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   Table of Contents - Current issue
Coverpage
April-June 2021
Volume 33 | Issue 2
Page Nos. 35-60

Online since Thursday, May 26, 2022

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ORIGINAL ARTICLES  

Virtual reality simulator face validity for topographic real situation of inflated abdomen Highly accessed article p. 35
Tuncay Tas, Basri Çakiroglu, Esra Akdeniz, Ismet Aydin Hazar, Can Balci
DOI:10.4103/HUAJ.HUAJ_30_21  
Objective: The aim of this study is to investigate the face validity of LapSIM® (haptic feedback Xitact™ IHP, Mentice AB, Sweden) for the topographic real condition of the inflated abdomen in upper urinary tract laparoscopic interventions. Materials and Methods: The present study was conducted with 30 urologists with experience in transperitoneal laparoscopic renal surgery. Surgeons were divided into three groups: novices, intermediate experience, and experts. After performing the tasks, the participants were then asked to finish a five-item questionnaire regarding the face validity of the simulator. Participants answered questions with ratings from 1 (not realistic/useful) to 5 (very realistic/useful). Results: The mean age of the study group was 38.33 ± 5.45 (29–47) years. The mean years of experience of the doctors were 4.27 ± 1.89 (1–7) years. All the variables showed significant differences from the ideal value of 5. We also tested whether the medians differed from 3, and the restrained body posture of the surgeon, the monitor position, and the trocar position not show significance with one-sided P value of P = 0.825, P = 0.992, and P = 0.265, respectively. Conclusion: Although the LapSIM® virtual reality simulator provides face validity for the topographic real condition of the inflated abdomen, it should be improved.
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Endoscopic treatment of vesicoureteral reflux with macroplastique in spinal cord injury patients: A comparison of video-urodynamic parameters between treated and failed cases p. 40
Vasileios Sakalis, Rachel Oliver, Peter Guy, Melissa Davies
DOI:10.4103/HUAJ.HUAJ_39_21  
Context/Objective: Vesicoureteric reflux (VUR) is a well-known complication of neurogenic lower urinary tract dysfunction. VUR results to progressive renal deterioration and eventually renal failure. Our aim was to assess the efficacy of Macroplastique bulking agent in managing VUR in spinal cord injury population and correlate the pre- and postintervention VUDS (Video-urodynamics) findings with the outcome. Design: Retrospective cohort study. Participants: Spinal cord injury patients with VUR, treated with Macroplastique, had pre- and postintervention VUDS and followed up for at least 12 months. Interventions: Macroplastique injection and video-urodynamics. Outcome Measures: The primary endpoint was the overall treatment rate of VUR at 3 months. The secondary outcomes were the overall treatment rate of VUR at 12 months, the success rate at 3 and 12 months, the need for additional treatments, and the comparison of VUDS parameters in treated versus failed cases. Results: Forty-eight patients and 62 refluxing ureteric units were studied. At 3-month follow-up, the overall treatment rate was 79.1%. The overall success rate (treated + improved) was 90.3%. There is a statistically significant difference in baseline cystometric capacity (P = 0.047), degree of reflux (P < 0.01), and bladder compliance (P = 0.023) between the treated and failed cases. Conclusion: Macroplastique is effective in the management of VUR in spinal cord injury population. It is minimally invasive, quick, with low complication rates. Care should be taken to treat the parameters of the neurogenic bladder that contributes to secondary VUR development such as detrusor overactivity and poor bladder compliance.
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REVIEW ARTICLES Top

Rare histolopathologic variants in bladder cancer p. 45
Eleftherios Tsiakoulas, Anastasios Zarkadas, Vasileios Tzortzis, Diomidis Kozyrakis
DOI:10.4103/HUAJ.HUAJ_41_21  
The heterogeneous spectrum of bladder cancer comprises the coexistence of conventional urothelial carcinoma (UC) with its variants as well as the non-urothelial carcinoma (including squamous and glandular tumors). Since the official classification of rare histologic subtypes, by the World Health Organization (WHO) in 2004, uropathologists and urologists are paying more attention to the role of these subtypes as potential prognostic markers. Most of these rare variants have been associated with increased risk of progression and poor prognosis. Therefore, patients diagnosed with some of the histologic subtypes, have been classified to “the very high risk group” of recurrence and progression, although it has not yet been clarified if this is due to advanced stages at presentation and underdiagnosis or due to the aggressiveness of each variant, as an independent factor. This review discusses the most common variants of bladder cancer (urothelial carcinoma with squamous and/or glandular differentiation, pure squamous carcinoma, pure adenocarcinoma, urachal carcinoma, nested pattern, microcystic, micropapillary, small cell carcinoma, plasmacytoid, sarcomatoid, and lymphoepithelial like carcinoma), outlining the recent advances regarding the diagnosis, differential diagnosis, treatment and clinical significance for each one. High index of suspicious is required by the uropathologists for detection of these variants and well-designed multi-institutional studies are necessary in order the specific treatment strategies for these patients to be established.
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Guidelines and medical management of stone disease: Do we have a consensus? p. 50
Lazaros Tzelves, Panagiotis Mourmouris, Andreas Skolarikos
DOI:10.4103/HUAJ.HUAJ_37_21  
Medical management of the stone disease is a topic of controversy even between worldwide guidelines. With this review, we attempt to clarify the disparities that exist in the literature and provide to the clinical urologist a tool for battling this common disease. The search was based on current Guidelines from national and international urological Associations including European and American guidelines and the guidelines of Societe d”Urologie. The use of a-blockers is highly indicated by most Guidelines as medical expulsion therapy, whereas nonsteroidal anti-inflammatory medication for pain relief. Fluid intake of 2 lit/day, controlled dietary calcium consumption and sodium restrictions are universal dietary modifications from urological Associations on the prevention of stone disease. Despite methodological heterogeneity and subjective rating of recommendations, an acceptable degree of consensus was noted on Guidelines regarding medical management of the stone disease.
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CASE REPORTS Top

Mucinous adenocarcinoma of the prostate found incidentally in adenomectomy specimen complicated with vesicocutaneous fistulae p. 53
Spinos Theodoros, Lardas Michail, Kotoulas Grigorios, Thanos Anastasios, Kyriazis Iason
DOI:10.4103/HUAJ.HUAJ_34_21  
Primary mucinous tumors of the prostate gland are rare, including mucinous adenocarcinoma, prostatic adenocarcinoma with mucinous features, and mucinous adenocarcinoma of the prostatic urethra. In this report, we present a case of a locally advanced mucinous variant of prostatic ductal adenocarcinoma, found incidentally during pathology examination of an adenomectomy specimen, after bladder outlet obstruction surgery. Recent large studies indicated that mucinous adenocarcinoma of the prostate, treated by radical prostatectomy, is not more aggressive than ordinary nonmucinous prostatic adenocarcinoma. In our case, the rapid deterioration of our patient, the return of tumor in its initial size soon after surgery, in addition to its distal metastatic spread should be attributed not only to the mucinous variant of prostatic adenocarcinoma but also to the advanced stage during initial diagnosis and the noncompliance of the patient with the suggested treatment after surgery, omitting radiotherapy, and hormonal maneuvers.
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Isolated adrenal gland hematoma after blunt abdominal trauma: A case report and literature review p. 56
Savvas Tsakiris, Spyridon Paparidis, Maria Zerva, Antonios Katsimantas, Konstantinos Bouropoulos, Nikolaos Ferakis
DOI:10.4103/HUAJ.HUAJ_45_21  
Isolated traumatic adrenal gland hematoma is a very rare condition. Our aim is to present a case of an isolated traumatic hematoma of the adrenal gland after a low-speed motorcycle accident without other associated injuries. A 30-year-old Caucasian male presented to the emergency department complaining of intense upper abdominal pain associated with shortness of breath. Trauma ultrasonography assessment, focused assessment with ultrasonography for trauma, was negative; emergency computed tomography (CT) imaging revealed a well-defined 3.8 cm × 2.8 cm mass in the location of his right adrenal gland. He was hospitalized for 48 h and was discharged hemodynamically stable, with normal hemoglobin levels. CT imaging at 1-month follow-up revealed a decrease in hematoma size and complete resolution of symptoms. Conservative treatment may be the method of choice for adrenal trauma, provided that patients remain hemodynamically stable and closely monitored.
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Bladder metastasis of renal cell carcinoma. A case report and review of the literature p. 59
Panagiotis Velissarios Stamatakos, Loannis Glykas, Charalampos Fragkoulis, Georgia Theodoropoulou, Sofia Pappa
DOI:10.4103/HUAJ.HUAJ_29_21  
Renal cell carcinoma (RCC) metastasis to the urinary bladder is an exceedingly rare entity. In this paper, we present a case of a 78-year-old male presented in our department with painless gross hematuria, 2 years after he underwent a left open nephrectomy that revealed a clear cell RCC. Imaging examination revealed a sessile mass on the bladder wall. The patient underwent a transurethral resection of the bladder tumor with the histological diagnosis of clear cell RCC. Pathogenesis and possible routes of such a metastasis are not well-documented and no treatment of choice has been established yet.
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