Multifocal renal oncocytoma in a patient with Von Hippel-Lindau mutation.

Von Hippel-Lindau disease (VHL) is a rare genetic disease with a lifetime risk of clear cell renal cell carcinoma in approximately 70% of cases. We present a case of a 63-year-old man with bilateral, multifocal renal masses. Genetic testing results were consistent with a VHL deletion. The patient had no other disease manifestations consistent with VHL. The patient underwent staged bilateral nephron-sparing procedures. Pathology of all renal masses revealed oncocytoma. To our knowledge, we describe the first reported case of multiple renal oncocytomas in a male patient with a germline VHL mutation.

Isolated renal vein thrombosis after blunt trauma.

Renal vein thrombosis typically occurs in the setting of nephrotic syndrome, tumor thrombus, primary retroperitoneal processes with vein compression, oral contraceptive use, steroid therapy, transplanted kidney, or trauma. Trauma-induced renal vein thrombosis usually presents in combination with renal arterial or parenchymal injury. We report a case of isolated renal vein thrombosis secondary to blunt abdominal and flank trauma. The diagnosis was made with computed tomography, which revealed a filling defect in the affected renal vein and persistent nephrogram on delayed images. In general, conservative management is the preferred treatment approach with anticoagulation.

Degree of bother caused by nocturia in women.

AIMS: The prevalence of nocturia in women has been studied, but its severity has not been categorized based on degree of bother. The number of nighttime voids that defines clinically significant nocturia has not been established. The objective of this study was to establish how bothersome nocturia is in women and to determine whether number of nighttime voids correlates with the degree of bother. We also sought to determine if this correlation was affected by age or continence status. MATERIALS AND METHODS: The charts of 1,214 neurologically healthy women that presented to a female urology office were reviewed. All women completed the American Urological Association Symptom Index (AUASI) and the symptom problem index (SPI). Question no. 7 of the AUASI assesses the number of voids per night and question no. 3 of the SPI assesses the bother of nighttime voiding. The correlation of these two variables was evaluated using a proportional odds model. RESULTS: Mean age was 54.6 years (18-93). 87.3% complained of waking at least one time per night to void. Bother score increased as the number of nightly voids increased, irrespective of age or continence status. The proportional odds model showed that as the number of voids increases 1 value on AUASI, the odds of having an increase in bother increases 2.7 times (P<0.0001). CONCLUSIONS: As the number of nighttime voiding episodes increases, the bother increases, independent of age or continent status. Based on the degree of bother, we propose that clinically significant nocturia in women be classified as two or more episodes per night.

Tamsulosin reduces the incidence of acute urinary retention following early removal of the urinary catheter after radical retropubic prostatectomy.

OBJECTIVES: To determine the efficacy of tamsulosin in preventing acute urinary retention following early catheter removal after radical retropubic prostatectomy. METHODS: Between February 2000 and October 2000, cystography was performed on postoperative day 7 after radical retropubic prostatectomy by a single surgeon (group 1). Between September 2001 and August 2002, cystography was performed on postoperative day 8 after radical retropubic prostatectomy by the same surgeon (group 2). The protocol for performing cystography and assessment of extravasation was similar for both groups. Tamsulosin 0.4 mg was administered 3 days before and 4 days after cystography for all men in group 2. RESULTS: Of 179 cystograms in group 1, 135 (75%) revealed no extravasation, and the catheters were removed in 130 of these cases. Of 246 cystograms in group 2, 230 (93.5%) revealed no extravasation, and the catheters were removed in 229 of these cases. A significantly greater proportion of men in group 2 had no extravasation (P = 0.0007). The incidence of acute urinary retention in groups 1 and 2 was 10% and 2.6%, respectively (P = 0.0018). The incidence of anastomotic stricture was not significantly different between the two groups. CONCLUSIONS: Our data strongly suggest that tamsulosin significantly reduces the risk of acute urinary retention after attempts at early catheter removal following radical retropubic prostatectomy. Therefore, we recommend administering a 7-day course of tamsulosin therapy when attempting to remove the urinary catheter before postoperative day 8.

American Urological Association Symptom Index for lower urinary tract symptoms in women: correlation with degree of bother and impact on quality of life.

OBJECTIVES: To determine first whether the American Urological Association Symptom Index (AUASI) correlates with the degree of bother caused by lower urinary tract symptoms (LUTS) in women and whether the association varies with a woman's age and continent status; and second, whether the AUASI and degree of bother caused by symptoms correlate with a woman's quality of life (QOL) and whether the association varies with a woman's age and continent status. LUTS occur in women and may produce significant bother and affect their QOL. The AUASI has been used to evaluate LUTS in female patients; however, its correlation with the degree of bother and QOL has not been clearly established in women. METHODS: The charts of 1232 women who completed the AUASI, as well as the Symptom Problem Index and global QOL question, were reviewed. Spearman's rank order correlation was computed to assess the correlation between the AUASI and Symptom Problem Index. It was also computed after stratifying the women's age and continence status (continent versus incontinent). A linear regression model was applied, with the AUASI and Symptom Problem Index as the response variables and QOL as the continuous explanatory variable. RESULTS: The mean age was 54.6 years. Six hundred women (49%) were incontinent. Spearman's rank order showed a strong correlation between symptoms and problems caused by symptoms (0.858, P <0.0001). The correlation existed throughout various age groups and was independent of coexisting incontinence. The symptoms correlated with QOL in a similar pattern. CONCLUSIONS: The AUASI accurately described LUTS in women and, as with men, is a good indicator of the degree of bother and affect on QOL.