Shilo Rosenberg

A Single Dose of 240 mg Gentamicin During Transrectal Prostate Biopsy Significantly Reduces Septic Complications

OBJECTIVE To evaluate whether the addition of a single dose of an aminoglycoside to a fluoroquinolone-based prophylaxis regime would decrease septic complications associated with transrectal prostate biopsy. METHODS A retrospective survey of all patients undergoing transrectal ultrasound guided prostate biopsy (TRUS-PB) between 2001 and 2012 at Hadassah Hebrew University Medical Center was performed. All patients received prophylactic ofloxacin for 3 days. From 2008, patients received an augmented protocol, consisting also of a single injection of gentamicin. The dose of the aminoglycoside was left to the discretion of the attending physician. RESULTS Of 4655 patients, 110 patients (2.4%) were admitted because of urosepsis. Ninety patients (82%) had a positive urine or blood culture or both. From 2008, among 581 patients treated solely with ofloxacin, the infection rate was 3.6%, and among the 538 patients who also received 80 mg gentamicin, the rate of sepsis was 3.5% (P = 1.0). Among the 376 patients treated with gentamicin, 160 mg infection rate was 2.7% (P = .27). The sepsis rate dropped significantly to 0.6% (P = .04) among the 169 patients who received 240 mg gentamicin during the biopsy. CONCLUSION Addition of a single dose of gentamicin 240 mg resulted in a significant drop in infection rates after TRUS-PB. However, addition of 80 mg or 160 mg gentamicin had no significant effect on the infection rates. We recommend adding a single dose of gentamicin 240 mg to all patients with normal kidney function undergoing TRUS-PB during the procedure.

Intravesical administration of green tea extract attenuates the inflammatory response of bacterial cystitis--a rat model.

To explore the effect of intravesical instillation of green tea extract (GTE) on a rat model of bacterial cystitis.

An ALK translocation positive carcinoma of the lung presenting as uremia due to bilateral

We describe an unusual presentation of metastatic lung adenocarcinoma as malignant retroperitoneal fibrosis (MRPF). The diagnostic challenge, due to the small solitary lung mass and absence of a discrete retroperitoneal mass, was overcome by diagnostic laparoscopy. Molecular analysis of tissue acquired was positive for ALK gene rearrangement. Treatment of the patient with crizotinib reversed MRPF. He was weaned off the nephrostomy tubes and is with stable renal function 11 months after diagnosis.

Pregnancy Rates after Testicular Torsion

PURPOSE To our knowledge the effect of testicular torsion on the pregnancy rate is unknown. In this study we focused on the pregnancy rate, which is the ultimate index of fertility status. MATERIALS AND METHODS We reviewed the records of 273 patients who presented to our emergency room with testicular torsion between 1994 and 2014. Study inclusion criteria included being in a relationship with the intent to conceive for at least 1 year, age greater than 25 years and a normal contralateral testis. Patients with primary infertility, those who were unwilling to participate or unreachable and those with a history of undescended testis and/or varicocele were excluded from analysis. Patients were contacted by telephone and interviewed according to a standardized questionnaire. Pregnancy rates in the orchiopexy and orchiectomy groups were compared to each other and to the accepted pregnancy rate in the literature. RESULTS A total of 63 patients met study inclusion criteria, including 41 and 22 in the orchiopexy and orchiectomy groups, respectively. The pregnancy rate in the orchiopexy and orchiectomy groups was 90.2% and 90.9%, respectively (p = 1.0). The accepted pregnancy rate in the general population is 82% to 92%. Mean ± SD time to pregnancy in the orchiopexy and orchiectomy groups was 6.6 ± 5.50 and 7.2 ± 5.4 months, respectively (p = 0.27). CONCLUSIONS Several studies suggest decreased fertility potential in patients with a history of testicular torsion. However, in the current study in couples in which the male had a history of testicular torsion the pregnancy rate and the interval to pregnancy were within the accepted range of the general population.

Neobladder—Vaginal fistula: The University of Southern California experience

The use of orthotropic neobladder (ONB) construction in women has increased in popularity. With increasing numbers so have complications distinct to this procedure. Neobladder vaginal fistula (NVF) is a rare but challenging complication. We present our experience correcting this problem.

Late ureteral obstruction in an adult who had STING/Teflon in childhood: Should we expect an epidemic?

We present a case of left renal colic in a 25-year-old female patient. She had subureteral injection of Teflon (STING) at the age of 10 due to vesico-ureteral reflux (VUR) disease and recurrent urinary tract infections. Renal colic was the result of late ureteral obstruction due to Teflon-induced periureteral foreign body reaction. To our knowledge, this is the longest interval between STING and ureteral obstruction reported and the first case of delayed ureteral obstruction caused by Teflon. Monitoring the upper tracts of patients after STING should go beyond childhood.

Diagnosing spontaneous ileal neobladder perforation: Too often delayed

Spontaneous neobladder perforations are rare, but well-documented; the first cases were reported more than 2 decades ago mostly in urologic journals. However, the diagnosis of these patients is often delayed in the emergency room setting because initial care is given by non-urological medical staff that is too often unaware of this etiology. We present 2 cases and discuss the shift in treatment that has occurred over time.

Augmented Lower Urinary Tract

Augmentation cystoplasty (AC) is an outstanding option for patients with a threatened upper urinary tract who have failed conservative or minimally invasive therapy. However, AC is a nonphysiologic option putting a patient in need for lifelong medical surveillance. Urodynamics have an important role in assessing patients with lower urinary tract dysfunction prior to AC. In addition, many patients will require some type of intervention after AC. Urodynamics may be part of the post-AC diagnostic evaluation for patients with suboptimal outcomes after lower urinary tract reconstruction.

Neobladder Voiding Function in Men

Following construction of an orthotopic neobladder, the lower urinary tract manifests an altered function. The voiding mechanism in neobladder patients is non-physiologic. To ensure acceptable continence and protect the upper urinary tract, careful patient selection and surgical expertise are required. Although functional qualities of the orthotopic reservoir often remain stable over time, long-term follow-up is necessary as distinct complications are an ever-present concern.

The Fate of the Seminal Vesicle Remnant After Proximal Transection or Ligation: An Animal Model

PURPOSE Dissection of the seminal vesicles during radical prostatectomy has the potential to damage the pelvic plexus, thus compromising trigonal, bladder neck and cavernous innervation, and contributing to delayed gain of continence and erectile function. The rate of prostate cancer invasion into the seminal vesicles in currently operated patients is low and in most it may be predicted preoperatively. This situation calls for seminal vesicle sparing radical prostatectomy in select patients, leaving a distal remnant of the seminal vesicles in place. We investigated the fate of the seminal vesicle remnant after proximal transection or ligation in an animal model. MATERIALS AND METHODS The right seminal vesicle in 36 anesthetized male rats was divided by suture ligation or by transection. The left seminal vesicle served as a control. Six rats per group were sacrificed 1, 2 and 4 weeks after division, respectively. Seminal vesicle morphology was evaluated macroscopically and microscopically. RESULTS All rats tolerated surgery well and gained weight postoperatively. Transected seminal vesicles were similar in weight and morphology to control contralateral glands. One week after seminal vesicle ligation the remnants became significantly heavier and showed balloon dilatation of the hollow spaces, while the lining epithelium became significantly flattened. Two and 4 weeks after ligation half of the animals showed gland shrinkage and half demonstrated persistent dilatation. CONCLUSIONS Seminal vesicle transection preserves the gland remnant in a relatively normal morphology, while ligation leads to severe and inconsistent morphological changes. When considering seminal vesicle sparing radical prostatectomy, seminal vesicle transection may be preferred to ligation.