer: How Can We Improve?

The majority of patients with bladder cancer will be diagnosed following an episode of hematuria. With few exceptions, these patients should be referred for a complete urologic evaluation, including a history and physical examination, flexible cystoscopy, imaging of the upper urinary tract, and optional urine cytology. Those found to have a bladder tumor should undergo transurethral resection for the combined purposes of initial staging and treatment. Delays in diagnosing invasive bladder cancer are associated with adverse outcomes. In this review, we cover the diagnosis and management of bladder cancer. In addition, we discuss ways to improve outcomes through increased public awareness, improvements in tumor detection, accurate staging, and regimented patient surveillance.

Occurrence of erectile dysfunction, testosterone deficiency syndrome and metabolic syndrome in patients with abdominal obesity. Where is a sufficient level of testosterone?

The aim of this study was to determine the prevalence of erectile dysfunction (ED), testosterone deficiency syndrome (TDS), and metabolic syndrome in patients with abdominal obesity (AO) and the prevalence of morbidity at different levels of testosterone (TST). Male sex hormones play an important role in ED and variety of TDS and may have influence on the development of metabolic syndrome. The number of men with AO which constitutes a serious health risk is continuously growing. Currently, there are different views that TST levels are already insufficient, and the patient should benefit from treatment. This study examined the association between ED, testosterone level and metabolic syndrome in men with AO. The study was carried out in an outpatient urology center of Urology Clinic and Obesity Center of the Clinic of Internal Medicine. There were 167 participants—men with AO which were examined as part of preventive examination. Hormonal, a complete urological and internal evaluation was carried out in every patient. We found some degree of ED in 73% (122/167) in men with AO. The TST levels below 14 nmol/l had of these 122 patients 84 patients (68.9%) and 49 patients (40.2%) below 10 nmol/l. In this group of patients, we found 103/167 patients (61.7%) with metabolic syndrome. When we compared TST level and morbidity, we found significantly more patients with diabetes mellitus (DM), hypertension and dyslipidemia in group with TST below 10 nmol/l. We also found difference in the levels of HDL cholesterol and triglycerides in the group of patients with TST 10–14 and over 14 nmol/l. Patients over 40 years of age with AO and ED should also be examined for TDS and metabolic syndrome. In this group of patients we found that 113/167 patients (67.6%) had total TST below 14 nmol/l, and sufficient level of TST seems to be above this level.

2019 PERFORMANCE OF COMPUTED TOMOGRAPHIC UROGRAPHY FOR THE DETECTION OF BLADDER TUMORS IN PATIENTS EVALUATED FOR MICROSCOPIC HEMATURIA

You have accessJournal of UrologyImaging/Radiology: Uroradiology I1 Apr 20102019 PERFORMANCE OF COMPUTED TOMOGRAPHIC UROGRAPHY FOR THE DETECTION OF BLADDER TUMORS IN PATIENTS EVALUATED FOR MICROSCOPIC HEMATURIA Bernardo Aguilar-Davidov, Jose Arturo Ramirez-Muciño, Mariano Sotomayor, Ricardo Castillejos-Molina, Guillermo Feria-Bernal, and Francisco Rodriguez-Covarrubias Bernardo Aguilar-DavidovBernardo Aguilar-Davidov More articles by this author , Jose Arturo Ramirez-MuciñoJose Arturo Ramirez-Muciño More articles by this author , Mariano SotomayorMariano Sotomayor More articles by this author , Ricardo Castillejos-MolinaRicardo Castillejos-Molina More articles by this author , Guillermo Feria-BernalGuillermo Feria-Bernal More articles by this author , and Francisco Rodriguez-CovarrubiasFrancisco Rodriguez-Covarrubias More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2052AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The prevalence of microscopic hematuria varies from 0.19% to 21% depending on the studied population. In patients without risk factors for primary renal disease, a complete urologic evaluation should be performed, and this includes imaging of the upper urinary tract followed by cystoscopic examination. Nevertheless, this recommendation was established before the widespread use of computed tomographic urography (CTU), which seems to provide accurate information of the urinary tract anatomy including the bladder. Some authors report very high performance of CTU making controversial the need of cystoscopy. Our objective was to evaluate the sensitivity, specificity, predictive value, and accuracy of CTU for the detection of bladder tumors in patients with microscopic hematuria. METHODS Institutional review board approval was obtained for this retrospective review of medical records of patients with microscopic hematuria initially evaluated with CTU and cystoscopy afterwards from January 2006 to April 2009. Patients with history of macroscopic hematuria in the last year or with urinary tract infection were excluded. A total of 101 patients were eligible for analysis. Official radiologist report of CTU detecting a bladder lesion suspicious of malignancy was considered positive. Since cystoscopy is the gold standard for the evaluation of bladder pathology, this study was considered the control. Cystoscopy was classified as positive when a lesion requiring biopsy or resection was found. Performance characteristics of CTU were determined by using the cystoscopic findings. RESULTS There were three CTU positive reports, two of which were confirmed by cystoscopy (true positive). In 3 additional patients CTU failed to detect a bladder tumor. The histologic report was transitional cell carcinoma in 3 patients, 1 papilloma, and 1 malacoplakia. Based on these results the CTU sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for bladder tumor detection is 40%, 99%, 67%, 97%, and 96%. CONCLUSIONS Although CTU has a high specificity, its sensitivity is limited. For this reason conventional cystoscopy should be considered the standard for the initial evaluation for patients with microscopic hematuria. Mexico City, Mexico© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e783 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bernardo Aguilar-Davidov More articles by this author Jose Arturo Ramirez-Muciño More articles by this author Mariano Sotomayor More articles by this author Ricardo Castillejos-Molina More articles by this author Guillermo Feria-Bernal More articles by this author Francisco Rodriguez-Covarrubias More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Multidetector Computerized Tomography Urography as the Primary Imaging Modality for Detecting Urinary Tract Neoplasms in Patients With Asymptomatic Hematuria

We determined whether multidetector computerized tomography urography is sensitive and specific for detecting urinary tract neoplasms when used as the primary imaging modality for evaluating patients with hematuria. A retrospective review was performed of the radiological, urological and pathological records of 468 patients without a history of urinary neoplasms who presented with hematuria. All patients underwent multidetector computerized tomography urography and complete urological evaluation, including cystoscopy. Laboratory urinalysis and cytology were done in 350 and 318 of the 468 patients, respectively. Multivariate logistic regression analysis was performed using the variables multidetector computerized tomography urography diagnosis, worst urine cytology, number of red blood cells per high power field, gross hematuria, age and gender to predict urinary tract neoplasm. A total of 50 urinary neoplasms were diagnosed in 468 patients. Multidetector computerized tomography urography detected 32 of 50 neoplasms for a sensitivity of 64%, specificity of 98%, positive predictive value of 76% and negative predictive value of 96%. There were 10 false-positive and 18 false-negative multidetector computerized tomography urography studies. Multivariate logistic regression showed that abnormal multidetector computerized tomography urography findings, ie neoplasm (p <0.0001), and suspicious or positive urine cytology (p = 0.0009) were significant. Patients with an abnormal multidetector computerized tomography urography diagnosis and suspicious or positive urine cytology had 44 and 47 times greater odds, respectively, of having urinary neoplasms compared to the odds in those with normal examinations. Multidetector computerized tomography urography is relatively sensitive and highly specific for detecting urinary neoplasms. It may serve as the primary imaging modality to evaluate patients with hematuria. Multidetector computerized tomography urography does not eliminate the role of cystoscopy in the evaluation of hematuria.

Is a complete urological evaluation necessary in all newborns with asymptomatic renal ectopia?

To evaluate if a complete urological screening is justified by potential urological anomalies in newborns or infants with asymptomatic renal ectopia (RE). The database records of 60 consecutive neonatal cases of RE diagnosed at the authors' hospital from 1990 to 2004 were retrospectively reviewed. At diagnosis, mean patient age was 1.6 months. In 58 of 60 patients, the suspected diagnosis of RE was made during prenatal or postnatal screening ultrasonography, including two newborns with anorectal malformation. There were 24 patients with crossed RE (C-RE) and 36 patients with simple RE (S-RE). A solitary RE was present in two patients. The most frequent associated urological abnormality was vesico-ureteral reflux (37.5% of C-RE and 16.6% of S-RE). Hydronephrosis was detected in seven RE and five contralateral kidneys. An obstructive megaureter was present in one patient with C-RE. In 40% of S-RE and 92.9% of C-RE, the (99m)Tc DMSA documented reduction of function of RE. The longitudinal diameter of the ectopic kidney was significantly smaller than the contralateral one. Other non-renal diseases were present in 15% of patients, of which the most frequent was cryptorchidism (6.6%). A complete urological evaluation is necessary in newborns with C-RE for the high incidence of associated urological anomalies, of which VUR is the most frequent. A complete urological evaluation is also reasonable in patients with S-RE who have a pelvic dilatation. No diagnosis or treatment of the associated urological diseases, in consideration of congenital decreased function of the ectopic kidney, might predispose these children to improvement of renal function impairment.

Spontaneous resorption of a sacral meningocele

Meningoceles are thought to be the products of postneurulation disorder. The neural tube is normally formed beneath the cutaneous lesion; however, when the subsequent development of the overlying mesenchymal tissues and cutaneous ectoderm are aberrant, the result is a cutaneous and mesenchymal defect that contains only cerebrospinal fluid (CSF). Chiari malformation Type II and hydrocephalus are not associated with meningoceles.1 They are important because of concomitant tethered cord, the chance of CSF leakage, discomfort and pain, their large size, and cosmetic aspects. Skin-covered lesions are managed in an elective manner when CSF leakage is not present. Meningoceles often increase in size. A girl born via cesarean section at term to a 24-year-old Gravida 1 mother was noted to have a large, skin-covered, soft-tissue mass protruding from her sacral region in the dorsal midline. Prenatal ultrasonography performed 1 month before delivery had revealed a large sacral meningocele, 7 cm in diameter without other abnormalities. The infant had no obvious neurological deficits. Spinal magnetic resonance (MR) imaging revealed a sacral meningocele, which seemed to be devoid of neural elements (Fig. 1). Its greater diameter was only 5.5 cm, smaller than the lesion observed on prenatal ultrasonography. We performed a complete urological evaluation that confirmed a normal urological state. Brain ultrasonography performed during the neonatal period had shown a normal ventricular system. Because of the normal skin covering the lesion, the lack of a tethered cord, and the progressive reduction in size, the girl was observed and did not undergo surgery. At 3 months of age, no obvious mass could be discerned on her back; only wrinkled skin was visible (Fig. 1 upper right). The second MR image obtained at 6 months of age demonstrated that the meningocele sac had disappeared (Fig. 1 lower right). A comprehensive Medline search of articles from 1966 to March 2004 revealed no previous cases of spontaneous regression of a meningocele. In some circumstances, meningoceles resolve after ventriculoperitoneal shunting or CSF diversion. 2,3 Restoration of normal CSF dynamics can reduce flow into the sac, resulting in meningocele size reduction. In our patient, the large meningocele sac (which was in direct communication with the spinal subarachnoid space) underwent a gradual size reduction perinatally that permitted us to observe the lesion only. We presume that this process of reduction is caused by a gradual obliteration of the dural defect or stalk (in which the communication disappears by thickening and adhesion of the leptomeninges at the orifice and by subsequent CSF resorption). High CSF pressure causes the sac to act as an additional fluid space that reduces the chance of spontaneous sac reduction. The absence of hydrocephalus in our patient may be another important factor that helped the resorption process.

Gangrena de Fournier secundaria a cateterismo uretral

We report one case of Fournier's gangrene secondary to urethral catheterization. We describe the clinical case, in which the initial cause was identified, and perform a short bibliographic review. Although Fournier's gangrene was initially considered as idiopathic in etiology, currently it is possible to identify the entrance site of the infection. In the present case the insertion of a urethral catheter was the starting mechanism, associated with factors such as diabetes and alcoholism which favour its development. The patient was treated by surgical debridement and partial urethrectomy but finally died. We want to point out that urethral instrumentation should be done by expert hands due to the severity of possible complications. We should insist in the need of precocious treatment with wide spectrum antibiotics, radical debridement and complete urologic evaluation.

Relationship of serum sex-steroid hormones and prostate volume in African American men.

Previous epidemiologic investigations of the associations of sex-steroid hormones and benign prostatic hyperplasia (BPH) have focused on predominately white populations. The objective of this study was to evaluate potential associations of body mass index (BMI), cigarette smoking, use of alcohol, and endogenous sex-steroid hormones with prostate volume in a population-based sample of African American (AA) men, ages 40-79 yr. A total of 369 AA men without clinical evidence of prostate cancer were identified in the Flint Men's Health Study by using a population-based sampling procedure. All subjects underwent a complete urologic evaluation that included prostate volume determination by transrectal ultrasonography and serum assays for androgens and estrogens. After age adjustment, BMI (weight (kg)/height (m)2) was positively correlated with increasing levels of androstanediol glucuronide (AG), estradiol (E2), estrone sulfate (E1S), and the ratios of E2:total testosterone (TT) and E2:free testosterone (FT); however, increasing BMI was negatively correlated with androstenedione (AD), FT, TT, and sex hormone-binding globulin (SHBG). Multivariable regression models demonstrated that prostate volume increased with age (P < 0.001) and BMI (P = 0.02) and decreased with increasing levels of SHBG (P = 0.01). Larger prostatic volumes were also marginally associated with increasing levels of TT (P = 0.058). Circulating serum levels of SHBG and endogenous sex-steroid hormones are correlated with prostate volume and potentially impact the natural history of BPH. However, longitudinal studies are needed to demonstrate the temporal relationships of hormones and growth factors in the pathogenesis of BPH in AA men.