Tomé Lopes

Hyperbaric oxygen therapy for refractory radiation-induced hemorrhagic cystitis.

To analyze the efficacy of hyperbaric oxygen for the treatment of radiation‐induced hemorrhagic cystitis and to identify factors associated with successful treatment.

Urolithiasis and crohn's disease.

Objective: To present an updated description of the relation between Crohns disease (CD) and Urolithiasis. Patients and Methods: A literature search for English-language original and review articles was conducted in Medline, Embase, and Cochrane databases in the month of December 2014 for papers either published or e-published up to that date, addressing the association between CD and urolithiasis as its consequence. All articles published in English language were selected for screening based on the following search terms: “CD,” “renal calculus,” “IBD,” and “urolithiasis.” We restricted the publication dates to the last 15 years (2000–2014). Results: In total, 901 patients were included in this review of which 95 were identified as having CD and urolithiasis simultaneously, for a total of 10.5%. Average age was 45.07 years old, irrespective of gender. 28.6% of patients received some kind of medical intervention without any kind of surgical technique involved, 50% of patients were submitted to a surgical treatment, and the remaining 21.4% were submitted to a combination of surgical and medical treatment. Urolithiasis and pyelonephritis incidence ranged from 4% to 23% with a risk 10–100 times greater than the risk for general population or for patients with UC, being frequent in patients with ileostomy and multiple bowel resections. We found that urolithiasis occurred in 95 patients from a total of 901 patients with CD (10.5%); 61.81% in men and 38.19% in women. Stone disease seems to present approximately 4–7 years after the diagnosis of bowel disease and CaOx seems to be the main culprit. Conclusions: CD is a chronic, granulomatous bowel disease, with urolithiasis as the most common extraintestinal manifestation (EIM), particularly frequent in patients submitted to bowel surgery. This complication needs to be recognized and addressed appropriately, especially in patients with unexplained renal dysfunction, abdominal pain, or recurrent urinary tract infection. We believe this study to be an updated valuable review as most data related to this kind of EIM refers to articles published before 2000, most of them before 1990. These patients need to be followed up with a specific prevention plan to eliminate or mitigate the risk factors for stone disease, aiming at preventing its formation and its complications, preserving renal function, reducing morbidity, and ultimately improving their quality of life.

Magnetic Resonance Imaging and Pelvic Fracture Urethral Injuries

Pelvic fracture urethral injuries (PFUI) are devastating lesions that lead to fibrosis and urethral disruption, which result in recurrent strictures, urinary incontinence, fistulae, and even erectile dysfunction, representing a management problem for the urologist. Magnetic resonance imaging (MRI) may be a valuable tool in establishing or confirming the diagnosis by providing detailed anatomy and estimating disease extent. We present a comprehensive review of the current literature on the role of MRI on diagnostic evaluation and surgical management of patients with PFUI.

Isolated Shotgun Injury to the Ureter: The Importance of Clinical Suspicion

Traumatic ureteral injuries are rare and account for less than 1% of all urological traumas. Associated abdominal injuries are almost always present. We present a rare case of isolated shotgun injury to the ureter where clinical suspicion was of paramount importance.

Bilateral synchronous testicular seminoma: A rare presentation of a rare disease

OBJECTIVE To present a case of a bilateral synchronous testicular seminoma in a young male clinical stage IIB. MATERIAL AND METHOD A 37 years old man presented a bilateral testicular mass with elevated tumoral markers. Histology of frozen section revealed bilateral seminoma and bilateral radical orchiectomy was performed. RESULT Enhanced chest and abdominopelvic staging CT scan revealed a lymphadenopathy of 30 mm within the inter-aortocava nodal chain (stage IIB). Patient received three cycles of BEP. Three months later 18F-FDG PET showed no evidence of hypermetabolic activity and serum tumoral markers were normal. CONCLUSION Bilateral testicular germ cell tumors are a rare disease. Management of this tumors is controversial. Bilateral radical orchiectomy is the standard of care, nevertheless, in order to preserve fertility and androgen production, an organsparing surgery can be attempted in selected cases. Although prognosis is good, with overall survival rates similar to patients with unilateral disease, life-long close follow-up may be advocated due to relapse risk.

A Prospective Randomized Trial Comparing the Vienna Nomogram and a Ten-Core Prostate Biopsy Protocol: Effect on Cancer Detection Rate

&NA; We performed a prospective randomized study of men undergoing prostate biopsy randomized to a Vienna nomogram protocol (group A) or a 10‐core protocol (group B). The results suggest that the use of the Vienna nomogram does not significantly increase the overall cancer detection rate compared with a 10‐core biopsy scheme. Further prospective randomized studies, with adequate sample sizes, are needed to definitively determine the best prostate biopsy protocol. Background: We evaluated whether the Vienna nomogram increases the detection rate of transrectal ultrasound‐guided prostate biopsy compared with a 10‐core biopsy protocol. Patients and Methods: In the present prospective randomized study, men eligible for prostate biopsy were randomized to a Vienna nomogram protocol (group A) or a 10‐core protocol (group B). They were further stratified according to age (≤ 65, > 65 but ≤ 70, and > 70 years) and prostate volume (≤ 30, > 30 but ≤ 50, > 50 but ≤ 70, and > 70 cm3). The cancer detection rate (CDR) was compared between the groups by logistic regression analysis, with adjustment for age as necessary, overall and with age and prostate volume stratification. Additional statistical analysis was performed with Fishers exact test for contingency tables and the Mann‐Whitney U test for 2 independent samples. P < .05 was considered statistically significant. A subgroup analysis was performed for patients with serum prostate‐specific antigen levels of 2 to 10 ng/mL. Results: From January 2009 to July 2010, 456 patients were enrolled, 237 to the Vienna nomogram group and 219 to the 10‐core group. No significant differences were found in serum prostate‐specific antigen or prostate volume between the 2 groups. Multivariate analysis with adjustment for age revealed no significant differences in CDR, with 42.6% in group A and 38.4% in group B (P = .705). When stratified by age and prostate volume, no statistically significant differences were found in the CDR between the groups in all subclasses. Also, in the subgroup analysis, CDR was not significantly different, 37.9% versus 34.7% for groups A and B, respectively (P = .891). Conclusion: These results study suggest that the use of the Vienna nomogram does not significantly increase the overall CDR compared with a 10‐core biopsy scheme. Further prospective randomized studies, with adequate sample sizes, are needed to definitively determine the best prostate biopsy protocol.

Hutch bladder diverticulum - unusual cause of adult obstructive uropathy

OBJECTIVE To present a case of a Hutch bladder diverticulum containing the ureteral opening. MATERIAL AND METHODS An 83-year-old man presented a giant bladder diverticulum causing obstructive azotemia due to bilateral ureteral compression. Endoscopy revealed an unusual and potentially harmful anatomical alteration: the left ureteral orifice was inside in the diverticulum. Despite bladder emptying, the diverticulum remained full, causing bilateral ureteral compression. The patient underwent diverticulectomy with ureteroneocystostomy. RESULT Post-operative follow-up showed renal and voiding functions restoration. CONCLUSION Although clinical watching is a valid option in patients with Hutch diverticulum, reconstructive surgical approach, especially when complications are present, should be the standard of care.

Ureteral endometriosis and silent renal loss: a retrospective study

Objective To present six cases of ureteral endometriosis with renal loss managed by a multidisciplinary minimally invasive approach. Introduction Severe ureteral endometriosis can potentially lead to urinary tract obstruction and silent loss of renal function. Nephrectomy should be considered and may be performed by a multidisciplinary minimally invasive approach. Material and methods Retrospective observational study of patients with deep endometriosis with ureteral involvement and consequently loss of renal function who underwent laparoscopic nephrectomy between April 2009 and April 2016 in a tertiary care university hospital. The clinical presentation, imaging characteristics, surgical findings, surgical procedures, operative time, blood loss, postoperative analgesic administration, mean hospital stay and recurrence rates were analyzed. Results The mean age of patients was 28 years (range 26 to 40). Mean overall operative time for the laparoscopic procedures was 382 minutes (range 310 to 705). Mean blood loss was 200 cc and there were no intraoperative complications in our series with no need to laparotomy conversion. Mean overall hospital stay was 157 hours (range 48 to 364). Regarding complications, a case of pyelonephritis and one of urinary retention were registered, the latter requiring bladder neurostimulation 2 years after surgery. All women remain asymptomatic in follow-up. Conclusions In ureteral deep endometriosis, nephrectomy should be considered for significant renal functional impairment associated with persistent ureterohydronephrosis and renal parenchymal atrophy. It may be performed by laparoscopy with minimal morbidity, minimal postoperative discomfort, and a short hospital stay.

Massive Vena Cava Thrombus Associated With a Renal Tumor

The thrombus reached a diameter of 7 cm in it’s subhepatic course (Fig. 1C), 6.3 cm in right atrium and 1.7 cm in the femoral veins. Collateral venous circulation was evident. Advanced diseased precluded any surgical intervention, and patient’s demise happened three months after first symptoms appeared. Inferior vena cava thrombosis has been reported in 4-15% of cases of renal tumors, with extension to the right atrium in 1%.1,2 Long-term cancer-free survival up to 2565% following nephrectomy with tumor thrombectomy.3-5 Massive Vena Cava Thrombus Associated With a Renal Tumor

THU0033 Overactive Bladder Symptom Bother is Increased in Patients with Systemic Lupus Erythematosus and SjÖGren's Syndrome

Background Interstitial Cystitis (IC) has been suggested to have an underlying autoimmune mechanism and to be associated with Systemic Lupus Erythematosus (SLE) and Sjögrens syndrome (SS). In these conditions, lower urinary tract symptoms (LUTS) associated with overactive bladder (OAB) may be present since early stages of disease and be interpreted by patients as normal. Objectives To compare OAB symptom bother (SB) and health-related quality of life (HRQL) between healthy controls and patients with SLE and SS. Methods In a cross-sectional cohort study, we applied a validated questionnaire assessing LUTS and HRQL, the OAB questionnaire short form (OABq-SF, range 0-100), to SLE/SS patients followed in a hospital outpatient clinic and to patients from a primary health care centre that had none of the diseases. We further collected information on possible confounding variables. Group comparisons by Mann-Whitney and chi-square test and multiple regression analyses were conducted. Based on literature findings, we defined a SB score greater than 20/100 and a HRQL score lower than 90/100, as clinically meaningful. Results We included 203 controls and 93 rheumatic patients (64 SLE, 29 SS). Both groups had similar characteristics except for gender distribution, anti-depressant and corticosteroid consumption (Table 1). OABq-SF SB scores were greater and HRQL scores were lower in the SLE/SS group, compared to controls (p<0.0001 and p=0.0002, respectively). SLE/SS patients had higher proportions of SB score ≥20 (OR 3.1, 1.9-5.2) and HQRL≤90 (OR 2.4, 1.4-4.2). The same differences were seen for the SLE/SS subgroups separately. Multivariate logistic regression revealed that SLE/SS patients were more likely to have a SB score greater than 20/100 (OR 2.72, 1.55-4.79) and a HRQL score lower than 90/100 (OR 1.90, 1.01-3.56), adjusting for age, sex, diuretics, recent urinary infection (≤3 months) and antidepressants. Table 1. Proportion of patients in remission according to different criteria and biologic class Controls (n=203) SLE/Sjögren (n=93) p-value Age 44.7±16.7 47.6±17.5 0.17 Female 129 (63.6) 86 (92.5) <0.0001 Urinary tumor 3 (1.5) 4 (4.3) 0.14 Urinary Infection ≤3 mo 15 (7.4) 5 (5.4) 0.52 Diuretics 21 (10.3) 8 (8.6) 0.64 Anti-cholinergics 4 (2.0) 4 (4.3) 0.25 Anti-depressants 8 (3.9) 20 (21.5) <0.0001 Corticosteroids 3 (1.5) 64 (68.8) <0.0001 SB score 12.97±15.87 22.97±21.11 <0.0001 HRQL score 94.35±10.77 89.26±15.63 0.0002 SB score ≥20 50 (24.6) 47 (50.5) <0.0001 HQRL score ≤90 35 (17.2) 31 (33.3) 0.002 Conclusions Patients with SLE/SS had higher OAB symptom scores and lower HRQL scores compared to controls, using a validated questionnaire. They were also more likely to have a clinically meaningful score, suggesting that OAB and IC might be, indeed, more frequent in these patients. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.4745