Search

Circumcision is possibly the most frequently performed elective surgical procedure in men. It can simply be described as the excision of the preputium. There have been several studies about the association between circumcision and urinary tract infections (UTI). Many studies have demonstrated that the frequency of UTI increase in uncircumcised males, especially in the first year of life. This review discusses the embryology of the preputium, epidemiology, indications, complications and benefits of circumcision, as well as operation and anesthesiology techniques. It especially examines the association between UTI and circumcision and the importance of circumcision in congenital urinary system anomalies. In addition, this review examines the associations between circumcision and sexually transmitted diseases, including HIV, and the protective role of circumcision on penile cancer.

Objective: Bladder wall thickness (BWTh) measurements and Nerve Growth Factor (NGF) /creatinine (Cr) values, as noninvasive tools, were found to predict daytime voiding problems in children with overactive bladder (OAB). The goal of this research was to examine if bladder wall thickness together with urine NGF/Cr could be a clinical utility in treatment outcome of OAB in children., Patients and Methods: A total of 60 children with OAB, (Group 1; n=40) and healthy normal controls (Group 2; n=20), aged 6-14 years old were involved in this prospective study. Children were evaluated with detailed history and physical examination, including neurologic examination, and were asked to complete a self-reported questionnaire and a 3-day bladder diary with the aid of their parents. Uroflowmetry was performed in all cases. Urinary nerve growth factor levels were measured by the ELISA and BWTh was measured trans-abdominally by one uro-radiologist specialized in pediatric ultrasonography. Urinary NGF levels were normalized by urinary creatinine levels and compared among all subgroups. Children with OAB received urotherapy as first line treatment at least for three months. 18 children refractory to urotherapy received anticholinergic therapy defined as group 3., Results: The median age of the study group was 10 (range 6 to 16). After urotherapy, 22 children had similar BWTh and NGF/Cr values compared to controls. (2.75 ± 1.15; 2.40 ± 1.00 mm; p=0.86 and 1.02 ± 0.10; 0.78 ± 0.15; p=0.12, respectively). After anticholinergic treatment, BWTh levels (2.25 ± 0.90; 2.40 ± 1.00 mm; p=0.94) and NGF/Cr values (0.95 ± 0.10; 0.78 ± 0.15; p=0.42, respectively) had no significantly difference compared to controls (Group 2). In receiver operating characteristic analysis, bladder wall thickness was found to have sensitivity of 85% and specificity of 84.2% (3,20 AUC ,913; 95 %) and NGF/Cr had sensitivity of 90% and specificity of 92.1% (1,595; AUC ,947; 95 %) in predicting treatment outcome in children with OAB., Conclusions: Bladder wall thickness measurements and NGF/Cr values, as noninvasive tools, could guide outcomes in the treatment of children with overactive bladder., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Purpose: To  discuss  whether  concealed  penis  after  circumcision  lowers  perimeatal  urethral  and  glanular  sulcus  uropathogenic  bacterial  colonization  in  healthy  boys  with  no  urinary  tract  problems  and  prevents  attacks  of  febrile  urinary  tract  infections  in  non-healthy  boys  with  defined  urinary  tract  abnormalities.  Materials and Methods:  This  case-control  study  was  conducted  in  Ibn-i  Sina  Hospital  and  retrospectively  collected  data  of   471 boys  were  analyzed.  All  patients  were  scanned  for  any  urinary  tract  abnormality  and  those  with  any  defined  abnormalities  were  classified  as  non-healthy  group. (123 patients)  Non-healthy  patients  were  divided  into  two  subgroups  as  concealed  (n:31)  and  non-concealed  (n:92)  penis  after  circumcision.  Healthy  patients  with  no  urinary  problems  were  divided  into  three  groups  as  circumcised  without  concealed  penis  (n:144),  with  concealed  penis  after  circumcision  (n:104)  and  uncircumcised  control  group  (n:100).  Bacterial  cultures  were  obtained  from  both  periurethral  meatal  and  glanular  sulcus  areas  by  adhering  strictly  to  the  rules  of  obtaining  bacterial  culture  to  avoid  false-positive  or  negative  culture  results.  Also  only  uropathogenic  bacterias  were  evaluated,  irrelevant  results  were  excluded.     Results:  Mean  age  was  similar  in  healthy  population.  Comparison  of  three  groups  showed  that  there  was  a  significant  difference  in  both  cultures.(P = .026 for periurethral meatal region, P = .039 for glanular sulcus region)  In  post  hoc  analysis,  non-concealed  group  had  a  lower  rate  of  culture  positivity  in  both  areas  compared  to  other  groups.    Mean  age  was  also  similar  in  non-healthy  population.  Mean  follow-up  period  was  18.2  months.  Patients  with  concealed  penis  after  circumcision  had  a  significantly  higher  number  of  febrile  UTI  attacks  (20 attacks in 8 patients vs 7 attacks in 5 patients)  compared  to  non-concealed  group. (P = .019)  All  febrile  UTI  attacks  except  one  in  this  group  occurred  below  the  age  of  12  months. A  total  of  10 patients  in  both  healthy  and  non-healthy  groups  had  postoperative  hemorrhage  after  circumcision  and  only  1  patient  had  a  wound  infection.          Conclusion:  Concealed  penis  after  circumcision  does  not  lower  perimeatal  urethral  and  glanular  sulcus  uropathogenic  bacterial  colonization  in  healthy  patients  and does not  protect  unhealthy  patients  from  febrile  urinary  tract  infection  attacks.  If  circumcision  is  planned,  concealed  penis  should  be  avoided  and  also  parents  should  be  informed  about  the  possible  risks  due  to  concealed  penis  before  the  procedure,  particularly  in  patients  with  urinary  tract  abnormalities.

Peutz-Jeghers syndrome (PJS) is inherited as an autosomal dominant trait characterized by multiple gastrointestinal hamartomatous polyps, mucocutaneous pigmentation, and an increased risk of neoplasm. Large-cell calcifying Sertoli cell tumor (LCCSCT) is a kind of sex cord-stromal tumor which may co-exist with PJS and which is characterized radiologically by calcification foci within the testes. Surgical treatment options for this tumor range from testis-preserving surgery to radical orchiectomy. Not with standing this invasive approach, recently, there are some case reports demonstrating the efficacy of aromatase inhibitors in avoiding orchiectomy and its associated complications. In this paper, we have presented a LCCSCT case diagnosed in a boy with PJS and his response to anastrozole treatment.

Purpose: To date, laparoscopy has gradually become the gold standard for treatment of non-palpable testicles (NPT) with different success and complication rates. In this study, we aimed to evaluate outcomes of laparoscopic approaches for NPT., Materials and Methods: We reviewed data of 82 consecutive patients who underwent laparoscopic treatment for unilateral NPT at two institutions by two high volume surgeons from 2004 January to 2014 December. Laparoscopic-assisted orchidopexy (LAO) and two-stage Fowler-Stephens technique (FST) was performed for 45 and 37 patients, respectively. Age (at surgery), follow-up time, laterality of testes, and postoperative complications were analyzed. Modified Clavien classification system (MCCS) was used for evaluating complications., Results: The median age (at surgery) and median follow-up time were 18 (range: 6-56) and 60 (range: 9-130) months, respectively. Overall success rate for two laparoscopy techniques was 87.8% during the maximal follow-up time. We observed wound infection in two, hematoma in one, testicular atrophy in five, testicular re-ascending in two patients at follow-up period. There was no statistical difference between two laparoscopic techniques for grade I (five vs. two patients, p = 0.14) and grade IIIb MCCS complications (five vs. two patients, p = 0.44)., Conclusion: Our results have shown that two laparoscopic approaches have low complication rates.

Introduction: To evaluate possible factors that can guide the clinician to predict potential cases refractoriness to medical treatment for giggle incontinence (GI) and to examine the effectiveness of different treatment modalities., Material and Methods: The data of 48 children referred to pediatric urology outpatient clinic between 2000 and 2013 diagnosed as GI were reviewed. Mean age, follow-up, GI frequency, associated symptoms, medical and family history were noted. Incontinence frequency differed between several per day to less than once weekly. Children were evaluated with uroflowmetry-electromyography and post-void residual urine. Clinical success was characterized as a full or partial response, or nonresponse as defined by the International Children's Continence Society. Univariate analysis was used to find potential factors including age, sex, familial history, GI frequency, treatment modality and dysfunctional voiding to predict children who would possibly not respond to treatment., Results: Mean age of the patients was 8.4 years (range 5 to 16). Mean follow-up time and mean duration of asymptomatic period were noted as 6.7±1.4 years and 14.2±2.3 months respectively. While 12 patients were treated with only behavioral urotherapy (Group-1), 11 patients were treated with alpha-adrenergic blockers and behavioral urotherapy (Group-2) and 18 patients with methylphenidate and behavioral urotherapy (Group-3). Giggle incontinence was refractory to eight children in-group 1; six children in-group 2 and eight children in-group 3. Daily GI frequency and dysfunctional voiding diagnosed on uroflowmetry-EMG were found as outstanding predictive factors for resistance to treatment modalities., Conclusions: A variety of therapies for GI have more than 50% failure rate and a standard treatment for GI has not been established. The use of medications to treat these patients would not be recommended, as they appear to add no benefit to symptoms and may introduce severe adverse effects.

Sodium phosphate based laxatives are commonly used for constipation and pre-procedural bowel cleansing. Phosphate intoxication related with these preparations is well recognized. Herein, we present a case of severe hyperphosphatemia and seizure in a 7-year-old male patient after administration of an oral sodium phosphate based laxative. At the time of admission, serum phosphorus level was 25.6 mg/dl. Aggressive fluid therapy was started. Although serum phosphorus level decreased to 20.9 mg/dl eight hours after admission, hemodialysis was performed because of the preexisting renal disease and declined glomerular filtration rate. Serum phosphorus level and blood gas analysis returned to normal after hemodialysis and the patient was discharged on hospital day two. In conclusion, sodium phosphate based laxatives should be used carefully in patients with preexisting renal diseases. Intravenous hydration and correction of hypocalcemia are important components of treatment. Hemodialysis is indicated in patients with renal failure.

Congenital bladder diverticulum (CBD) is a very uncommon entity in adults. CBD could be unilateral or bilateral and is caused by a congenital weakness in the bladder musculature. CBD is differentiated from the paraureteral or Hutch type of diverticula. A 42-year-old male presented with bilateral Hutch diverticulum and multiple diverticulum calculus on intravenous pyelography. Cystoscopy revealed bladder diverticulum just medial to the left ureteral orifice with multiple calculi; the patient successfully underwent endoscopic laser cystolithotripsy with resolution of his urinary tract infection. To the best of our knowledge, this is the first case report presenting stone formation of CBD in an adult.

Objective: In this study we aimed to compare photoselective vaporization (PVP) with the GreenLight 120-W Laser and monopolar transurethral resection as surgical treatments of prostates less than 80 cc in men with obstructive benign prostatic hyperplasia., Methods: From February 2009 to March 2012 we allocated 101 patients with a prostate glands of less than 80 cc; patients were randomly assigned for surgical treatment with monopolar transurethral resection of the prostate (TURP) (n = 62) or PVP (n = 39). Serum prostate specific antigen (PSA), International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), maximum flow rate (Qmax) postmicturition residual (PMR), transrectal ultrasound volumes (TRUS), postvoid urine residual (PVR), complications, re-operations and hospitalization time were collected. The patients were seen in the follow up at 6, 12 and 24 months., Results: Median age was 69 (56-87) years old in the TURP group and 67 (51-87) years old in the PVP group. Mean preoperative prostate volume was 55 cc (40-72) and 60 cc (41-75) cc in the TURP group versus the PVP group. There was no statistically difference in subjectively (IPSS, SHIM) and objectively (Qmax-PMR) parameters and postoperatively complication rates between the two groups (p > 0.05). A significant difference was observed in the PVP group with a 2 (1-4) days hospital stay compared with 5 (3-9) days for the TURP group (p  < 0.001)., Conclusion: Prostate PVP and TURP are effective surgical treatments for benign prostatic hyperplasia. Postoperative functional improvements were durable and equivalent in the two groups. The two techniques have a similar complication rate.

Undescended testes can be found in the inguinal channel or in the abdomen. Rarely, undescended testes can present with transverse testicular ectopia (TTE) and very rarely, with residual Müllerian duct (MD) structures. This latter presentation is called persistent MD syndrome (PMDS). PMDS is mostly discovered during surgery for inguinal hernia or cryptorchidism. TTE is a rare congenital anomaly in which both testes descend through a single inguinal canal. Patients with TTE present with symptoms of unilateral cryptorchidism and contralateral inguinal hernia. Herein, we report two TTE cases: one associated with PMDS and the other having only cross ectopia. For patients with inguinal hernia and cryptorchidism associated with TTE, PMDS should be kept in mind and radiologic evaluation with ultrasonography or magnetic resonance imaging of the genitourinary system and karyotyping are recommended. Radiologic evaluation can be helpful in the diagnosis of TTE; however, it cannot diagnose the malignancy itself. Laparoscopy is very useful for both diagnosis and treatment of TTE.

Purpose: To evaluate the influence of perinephric fat infiltration and tumor size on survival of patients with renal cell carcinoma (RCC)., Materials and Methods: We have retrospectively reviewed the records of 338 consecutive patients with pT1-3aN0M0 RCC, including 275 pT1-2 and 63 pT3a tumors, who underwent open partial or radical nephrectomy between 1995 and 2008. Univariate and multivariate analyses were performed in order to evaluate the prognostic factors., Results: Median follow-up period was 36.07 months. Receiver Operating Characteristic curve analysis determined the optimal tumor size cutoff value as 7 cm (Area Under the Curve: 0.65 ± 0.047; 95% Confidence Interval: 0.558 to 0.741). Perinephric fat invasion and Fuhrman grade were independent prognostic factors for disease-specific survival (DSS). In patients with tumor size >7 cm, perinephric fat invasion affected DSS significantly. Tumor size (according to the cutoff value of 7 cm) significantly affected DSS in patients with pT3a disease. According to the TNM 2002 staging system, perinephric fat invasion did not have any significant effect on DSS in patients with tumor size smaller than 4 cm, unlike tumor size of 4 to 7 cm and >7 cm. pT3a tumors larger than 7 cm demonstrated the worst prognosis compared to other groups., Conclusion: Perinephric fat invasion was demonstrated as a significant prognostic factor for RCC patients with tumor size >4 cm. Consequently, evaluation of pT3a patients should take tumor size into consideration for better prognostic analysis.

Urofacial syndrome (UFS) (or Ochoa syndrome) is an autosomal-recessive disease characterized by congenital urinary bladder dysfunction, associated with a significant risk of kidney failure, and an abnormal facial expression upon smiling, laughing, and crying. We report that a subset of UFS-affected individuals have biallelic mutations in LRIG2, encoding leucine-rich repeats and immunoglobulin-like domains 2, a protein implicated in neural cell signaling and tumorigenesis. Importantly, we have demonstrated that rare variants in LRIG2 might be relevant to nonsyndromic bladder disease. We have previously shown that UFS is also caused by mutations in HPSE2, encoding heparanase-2. LRIG2 and heparanase-2 were immunodetected in nerve fascicles growing between muscle bundles within the human fetal bladder, directly implicating both molecules in neural development in the lower urinary tract., (Copyright © 2013 The American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.)

A 48-year-old man was hospitalized with the chief complaints of lower abdominal pain, pain during micturation and pollakuria. Plain radiography showed 2 giant bladder stone shadows: one as 6.0 × 5.0 cm and the other one 5.0 × 5.0 cm in size. Cystolithotomy was performed. The first stone weighed 400 g and measured 6.0 × 5.0 × 6.0 cm in size, and the other stone was fragmented to smaller particles with pneumatic lithotriptor. Although a bladder stone is not rare, this case is interesting for 2 huge bladder calculi that were completely obstructing the bladder outlet and observed several years following pelvic trauma. To the best of our knowledge, our patient represents one of the largest bladder stone cases reported to date.

Objective: To evaluate the change in penile size r bilateral nerve sparing retropubic radical prostatectomy (BNSRRP) and possible effect of Tadalafil., Materials and Methods: A total of 65 patients underwent BNSRRP and they were evaluated prospectively for a whole year of follow-up. The patients were randomized to control without rehabilitation (Group 1) or Tadalafil rehabilitation group (Group 2). The patients were evaluated at months 3, 6 and 12 postoperatively for erectile function, penile measurements (flaccid penile length, penile length at maximum erection, penile circumference at flaccid status, and penile circumference at maximum erection), penile abnormalities and general health status. Statistical analysis was performed by Chi-Square test and significance was defined as p value < 0.05., Results: In Group 1 there was significant decrease in penile measurements at month 3 compared to preoperative measurements. There was decrease in all parameters at month 6 compared to month 3 but only the decrease in penile length at maximum erection was significant. There were no significant differences between postoperative months 6 and 12 for all measurements. In Group 2 there was a tendency to decrease in all measurements at month 3 compared to baseline. There was no significant difference for penile measurements between postoperative 3rd and 6th months and between 6th month and the first year., Conclusion: Although further large sampled trials are needed to describe the possible positive effect of tadalafil or other PDE5-I 's on penile size after BNSRRP, tadalafil rehabilitation is effective in preserving penile size especially in the early postoperative period after BNSRRP.

A multidisciplinary approach is mandatory in defining the cause and directing the treatment of childhood urinary incontinence. Both pediatricians and pediatric urologists should carefully evaluate a child with incontinence for possible overlapping etiologies, before labeling him or her as a refractory case. We report an epileptic boy with dysfunctional elimination syndrome (DES) with associated rare complications of giggle incontinence and idiopathic urethritis, proving the need for a good voiding diary, patient history and structured symptom scores.

Urinary voiding dysfunction in childhood, manifesting as incontinence, dysuria, and urinary frequency, is a common condition. Urofacial syndrome (UFS) is a rare autosomal recessive disease characterized by facial grimacing when attempting to smile and failure of the urinary bladder to void completely despite a lack of anatomical bladder outflow obstruction or overt neurological damage. UFS individuals often have reflux of infected urine from the bladder to the upper renal tract, with a risk of kidney damage and renal failure. Whole-genome SNP mapping in one affected individual defined an autozygous region of 16 Mb on chromosome 10q23-q24, within which a 10 kb deletion encompassing exons 8 and 9 of HPSE2 was identified. Homozygous exonic deletions, nonsense mutations, and frameshift mutations in five further unrelated families confirmed HPSE2 as the causative gene for UFS. Mutations were not identified in four additional UFS patients, indicating genetic heterogeneity. We show that HPSE2 is expressed in the fetal and adult central nervous system, where it might be implicated in controlling facial expression and urinary voiding, and also in bladder smooth muscle, consistent with a role in renal tract morphology and function. Our findings have broader implications for understanding the genetic basis of lower renal tract malformations and voiding dysfunction.