ABSTRACT

Nocturia, which affects general health and quality of life, is a symptom often observed not only in patients with benign prostatic hyperplasia, but in the elderly of both genders as well. There are 5 causes of nocturia: (1) nocturnal polyuria, (2) reduction of nocturnal bladder capacity, (3) a combination of 1 and 2, (4) global polyuria, and (5) sleep disorders. To understand the pathogenesis of nocturia, it is important to investigate different factors for each cause. For nocturnal polyuria (1), it is important to investigate excessive fluid intake, hypertension, circadian rhythm of arginine vasopressin (AVP), and cardiovascular conditions based on brain natriuretic peptide (BNP) levels in plasma. For reduction of nocturnal bladder capacity (2), blood pressure and plasma concentrations of melatonin and glycine must be measured. Complicating systemic diseases such as diabetes mellitus, diabetes insipidus and polydipsia can lead to global polyuria (4), and sleep disorders (5) are defined by the quality of sleep, including conditions of arousal and hypnagogic disorders. The purpose of this article is to review the pathogenesis and diagnosis of nocturia, particularly by focusing on other causes than urological fields, which might lead to a better understanding of nocturia. To diagnose and make a therapeutic plan for nocturia, a modified bladder diary, International Prostate Symptom Score (IPSS), King’s Health Questionnaire (KHQ), Pittsburgh Sleep Quality Index (PSQI), and a sleeping diary are useful and should be combined with an interview and urological examination.

Keywords: Nocturia, Pathogenesis, Diagnosis

Correspondence: Hitoshi Oh-oka, Department of Urology, Independent Administrative Institution National Hospital Organization Kobe Medical Center 3-1-1, Nishi-Ochiai, Suma-ku, Kobe, Hyogo 654-0155, Japan,
ohoka-h@ares.eonet.ne.jp

ABSTRACT

Renal cell carcinoma (RCC) with gallbladder metastasis is a very rare entity, whether as a synchronous or metachronous lesion. Additional ancillary immunohistochemical tests may be required to make the diagnosis. We report the case of a 66-year-old woman with primary RCC and a synchronous gallbladder metastasis, who underwent laparoscopic radical nephrectomy and cholecystectomy in the same setting. Gallbladder histopathology revealed clear cell RCC, similar to the primary tumor. With positive immunostaining of the tumor for CA-IX, she has responded well to interleukin-2 immunotherapy.

Keywords: Kidney neoplasm, Gallbladder, Metastasis

Correspondence: J. Stuart Wolf, Jr., University of Michigan, Department of Urology, 1500 East Medical Center Drive, TC 3875, Ann Arbor, MI, 48109, wolfs@umich.edu

ABSTRACT

Between May 2000 and May 2003, 300 living donor nephrectomies were performed through an extraperitoneal flank approach. The majority of complications were minor, easily diagnosed, and managed during hospital stay. Early postoperative complications were reported in 22 (7.33%) cases. Of these, wound complications were the most common, accounting for 10 (3.33%) complications, followed by 8 (2.67%) pulmonary complications. The most serious postoperative complication was frank wound bleeding necessitating wound exploration in 2 (0.67%) patients. Postoperative urinary retention was reported in 3 (1%) patients, and deep venous thrombosis was reported in 1 (0.33%). Urinary tract infections were diagnosed in 15 (5%) patients, and there was a stricture of the urethra in 1 (0.33%) patient. All cases were diagnosed and managed carefully. Follow-up lasted for 18-36 months. Late postoperative complications were reported in 28 (9.33%) patients, and urinary calculi were found in 12 (4%) donors.

We proved that retroperitoneal flank nephrectomy is a safe approach for the donor, with acceptable early and late surgical complications. It provides optimal allografts for transplantation, and there were no complications related to non-drain fixation.

Keywords: Living donors, Nephrectomy, Surgical complications

Correspondence: Ahmed Shelbaia, Department of Urology, Cairo University, Borg El Atbaa, Faisal Street, Giza, Egypt, ahmedshelbaia@yahoo.com

ABSTRACT

Introduction: Although simple renal cysts are usually asymptomatic and discovered incidentally, treatment is undoubtedly still indicated in symptomatic patients. Significant pain, compression of the pelvicalyceal system, and possibly related hypertension or hematuria are indications for intervention.

Patients and Methods: Our study included 17 patients (11 men and 6 women, mean age of 46 years) with symptomatic simple renal cysts. The main presentation was renal pain in 9 patients, followed by hypertension in 5 and hematuria in 3. The patients were treated by ultrasonography (US)-guided percutaneous aspiration and with an injection of 95% ethanol. Patients were evaluated one month postoperatively and every six months thereafter by clinical assessment, US, and intravenous urography. Success was defined as complete when there was total ablation of the cyst and partial when there was a recurrence of less than half the original cyst volume and a resolution of symptoms. Failure was defined as the recurrence of more than half of cyst volume or persistent symptoms.

Results: After aspiration and ethanol sclerotherapy, there was microscopic hematuria in 2 patients and low-grade fever (< 38.3°C) in another 2, but no major complications. During a mean follow-up of 19 months (range 14–40), there was complete cyst ablation in 15 (88%) patients and partial resolution in 2 (12%). Pain disappeared or was much improved in all patients. Hypertension was well controlled with no medication in 4 previously hypertensive patients, and hematuria disappeared in all 3 affected patients.

Conclusion: Ethanol sclerotherapy for symptomatic simple renal cysts is simple, minimally invasive, and highly effective. We recommend it as the first therapeutic option in these patients.

Keywords: Simple renal cyst, Percutaneous aspiration, Sclerotherapy

Correspondence: Mohamed Awny Labib, Senior Lecturer, School of Medicine, University of Zambia, labib@mail.zamtel.zm

ABSTRACT

Background: Lower urinary tract symptoms (LUTS) have been described in patients with bladder dysfunction due to prolapsed lumbar disks. Progressive compression caused by lumbar disk herniation leads to loss of bladder sensation and voiding difficulty due to an acontractile detrusor.

Objective: Our objective in this study was to determine the cystometric findings in patients with lumbar intervertebral disk protrusion (LDP).

Methods: 80 patients with lumbar disk protrusion were included in this study. Their mean age was 39.9 years (26-64), 58 patients (72.5%) were males, and 22 (27.5%) were females. They were divided into two groups according to their urodynamic results: patients in Group I had normal detrusor function (52 patients), and patients in Group II had abnormal detrusor activity (28 patients). Thorough histories and clinical examinations, including general examinations, urological examinations, and neurological examinations, were done for each patient. Uroflowmetry and cystometry were done for the evaluation.

Results: 18 out of 28 patients in Group II had acontractile detrusor, 7 patients had detrusor underactivity, and 3 patients had neurogenic detrusor overactivity. 35 patients (43.75%, 12 from Group I, 23 from Group II) presented with urological symptoms, and all had more than one symptom. Of the 28 patients in Group II, 23 reported LUTS suggestive of bladder outlet obstruction, and only 5 patients in Group II showed no urological symptoms (P<0.05). There was a statistically significant difference between the two groups regarding multiple LDP affections (P<0.05). There was a high percentage of non-contained LDP in Group II with a statistically significant difference (P<0.05).

Conclusion: Acontractile detrusor represents the most common cystometric finding in patients with LDP. Neurogenic detrusor overactivity may occur in the initial stage of the disease. Patients with multiple, diffuse, and non-contained LDP are more liable to have abnormal detrusor activity.

Keywords: Lumbar intervertebral disk protrusion, urodynamics, acontractile detrusor

Correspondence: Mohamed Hassan, Urology Department, Suez Canal University, Ismailia, Egypt, hassanurol@yahoo.com