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   Table of Contents - Current issue
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July-September 2020
Volume 32 | Issue 3
Page Nos. 103-134

Online since Monday, February 22, 2021

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ORIGINAL ARTICLES  

Intravesical botulinum toxin Type A injection therapy in neurological patients: A single center experience p. 103

DOI:10.4103/HUAJ.HUAJ_15_20  
Objectives: The objective of this study is to present real-life data on the efficacy and safety of the intravesical injection of the approved dose of 200U BOTOX in patients with drug-resistant incontinence of neurogenic etiology. Available literature is relatively limited. Materials and Methods: We analyzed routinely collected prospective data from the treatment of patients with neurogenic drug-resistant incontinence who attended an academic neurourology outpatient clinic. All patients received at least one intravesical injection of 200U BOTOX, following urodynamic confirmation of neurogenic detrusor overactivity while recording the presence of urinary tract infection (UTI). Patients were followedup at 6 and 24 weeks with urodynamic retests. This protocol was followed with each repeat treatment, while recording the relapse time of incontinence. Results: Forty-nine patients (28 males, 21 females, mean age 47.04 ± 14.16 years) were treated; 18 (36.7%) suffered from spinal cord injury, 12 (24.54%) from multiple sclerosis, and the rest from other neurological conditions. Fifteen received a 2nd Botox treatment, 10 a 3rd, 6 a 4th, and one a 5th and 6th session. Forty-two (85.7%) patients had urodynamically proven incontinence and in 14 (28.6%) an UTI was identified before the first treatment. Subjective cure of incontinence was recorded in 73.7% of patients after the first treatment. There was no correlation of gender, neurological diagnosis, or presence of UTI before the BOTOX treatment with the persistence of incontinence. The median relapse time after the first two treatments was 6 (interquartile range = 5) and 10.5 months, respectively (P = 0.31). Significant improvements were recorded urodynamically in maximum cystometric capacity after each treatment (P < 0.001) and in maximum detrusor pressure after the first session compared to baseline (P < 0.05, Bonferonni correction). The presence of UTI did not affect the incontinence relapse time or urodynamic changes after initial treatment. Conclusions: In the present cohort, intravesical administration of 200U BOTOX achieved complete cure of neurogenic drug-resistant incontinence in a significant proportion of patients with sustained clinical and urodynamic changes after each repeat injection.
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Acupuncture as a treatment choice for persistent chronic bacterial prostatitis-related symptoms: A pilot study p. 109

DOI:10.4103/HUAJ.HUAJ_18_20  
Background and Aim: In several chronic bacterial prostatitis (CBP) cases, symptoms persist despite bacterial eradication. Since acupuncture has been shown to ameliorate the symptoms of chronic prostatitis/chronic pelvic pain syndrome, it may be an effective treatment option for clinically untreated CBP cases. In order to investigate the above hypothesis, we performed a pilot study. Methods: Patients with persistent CBP-related symptoms and confirmed bacterial eradication were randomly allocated to acupuncture or conventional medical treatment. Symptom burden was assessed at baseline, weeks 4 and 12. Eight patients received 30-min sessions of acupuncture twice weekly for 1 month (Group 1), ten patients received lornoxicam 8 mg orally once daily for 1 month (Group 2), eight patients received Serenoa repens (SR) 320 mg twice daily for 1 month (Group 3), and nine patients received pregabalin 25 mg twice daily for 1 month (Group 4). The primary outcome is the proportion of responders at week 4 with significant change from baseline in the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score and International Prostate Symptom Score (IPSS) at week 4. Secondary outcomes included ratings of clinical pain (visual analog scale) and quality of life at week 12. Results: At week 4, no statistically significant differences in the mean decrease of NIH-CPSI and IPSS total scores from baseline among groups were noted. After 12 weeks, none of the participants experienced complete resolution of pain. Differences in the mean pain and quality of life levels were statistically insignificant. Conclusion: Acupuncture is an effective treatment option for persistent CBP-related pain however is inferior to conventional medical treatment in reducing CBP-related lower urinary tract symptoms. For this reason, it may be offered in combination with medical therapy in patients with combined symptoms.
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Extracorporeal shock wave lithotripsy for bladder stones: Does it have any role in the modern endourology era? p. 113

DOI:10.4103/HUAJ.HUAJ_20_20  
Bladder lithiasis accounts for around 5% of all urinary tract stones diseases with typical symptoms dysuria, hematuria, urgency and intermittent urination. therapy, percutaneous procedures, and open surgical treatments have been replaced by transurethral lithotripsy. The aim of this study is to investigate the safety and efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of vesical lithiasis. A total of 47 patients underwent ESWL for bladder calculi, using the electromagnetic Dornier Lithotripter S. Stone and prostate size as well as postvoid urine residual was determined with sonography. The success of the procedure was determined in the absence of stone fragments after 4 weeks. The mean age of patients was 69.1 years (34–93 ± 11.43) with a median prostate size at 50.1 cm3 (0–85 ± 15.81) and an average postvoid residual at 131 ml (50–190 ± 32.82). The mean size of lithiasis was found 1.97 cm (1–4.5 ± 0.79) and the median number of impact waves 2704.34 (1800–3000 ± 293.37) with the average duration of session 20.63 min (15–25 ± 2.63). Only two patients received analgesic treatment and the mean pain visual analog scale score was 1.73 (0–4 ± 0.98). The stone-free rate was found at 76.5% (36/47) and no severe complications (Clavien–Dindo >2) were observed. ESWL is a safe and efficient alternative for the management of vesical lithiasis, especially for high-risk patients that are not candidates for a more invasive treatment.
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REVIEW ARTICLES Top

Acupuncture in the treatment of chronic prostatitis/chronic pelvic pain syndrome: A brief review p. 117

DOI:10.4103/HUAJ.HUAJ_17_20  
Introduction/Aim: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) affects many adult men worldwide. It has been almost a decade since the introduction of acupuncture on CP/CPPS treatment. Since then, a number of studies have been performed. The aim of the study was to assess the effects and safety of the use of acupuncture for CP/CPPS. Materials and Methods: A systematic search was performed in electronic libraries for clinical trials, experimental studies, and systematic reviews on the topic using the terms: “chronic prostatitis,” “chronic pelvic pain syndrome,” “acupuncture” combined with the keywords: “treatment,” “efficacy,” and “safety,” in various combinations. In order to provide accurate conclusions, we evaluated only randomized studies focused on the effects and safety data of acupuncture in the treatment of CP/CPPS-related symptoms. Only trials performed in patients with confirmed CP/CPPS randomized with adequate methods and providing clear outcome reports were finally evaluated. Only full-text available papers written in the English language were considered. There was no restriction on publication date. Results: According to our research, 40 papers examining the role of the acupuncture in the treatment of CP/CPPS exist. Only 8 out of 40 fulfilled the above-mentioned criteria. Overall, evidence supports acupuncture as an effective treatment for CP/CPPS-induced symptoms, particularly in relieving pain. Regarding long-term responses without additional treatment, the examined studies provide inconsistent information. Moreover, evidence regarding urination problems is limited. Conclusion: Available data suggest that acupuncture treatment is able to decrease CP/CPPS related pain. Since it was associated with rare and slightly adverse events, it could be considered as a safe complementary therapeutic option for men with CP/CPPS.
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Nephrometry scores in renal cancer p. 121

DOI:10.4103/HUAJ.HUAJ_21_20  
Several independent tools and measurements can be used to assess the same endpoint. This is the case for renal tumors, for which different nephrometry scores (NSs) based on preoperative imaging are currently available. These systems provide objective information with regard to surgical complexity, risk of blood loss, ischemia time, and perioperative complications that can assist physicians in the decision-making process and in planning the most appropriate surgical approach. In this review article, the most widely used preoperative NSs are being mentioned; their parameters are analyzed and their usefulness and reliability in everyday clinical and surgical practice are being compared.
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Optimizing anticancer therapy in newly diagnosed metastatic castration sensitive prostate cancer p. 128

DOI:10.4103/HUAJ.HUAJ_19_20  
Historically, androgen deprivation therapy has been the standard of care in the management of metastatic castration sensitive prostate cancer (mCSPC). However, during the past 5 years, numerous different treatment options have become available and have been set under investigation. The addition of docetaxel or abiraterone acetate has improved outcomes for patients with mCSPC and has become a new standard of care. New drugs targeting androgen receptor axis, local therapy including surgery, radiotherapy, and brachytherapy as well as metastatic-directed treatments have also demonstrated promising outcomes. In this work, the available data on all treatment modalities employed in mCSPC are being reviewed.
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CASE REPORT Top

Partial orchiectomy: Experience of four cases in a secondary hospital of greece p. 132

DOI:10.4103/HUAJ.HUAJ_16_20  
Aim of the Study: The aim of this study is to review our collective experience with partial orchectomy due to testicular tumors in a secondary hospital of Greece. Materials and Methods: In total four young patients with relative indications for a partial orchectomy (single testis and/or tumors <2 cm in diameter, patient consent for a close follow-up, negative tumor markers) underwent partial orchiectomy in our institution. All operations were performed under clamping of the spermatic cord, and postoperative period was uneventful. Results: Pathology examination revealed one case of Sertoli cell only tumor, one patient with testicular cancer of mixed pathology (embryonal and teratoma), one case of organized hematoma, and one case with focal atypical inflammation. Patients underwent a close follow-up protocol. The patient with the mixed tumor was subjected to adjuvant chemotherapy with BEP (bleomycin, etoposide, cisplatin). The patient with atypical inflammation had a single testis due to a history of contralateral seminoma. During follow-up, he developed local tumor recurrence and underwent orchiectomy that revealed the presence of seminoma. The patient was set under testosterone replacement therapy. Conclusions: Partial orchiectomy represents a safe treatment option in the management of small testicular tumors. A benign pathology in up to 50% of cases should be expected. In case of both malignant and benign pathologies, a close follow-up is deemed necessary for the timely recognition of local recurrences in case of insufficient cancer eradication.
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