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SamenvattingDe arterio-ureterale fistel (AUF) is een zeldzame aandoening met een relatief hoge mortaliteit, die meestal voorkomt na uitgebreide pelviene oncologische chirurgie in combinatie met bestraling en chronische ureterale stenting. Jaarlijks worden in Nederland ongeveer vier AUF’s gediagnosticeerd, mogelijk ligt de frequentie zelfs hoger. De pathofysiologie van een AUF berust hoofdzakelijk op chronische inflammatie, fibrose, slechte vascularisatie en uiteindelijk druknecrose. Lokalisatie van een AUF is voornamelijk ter hoogte van de overkruising van de ureter met de arteria iliaca communis. AUF presenteert zich vaak in een acute setting met massaal bloedverlies. Een angiografie is het meest sensitieve diagnosticum en de behandeling van voorkeur betreft een endovasculaire interventie.

Purpose Arterio-ureteral fistula (AUF) is an uncommon diagnosis, but potentially lethal. Although the number of reports has increased over the past two decades, the true incidence and contemporary urologists’ experience and approach in clinical practice remains unknown. This research is conducted to provide insight in the incidence of AUF in The Netherlands, and the applied diagnostic tests and therapeutic approaches in modern practice. Methods A nationwide cross-sectional questionnaire analysis was performed by sending a survey to all registered Dutch urologists. Data collection included information on experience with patients with AUF; and their medical history, diagnostics, treatment, and follow-up, and were captured in a standardized template by two independent reviewers. Descriptive statistics were used. Results Response rate was 62% and 56 AUFs in 53 patients were reported between 2003 and 2018. The estimated incidence of AUF in The Netherlands in this time period is 3.5 AUFs per year. Hematuria was observed in all patients; 9% intermittent microhematuria, and 91% presenting with, or building up to massive hematuria. For the final diagnosis, angiography was the most efficient modality, confirming diagnosis in 58%. Treatment comprised predominantly endovascular intervention. Conclusion The diagnosis AUF should be considered in patients with persistent intermittent or massive hematuria.

Purpose:Arterio-ureteral fistula (AUF) is an uncommon diagnosis, but increasingly reported and potentially lethal. This systematic review comprehensively presents risk factors, pathophysiology, location and clinical presentation of AUF aiming to increase clinical awareness of this rare but life-threatening condition, and to put this entity into a contemporary perspective with modern diagnostic tools and treatment strategies.Materials and Methods:This review was performed according to the PRISMA (Preferred Reporting Items for a Systematic Review and Meta-Analysis of Individual Participant Data) guidelines. A literature search in PubMed® and EMBASE™ was conducted. In addition, retrieved articles were cross-referenced. Data parameters included oncologic, vascular and urological history, diagnostics, treatment, and followup, and were collected using a standard template by 2 independent reviewers.Results:A total of 245 articles with 445 patients and 470 AUFs were included. Most patients had chronic indwelling ureteral stents (80%) and history of pelvic oncology (70%). Hematuria was observed in 99% of the patients, of whom 76% presented with massive hematuria with or without previous episodes of (micro)hematuria. For diagnosis, angiography had a sensitivity of 62%. The most predominant location of AUF was at the common iliac artery ureteral crossing. AUF-specific mortality before 2000 vs after 2000 is 19% vs 7%, coinciding with increasing use of endovascular stents.Conclusions:AUF should be considered in patients with a medical history of vascular surgery, pelvic oncologic surgery, irradiation and/or chronic indwelling ureteral stents presenting with intermittent (micro)hematuria. A multidisciplinary consultation is necessary for diagnosis and treatment. The most sensitive test is angiography and the preferred initial treatment is endovascular.

To study the effectiveness of two laser techniques clinically used to fragment renal stones: fragmenting technique (FT) and popcorn technique (PT).Phantom stones were placed in a test tube filled with water, mimicking a renal calyx model. A Holmium:YAG laser was used for fragmentation using both techniques. Four series of experiments were performed with two parameters: the technique (FT or PT) and the number of stones in the test tube (one or four). The mass decrease of the phantom stones was measured before, during, and after the experiment to quantify the effect of both techniques.Visualization of PT showed that the main effect of PT takes place, when the stone moves in front of the laser fiber and is subject to direct radiant exposure. Both FT and PT resulted in a decrease in stone weight; the mass decrease of the stones subjected to FT exceeded that of the stones subjected to PT, even with less laser energy applied. This difference in mass decrease was evident in both the experiments with one and four stones.PT was less effective in decreasing stone weight compared with FT. The FT is more effective regarding the applied energy than PT, even in a shorter time period and regardless of the number of stones. This study suggests that FT is to be preferred over PT, when stones are accessible by the laser fiber. Lasers Surg. Med. 49:698-704, 2017. © 2017 Wiley Periodicals, Inc.

Wij beschrijven een casus van een 48-jarige vrouw met een atypische blaastumor. Patient is bekend met familiaire paragangliomen. Een catecholamineproducerende blaastumor zou tijdens een operatie een plotselinge bloeddrukstijging kunnen veroorzaken als gevolg van een catecholaminecrisis. Uit voorzorg werden daarom, voorafgaand aan de resectie van de blaastumor, de catecholaminereceptoren (met name de alfareceptoren) geblokkeerd. Er werd een transurethrale resectie gedaan van een blaastumor met een doorsnee van 1 cm. Pathologisch onderzoek bevestigde de diagnose; het bleek inderdaad te gaan om een paraganglioom van de blaas.

Met elastografie kan er extra informatie worden verkregen over de hardheid ofwel strain van een (testiculaire) afwijking, wat de kans op een maligniteit meer of minder waarschijnlijk maakt. In deze PICO vergeleken wij elastografie met de conventionele (of grey-scale) echo scrotum bij patienten met een testiculaire afwijking, met als uitkomstmaat het vaststellen of uitsluiten van een maligniteit. Helaas is er over dit onderwerp heel weinig literatuur beschikbaar; wij vonden slechts vier studies. Aangetoond is dat elastografie extra informatie kan opleveren; de studie van Aigner et al. toont een stijging van de specificiteit van 6 % (75 % met conventionele echo versus 81 % met elastografie). Bovendien is elastografie een relatief makkelijk en snel uitvoerbaar onderzoek. Echter, harde conclusies zijn niet mogelijk gezien het geringe aantal onderzoeken en de methodologische beperkingen van de artikelen. Voor de dagelijkse praktijk zijn wij van mening dat elastografie bij testisafwijkingen een meerwaarde kan hebben, maar meer onderzoek is wenselijk.

An undesired side effect of cancer treatment is potential subfertility or infertility. Timely cryopreservation of semen is the best modality to ensure fertility. This retrospective data analysis established the usage rate of cryopreserved semen from cancer patients. Pubertal and post-pubertal patients who could become infertile as a result of cancer (treatment) were offered the option to cryopreserve semen prior to treatment. Of the 898 patients who cryopreserved their semen in our hospital, 96 (10.7%) used this for assisted reproductive technology. The live birth rates for intrauterine insemination, in-vitro fertilization, intracytoplasmic sperm injection and cryopreserved embryo transfer were 13%, 29%, 32% and 17%, respectively. Of all couples involved, 77% achieved parenthood, i.e. 60 of the 78 patients (with complete follow-up) fathered at least one child.

The purpose of this study was to assess the image quality and diagnostic value of MR urography in detecting abnormalities of the urinary collecting system relevant for the preoperative evaluation of living renal donors. Study subjects were selected from the existing intravenous urography (IVU) reports: 18 consecutive patients with a duplication or another abnormality of the collecting system and 20 consecutive patients with normal anatomy. They underwent a respiratory-triggered 3D T2-weighted fast spin-echo acquisition after oral administration of furosemide, without and with abdominal compression. The MR images were evaluated by two independent blinded observers. The IVU was used as the standard of reference. Image quality of the MR urograms with compression was overall better than those without compression, and the former were regarded as adequate for the evaluation of small filling defects and deformities of the pelvis and calyces in 76-81% of the kidneys and 74-79% of the patients. Both observers correctly diagnosed all 13 kidneys with a partial or complete duplication. The image quality of MR urography was inadequate to evaluate the calyces and pelvis for small filling defects or deformities in approximately 25% of the patients; however, the technique was accurate in the detection of abnormalities of the urinary collecting system relevant for the preoperative evaluation of living renal donors.

To date therapies for condylomata acuminata of the male genital are known for high recurrence rates and bothersome side effects, while urethral warts are not always reachable by most traditional therapies.To compare the clinical outcomes in the treatment of condylomata acuminata on the male external genitalia and/or urethra using the Thulium laser and the Neodymium:Yttrium Aluminum Garnet laser (Nd:YAG).From January 1994 to January 2013, 76 men with condylomata acuminata on the external genitalia or within the urethra were treated with the Nd:YAG laser and 39 men with the Thulium laser. Primary clearance rate, relapse characteristics and complications were investigated retrospectively and compared.Of the total of 115 patients, 39 patients (34%) developed recurrences, of which 13 in the Thulium laser group en 26 in the Nd:YAG laser group. Two patients in the Thulium group and four in the Nd:YAG group had minor complications.This first report of the treatment of condylomata acuminata with the Thulium laser shows that it is a safe and effective treatment for condylomata, both on the external genitalia and in the urethra. The recurrence rate is comparable to the Nd:YAG laser and there have been minimal complications as a result of minimal scarring.