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Urol Ann ; 10(3): 291-295, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30089988


Aims: The aim of this study is to compare between transrectal ultrasound (TRUS)-guided aspiration and transurethral (TU) deroofing in the treatment of prostatic abscess regarding safety and efficacy. Settings and Design: This prospective randomized study was done during the period between April 2009 and March 2015 and included 32 patients with prostatic abscess. Subjects and Methods: All patients were enrolled in the study after obtaining a written informed consent and approval of the local ethical committee. The patients were randomly allocated into two groups; Group A treated by TRUS-guided aspiration, saline wash, and local injection of antibiotics and Group B treated by TU deroofing of the abscess. All patients received broad-spectrum antibiotics during the period of treatment, and the follow-up was done on the 5th day by TRUS to ensure complete resolution of the abscess. Statistical Analysis Used: Statistical analysis was done using online social science statistical calculators using t-test for two independent means, Chi-square test, and Mann-Whitney U-test with P < 0.05 considered statistically significant. Results: The mean age was 59 ± 11.46 and 60 ± 13.65 years for Groups A and B, respectively. Diabetes mellitus was detected in 9 (56.25%) and 6 (37.5%) patients in Groups A and B, respectively, hypertension in 7 (43.75%) and 6 (37.5%) patients in Groups A and B, respectively, and two patients (12.5%) with liver cirrhosis in each group. The mean size of the abscess was 3.36 ± 0.86 and 3.04 ± 0.86 cm in Groups A and B, respectively (P = 0.29). The abscess recurred in five patients (31.25%) and one patient (6.25%) in Groups A and B, respectively (P = 0.08). TRUS-guided aspiration was done for all recurrent cases except for two patients (12.5%) in Group A required trans urethral deroofing of the recurrent abscess. The mean hospital stay was 12.9 ± 4.05 and 7.25 ± 2.40 days for Groups A and B, respectively (P = 0.000). In Group A, one patient (6.25%) was complicated by urethrorectal fistula, whereas in Group B, one patient (6.25%) was complicated by septic shock, three patients (13.75%) with epididymo-orchitis and two patients (12.5%) with urethral stricture. Conclusion: Patients with prostatic abscess treated with TRUS-guided aspiration show less morbidity, higher recurrence rate, and longer hospital stay than those treated with TU deroofing.

Urol Oncol ; 36(5): 242.e9-242.e14, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29519561


OBJECTIVE: To report the sensitivity and specificity of neural precursor cell-expressed developmentally down-regulated protein 9 (NEDD9) protein high expression in predicting BCG response and its effect on recurrence or progression free survivals. PATIENTS AND METHODS: Between May 2014 and April 2017, a prospective cohort study was conducted on 105 patients with intermediate or high-risk nonmuscle invasive bladder cancer. Immunohistochemical staining with mouse monoclonal anti-NEDD9 antibody was done. Examination of the slides was done to detect NEDD9 cytoplasmic expression. Intravesical induction bacillus Calmette-Guerin (BCG) instillation therapy was started for all patients 2 to 4 weeks after endoscopy with once weekly instillation for 6 weeks. Intravesical maintenance BCG instillation was then continued every 3 months for at least 1 year. Follow up with cystoscopy every 3 months for 2 years and every 6 months after that. RESULTS: The mean age ± SD of the patients was 57 ± 4.5 years. The median follow-up period was 25 (12-36) months. NEDD9 protein was highly expressed in 61 (58.1%) patients, whereas low expression was in 44 (41.9%) patients. Sensitivity and specificity of NEDD9 high expression in predicting recurrence were 83.6% and 64.2%, respectively. Its sensitivity and specificity in predicting progression to muscle invasion or distant metastases were 91.3% and 51.2%, respectively. Its sensitivity and specificity in predicting complete response to BCG therapy were 84.1% and 80.9%. Kaplan-Meier test showed highly significant difference (P<0.0001) in survival without recurrence or progression between patients showing high expression and those showing low expression. CONCLUSION: NEDD9 protein tissue marker could be used as a predictive marker for BCG response in nonmuscle invasive bladder cancer with reasonable sensitivity and specificity.

Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Vacina BCG/uso terapêutico , Biomarcadores Tumorais/metabolismo , Recidiva Local de Neoplasia/patologia , Fosfoproteínas/metabolismo , Neoplasias da Bexiga Urinária/patologia , Administração Intravesical , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/metabolismo , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/metabolismo
Urology ; 107: 103-106, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28456539


OBJECTIVE: To evaluate the role of preoperative testicular shear wave elastography (SWE) in the prediction of improvement of semen analysis parameters after subinguinal microsurgical varicocele ligation in patients with primary infertility and clinically detectable varicocele. PATIENTS AND METHODS: Testicular SWE before the surgical intervention was done. Forty-eight patients were scheduled for subinguinal microsurgical varicocele ligation as a treatment option. Computer-assisted semen analysis was repeated 6 months after the intervention. RESULTS: At a cutoff value of 4.5 kPa, the stiffness index had a sensitivity of 86.4% and a specificity of 84.2% for semen parameter improvement after varicocelectomy. Correlation between different parameters of semen analysis and SWE showed a statistically significant negative correlation between SWE stiffness index and both sperm count (million/mL) and total motility. On the other hand, a nonsignificant negative correlation was found between SWE stiffness index and percentage of normal form. CONCLUSION: Testicular SWE is a good test that can be used in the assessment of male infertility with clinically detectable varicocele, and its results may predict semen parameter improvement after varicocelectomy. Further studies on a larger number of patients are needed to verify our results.

Infertilidade Masculina/cirurgia , Sêmen/diagnóstico por imagem , Motilidade Espermática/fisiologia , Testículo/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Adulto , Diagnóstico por Computador , Seguimentos , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Ligadura , Masculino , Microcirurgia/métodos , Reprodutibilidade dos Testes , Fatores de Tempo , Varicocele/complicações , Varicocele/diagnóstico
Urology ; 105: 202-207, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28411100


OBJECTIVE: To report the functional results of continent cutaneous ileal urinary diversion using modified W-pouch with non-isolated extra limb for continence. PATIENTS AND METHODS: From January 2013 to January 2016, 21 patients with muscle-invasive bladder cancer with median (interquartile range) of 59 (56.5-62.5) years old underwent radical cystectomy with pelvic lymphadenectomy; they then had an ileal continent cutaneous pouch constructed from W-pouch with non-isolated extra limb for continence. The technique entails the creation of a detubularized ileal W-pouch with extra limb fashioned from 59 cm of the terminal ileum. This extra limb is not isolated from the pouch. The proximal part of this limb is tailored and fixed in a subserous extramural tunnel for continence, whereas the distal part is left continuous with the pouch. The median (interquartile range) of follow up was 12 (8-17) months. Evaluation of the technique included operative time, continence efficiency, overall complications, and quality of life questionnaire for the patients. RESULTS: The median (interquartile range) of operative time of the operation was 4.7 (3.9-5.4) hours. The median (interquartile range) of operative time of the cutaneous pouch creation was 39 (33-43) minutes. No perioperative mortality had occurred. The incidence of continence was 95.2%. The overall complications were 42.8%, and most of them were grade 1 or 2 on Clavien-Dindo classification system. CONCLUSION: Modification of W-pouch with non-isolated extra limb as continent cutaneous pouch can simplify the technique and shorten the operative time with efficient continence, less side effects, and good quality of life.

Cistectomia , Íleo/cirurgia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Coletores de Urina , Idoso , Estudos de Coortes , Feminino , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Qualidade de Vida , Resultado do Tratamento
J Oncol ; 2017: 6095205, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28194179


Background. The most common malignant tumor of the urinary bladder is transitional cell carcinoma (TCC). Neural precursor cell-expressed developmentally downregulated protein 9 (NEDD9) is found to be a cell adhesion mediator. P38 Mitogen-Activated Protein Kinase is a serine/threonine kinases member which can mediate carcinogenesis through intracellular signaling. Methods. To assess their prognostic role; NEDD9 and p38 protein were evaluated in sections from 50 paraffin blocks of TCC. Results. The high expressions of NEDD9 and p38 protein were significantly associated with grade, stage, distant metastasis (p < 0.001), number of tumors, lymph node metastasis, and tumor size (p < 0.001, 0.002; 0.018, <0.001; and 0.004, 0.007, respectively). High NEDD9 and p38 detection had a worse 3-year OS (p = 0.041 and <0.001, respectively). By multivariate analysis the NEDD9 and p38 protein expression levels and various clinicopathological criteria including gender, grade, stage of the tumor, and regional lymph node involvement were independent prognostic parameters of TCC of the urinary bladder patients' outcome. Conclusion. NEDD9 and p38 protein expressions were poor prognostic markers of TCC.