Osamu Ikari

Percutaneous Treatment of Bladder Stones

A total of 36 patients with bladder stones underwent percutaneous suprapubic cystolithotripsy. The successful rate was 89%. There were 11% failures due to nonfragmentation of the stones by the ultrasound probe. According to the presence of associated diseases 3 groups of patients were established. Two groups underwent concomitant treatments for benign prostatic hyperplasia and urethral stricture. No complications occurred even in patients with concomitant treatment. There was no statistically significant difference when these groups were compared (p > 0.05). Fluoroscopy was not necessary during the procedure. Since the technique is simple, safe and effective, it represents an alternative in the management of bladder stones.

Subureteric lipoinjection for vesicoureteral reflux in renal transplant candidates

OBJECTIVE Vesicoureteral reflux is a risk factor predisposing to infection after renal transplantation. Endoscopic correction of vesicoureteral reflux, a minimally invasive therapy, has been increasingly used with encouraging results. Although recent reports have described the successful use of Teflon paste in the endoscopic treatment of reflux, the choice of the material to be used is controversial. There is a need for finding an ideal substance for endoscopic injection for a simple and safe treatment of reflux. METHODS Based on the good results of autologous lipoinjection in other situations, we performed lipoinjection for vesicoureteral reflux in 12 renal transplant candidates. There were 10 female and 2 male patients with grade III reflux or higher, accounting for 17 ureters treated by endoscopic lipoinjection. Voiding cystourethrography was performed in the operating room immediately after the procedure and again three months later. RESULTS In 2 patients (16.2%) there was reduction of the grade of reflux, including the unique ureter that stopped refluxing. In the remaining 10 patients (83.3%) there was no change in the grade of reflux. CONCLUSIONS These results suggest that although simple and attractive, lipoinjection alone is not a good alternative for endoscopic correction of vesicoureteral reflux.

Traumatic rupture of female urethra

Complete avulsion of the female urethra secondary to blunt trauma is uncommon. It is associated with pelvic fractures, and because of the close association of the urethra and vagina a vaginal laceration also occurs. The paucity of lesions associated with pelvic fracture may be explained by the relative mobility and shortness of the urethra in the female. The treatment of urethral trauma in females has not been established. Vaginal, transpubic, or retropubic approaches have been used successfully. We report on 3 cases of urethral trauma with anterior vaginal lacerations treated by retropubic approach with good results.

Urologic aspects associated with isolated hypogastric artery aneurysm.

The isolated hypogastric artery aneurysm may give rise to urologic symptoms. This occurs as a consequence of extrinsic compression exerted by the aneurysm itself to the urinary tract or the involvement of the urinary tract by the perianeurysmatic fibrosis. We report 2 cases of isolated hypogastric artery aneurysm. One of the patients had unilateral ureteral obstruction while the other revealed a mass on rectal examination. In both cases surgery was performed and the urologic manifestations were relieved completely.

Delivery of a urology online course using moodle versus didactic lectures methods

PURPOSE To subjectively and objectively compare an accessible interactive electronic library using Moodle with lectures for urology teaching of medical students. METHODS Forty consecutive fourth-year medical students and one urology teacher were exposed to two teaching methods (4 weeks each) in the form of problem-based learning: - lectures and - student-centered group discussion based on Moodle (modular object-oriented dynamic learning environment) full time online delivered (24/7) with video surgeries, electronic urology cases and additional basic principles of the disease process. RESULTS All 40 students completed the study. While 30% were moderately dissatisfied with their current knowledge base, online learning course delivery using Moodle was considered superior to the lectures by 86% of the students. The study found the following observations: (1) the increment in learning grades ranged from 7.0 to 9.7 for students in the online Moodle course compared to 4.0-9.6 to didactic lectures; (2) the self-reported student involvement in the online course was characterized as large by over 60%; (3) the teacher-student interaction was described as very frequent (50%) and moderately frequent (50%); and (4) more inquiries and requisitions by students as well as peer assisting were observed from the students using the Moodle platform. CONCLUSIONS The Moodle platform is feasible and effective, enthusing medical students to learn, improving immersion in the urology clinical rotation and encouraging the spontaneous peer assisted learning. Future studies should expand objective evaluations of knowledge acquisition and retention.

Litotricia extracorpórea en niños: Eficacia y evaluación a largo plazo de la lesión del parénquima renal mediante gammagrafía con DMSA-99mTc

Objetivo: determinar la eficacia de la litotricia extracorporea por ondas de choque (LEOC) y los posibles efectos nocivos en el parenquima renal de ninos sometidos a tratamiento de la litiasis renal mediante gammagrafia renal con acido dimercaptosuccinico marcado con 99mTc (DMSA-99mTc). Pacientes y metodos: desde enero de 2004 a noviembre de 2007 se sometio a 18 ninos (de 3-10 anos) a LEOC (Philips-Dornier) por urolitiasis renal. A todos los pacientes se les realizo una evaluacion preoperatoria, que incluyo una exploracion fisica, cultivo de orina, pruebas de imagen y gammagrafia renal con DMSA-99mTc. La evaluacion tras el tratamiento consto de una exploracion clinica, determinacion de la presion arterial, cultivo de orina, ecografia renal y DMSA-99mTC, repetidas a los 3, 6 y 12 meses, que se compararon con las exploraciones obtenidas antes de la LEOC para determinar posibles cambios morfologicos o funcionales. Resultados: se fragmentaron con exito los calculos en todos los casos; en 9 pacientes (50%) con una sesion de LEOC, en 6 (33%) con dos sesiones y en tres pacientes (17 %) con tres sesiones de LEOC. Solo un paciente (5%) mostro un cambio de tamano del rinon derecho con descenso de la funcion tubular, sin hipertension ni otros cambios importantes despues de tres sesiones de LEOC y 6 meses de seguimiento. En los demas casos se comprobo la ausencia de hipertension hasta los 12 meses de seguimiento, de hematomas en la ecografia o de cicatrices renales importantes en las exploraciones gammagraficas. Conclusion: la LEOC es eficaz y segura para tratar la litiasis renal en ninos. Pueden aparecer lesiones del parenquima renal precozmente tras el tratamiento, pero estas lesiones son pasajeras y se resuelven espontaneamente en practicamente todos los casos. No existen generalmente lesiones renales irreversibles asociadas con la LEOC, ni siquiera despues del periodo de seguimiento con exploracion clinica y ecografica y gammagrafia con DMSA-99mTc.

Internal Urethrotomy of the Prostatic Urethra or Transurethral Resection in Benign Prostatic Hyperplasia

Transurethral resection of the prostate is the most common technique for the treatment of benign prostatic enlargement. The inconveniences of prostatic resection are retrograde ejaculation and bladder neck stenosis in small prostates. A randomized prospective trial was done to compare the results of conventional transurethral resection of the prostate in 22 patients and urethrotomy of the prostatic urethra in 27 with respect to postoperative retrograde ejaculation, persistent urinary symptomatology and maximal flow rates. After a mean followup of 25 months we concluded that internal urethrotomy of the prostatic urethra is the operation of choice in patients with a prostate of up to 30 gm.

Extracorporeal lithotripsy in children. The efficacy and long-term evaluation of renal parenchyma damage by 99mTc-DMSA scintigraphy

Abstract Purpose To determine the effectiveness of extracorporeal shock-wave lithotripsy (ESWL) and possible deleterious effects on renal parenchyma of children subjected to treatment of renal lithiasis, using renal scintigraphy with 99mTc dimercapto-succunic acid (DMSA). Patients and methods From January 2004 to November 2007, 18 children (age 3–10 years) underwent ESWL (Philips-Dornier) for kidney urolithiasis. All patients underwent preoperative evaluation, including physical examination, urine culture, image exams and renal scintigraphy with 99mTC-DMSA. Evaluation after treatment consisted of a clinical examination, blood pressure measurement, urine culture, renal ultrasound and 99mTCDMSA, repeated at 3, 6 and 12 months, which were compared to the scans obtained before ESWL to determine possible morphological or functional changes. Results Success in the stones fragmentation was achieved in all cases – in 9 patients (50%) with one session of ESWL, in 6 (33%) with two sessions and in 3 patients (17%) with 3 sessions of ESWL. Only one patient (5%), after three sessions of ESWL and 6 months of follow-up showed change in size of right kidney with a decrease in tubular function, without hypertension or other major changes. In the other cases, there was absence of hypertension up to 12 months of follow-up, absence of renal hematomas detected by ultrasound or significant renal scars in scintigraphic examinations. Conclusion ESWL is effective and safe for treating renal lithiasis in children. Renal parenchyma lesions may occur early after treatment, but these lesions are transients and resolve spontaneously in virtually all cases; generally, there are no irreversible renal lesions associated with ESWL, even after the follow-up period with clinical examination, ultrasound examination and 99mTc-DMSA scintigraphy.

Leiomyosarcoma in Association With Incidental Adenocarcinoma of the Prostate

Abstract: We report a case of leiomyosarcoma of the prostate treated by radical cystectomy, radiation and chemotherapy. Microscopic examination revealed a mixture of incidental adenocarcinoma and leiomyosarcoma of the prostate. At 1-year followup the patient had no evidence of metastasis.

Approach for treatment of subcoronal meatus with excessively deep glanular groove

We report on 9 children with subcoronal meatus and an excessively deep glanular groove who underwent a simple surgical repair. All the procedures were done on an outpatient basis, and there was no urinary diversion. The surgical results have been satisfactory, with no fistula formation, or urethral or meatal stenosis. The technique described is useful in selected cases.