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Yoram Mor

Publications and source records attributed to Yoram Mor.

At least 19 recordsLinked to original sources
PubMed2006

Fascial patch technique for repair of complicated urethrovaginal fistula.

INTRODUCTION: The operative repair of urethrovaginal fistula due to tension-free vaginal tape (TVT) erosion is a challenging task, and coexisting stress urinary incontinence may complicate the situation even further. We present our technique for the repair of recurrent urethrovaginal fistula combined with stress urinary incontinence, occurring after previous removal of an eroded TVT and failed repair of the fistula. TECHNICAL CONSIDERATIONS: With the patient in the dorsal lithotomy position, an inverted U-shaped incision was cut in the anterior vaginal wall, and a vaginal flap was developed. The Martius flap from the previous repair was identified and separated from the urethra, thereby disclosing a large fistula hole on the left side of the mid-urethra. Because the periurethral tissues were very friable and attenuated, only one-layer closure of the fistula hole with these tissues was feasible. Therefore, we opted to combine a pubovaginal fascial sling with a fascial patch graft, used to reinforce the fistula site. Through a low transverse abdominal incision, a 15 x 2-cm strip of rectus fascia was harvested. A 2 x 2-cm patch of fascia was excised from the strip and transfixed to the periurethral tissues, covering the sutured fistula site. The Martius flap was repositioned over the flap, and a pubovaginal sling procedure was done. The postoperative course was uneventful, the fistula has healed, and the patient regained full continence. CONCLUSIONS: This technique can be used in complicated urethrovaginal fistula repair when the surrounding periurethral tissues have been devastated and can be combined with pubovaginal fascial sling placement.

Adult↗
PubMed2006

Multiple imprinted and stemness genes provide a link between normal and tumor progenitor cells of the developing human kidney.

Wilms' tumor (WT), the embryonic kidney malignancy, is suggested to evolve from a progenitor cell population of uninduced metanephric blastema, which typically gives rise to nephrons. However, apart from blastema, WT specimens frequently contain cells that have differentiated into renal tubular or stromal phenotypes, complicating their analysis. We aimed to define tumor-progenitor genes that function in normal kidney development using WT xenografts (WISH-WT), in which the blastema accumulates with serial passages at the expense of differentiated cells. Herein, we did transcriptional profiling using oligonucleotide microarrays of WISH-WT, WT source, human fetal and adult kidneys, and primary and metastatic renal cell carcinoma. Among the most significantly up-regulated genes in WISH-WT, we identified a surprising number of paternally expressed genes (PEG1/MEST, PEG3, PEG5/NNAT, PEG10, IGF2, and DLK1), as well as Meis homeobox genes [myeloid ecotropic viral integration site 1 homologue 1 (MEIS1) and MEIS2], which suppress cell differentiation and maintain self-renewal. A comparison between independent WISH-WT and WT samples by real-time PCR showed most of these genes to be highly overexpressed in the xenografts. Concomitantly, they were significantly induced in human fetal kidneys, strictly developmentally regulated throughout mouse nephrogenesis and overexpressed in the normal rat metanephric blastema. Furthermore, in vitro differentiation of the uninduced blastema leads to rapid down-regulation of PEG3, DLK1, and MEIS1. Interestingly, ischemic/reperfusion injury to adult mouse kidneys reinduced the expression of PEG3, PEG10, DLK1, and MEIS1, hence simulating embryogenesis. Thus, multiple imprinted and stemness genes that function to expand the renal progenitor cell population may lead to evolution and maintenance of WT.

Animals↗
PubMed2006

Renal artery occlusion during nephron-sparing surgery: retrospective review of 301 cases.

OBJECTIVES: Temporary occlusion of the renal artery during nephron-sparing surgery may facilitate complete tumor resection and reduce operative bleeding. However, it may also entail a greater risk of ischemic kidney damage. In contrast, when vascular occlusion is not applied, the risk of bleeding, as well as the risk of positive margins, may be increased. To study these issues, we retrospectively evaluated our results with nephron-sparing surgery for kidney masses using renal artery occlusion compared with patients in whom vascular occlusion was not applied. METHODS: From 1988 to 2003, 301 consecutive patients underwent nephron-sparing surgery for a kidney mass at our institutions. At the surgeons' discretion, the renal artery was temporarily occluded in 181 patients (60%) and was not in 120 (40%). RESULTS: No statistically significant differences were found between the two groups regarding blood loss, transfusion rates, and overall complication rates. The loss of the renal unit because of ischemia was noted in 2 patients (1.2%) after renal artery occlusion and in none of the nonoccluded group. Positive tumor margins were found in 5 patients (4.2%) in the nonoccluded group and in 1 patient (0.6%) in the vascular occlusion group. CONCLUSIONS: Our results suggest that although vascular occlusion during nephron-sparing surgery may increase the risk of permanent kidney damage, patients with no vascular occlusion may have a greater risk of positive tumor margins after surgery. These two factors should be taken into consideration and could be discussed with the patient when attaining informed consent.

Adolescent↗
PubMed2006

Torsion of the cryptorchid testis--can it be salvaged?

PURPOSE: The literature concerning undescended testis mainly concentrates on the increased risks of infertility and development of germ cell tumors. Yet the UDT also appears to be at higher risk for torsion compared to the normally descended testis, and this issue is relatively poorly addressed. We reviewed all cases of torsion of UDTs operated on at our hospital during the last 20 years in an attempt to characterize better this condition and its salvageability. MATERIALS AND METHODS: In this retrospective clinical study we reviewed and analyzed all cases of testicular torsion involving UDT operated on at our hospital between 1984 and 2004. RESULTS: A total of 11 children were operated on at our hospital for torsion of undescended testis between 1984 and 2004. Patient age ranged from 1 month to 18 years (median 7.5 months). In all cases unilateral torsion of undescended testis was diagnosed, with 73% of cases involving the left side. Clinical symptoms included inguinal swelling and erythema associated with a tender, firm mass palpated in the groin area and an empty ipsilateral hemiscrotum. Doppler ultrasound examination was routinely performed in the last 7 patients to confirm the diagnosis. During inguinoscrotal exploration severe ischemia or overt necrosis of the testis was found in 5 of 11 cases. Three of these 5 cases were managed by orchiectomy, while in the other 2 cases the testis subsequently vanished. In the 6 patients who exhibited some improvement following detorsion and warming of the tissue the testes were preserved and orchiopexy was performed. Followup was available in only 5 patients, with vanishing of the torsed testis observed in 4 and a normal testicle detected 21 years postoperatively in 1 patient who was diagnosed early. CONCLUSIONS: This series clearly demonstrates poor rates of surgical salvage, which we mainly attribute to delays in parental response and in primary physician referral to the hospital. Parents, who have a pivotal role in early diagnosis, were usually unaware of this urological emergency, and some were surprisingly unaware of the presence of cryptorchidism. By increasing the awareness regarding this entity among members of the medical community and parents, we hope that torsion of the cryptorchid testis (literally, "hidden testis") will no longer necessarily be synonymous with "crypt-torsion" ("hidden torsion").

Adolescent↗
PubMed2006

Spontaneous reduction of bladder base prolapse with gradual filling: a video-urodynamic observation.

OBJECTIVE: To report video-urodynamic observations on the effect of gradual bladder filling on the degree of bladder base prolapse while erect, as the effect of bladder fullness on the degree of bladder base descent in patients with a cystocele has rarely been addressed. PATIENTS AND METHODS: Thirty-six consecutive patients with complaints of a protruding vaginal mass due to bladder prolapse underwent video-urodynamic studies, comprised of filling and voiding cystometry with contrast material, while standing. RESULTS: During filling cystometry, in 16 of 36 patients (44%) the prolapse gradually and spontaneously reduced with increasing bladder volumes, so that at cystometric capacity the bladder base was completely reduced. Straining at cystometric capacity did not affect the bladder base position and, during voiding cystometry, the bladder base remained completely reduced. In the remaining 20 patients there was only partial reduction of the cystocele during bladder filling, i.e. the cystocele was reduced by half or less. Seven of the 16 patients with a full reduction of cystocele had concurrent uterine prolapse, compared with 15 of 20 (80%) who had only partial or no spontaneous reduction; the difference was statistically significant (P = 0.02). CONCLUSION: These video-urodynamic results suggest that when erect the degree of bladder base descent is volume-dependent, and that concomitant uterine prolapse might hinder spontaneous reduction of the cystocele.

Aged↗
PubMed2006

Role of transrectal ultrasonography in the evaluation of azoospermic men with low-volume ejaculate.

OBJECTIVE: The purpose of this prospective study was to evaluate the incidence of distal ejaculatory system defects with transrectal ultrasonography (TRUS) among patients evaluated for azoospermia. METHODS: Forty-two patients with low-volume ejaculate and azoospermia were evaluated by physical examination, serum follicle-stimulating hormone and luteinizing hormone level determination, karyotyping, selective screening for cystic fibrosis mutations, and TRUS. RESULTS: On physical examination, in 29 patients (69%), either 1 (12 patients) or both (17 patients) of the vasa deferentia could not be palpated. In the group of 17 patients with bilateral involvement of the vasa deferentia, the ultrasonographic imaging universally showed bilateral absence or hypoplasia of the seminal vesicles with bilateral agenesis of the vasa deferentia and nonvisualization of both ejaculatory ducts. In the patients with a unilateral abnormality on physical examination, the ultrasonographic imaging showed absence of the ipsilateral seminal vesicle in 7 patients and the hypoplastic seminal vesicle in 5. In the group of 13 patients with normal physical examination findings, a variety of obstructive causes were diagnosed by TRUS examination. CONCLUSIONS: According to this study, TRUS appears to be a sensitive method for evaluating the anatomy of the distal ejaculatory system. Its safety and low costs make it a good alternative to the other invasive and expensive methods.

Adult↗
PubMed2005

Effects of intravesical chemotherapy and immunotherapy on semen analysis.

OBJECTIVES: To study the effect of intravesical chemo-immunotherapy on the sperm parameters of young patients. METHODS: Twelve young male patients with superficial transitional cell carcinoma, all younger than 40 years old at surgery, were included in this prospective study. The mean patient age was 34.8 years (range 22 to 40). Of the 12 patients, 8 had superficial transitional cell carcinoma, grade 2-3, and 4 had proven invasion to the lamina propria; 1 patient had accompanying carcinoma in situ. Accordingly, adjuvant intravesical treatment with either bacille Calmette-Guérin (BCG; 6 patients) or mitomycin C (6 patients) was indicated on the basis of the initial stage and grade. Sperm analysis was performed before bladder irrigation and subsequently 3 months after completion of intravesical therapy. RESULTS: All 12 patients had normal follicle-stimulating hormone and luteinizing hormone levels after surgery. All 12 patients had normal-volume ejaculate, except for 1 who had undergone multiple prior transurethral tumor resections. Of the 6 patients who were treated with mitomycin C, only a few minor insignificant changes in the sperm quality were noted, and 2 of them later fathered healthy children. However, in 3 of the BCG-treated patients, remarkable changes in all sperm quality parameters were evident, with a statistically significant decrease in the sperm count (P = 0.0021). CONCLUSIONS: We suggest that potential adverse effects on spermatogenesis can be induced by intravesical therapy with BCG and that, consequently, routine pretreatment semen preservation should be considered as a precaution before instillation of intravesical BCG to prevent subsequent fertility difficulties in young men.

Adjuvants, Immunologic↗
PubMed2005

Laparoscopic partial nephrectomy: is it advantageous and safe to clamp the renal artery?

OBJECTIVES: To compare the outcomes of laparoscopic partial nephrectomy (LPN) performed with and without vascular clamping and to evaluate the impact of clamping on postoperative renal function. METHODS: A total of 45 patients underwent LPN, 29 with and 16 without vascular occlusion. The two groups were compared regarding complication rates, blood loss, conversion rates, operative time, mean tumor size, and incidence of positive margins. Renal function was evaluated by postoperative dimethyl mercaptosuccinic acid scans. RESULTS: The mean blood loss was lower when vascular clamping was applied (320 versus 510 mL, P <0.05) than when it was not. The conversion rates were similar (10.3% versus 12.5%), and the mean operative time was shorter in the nonclamped group (115 versus 126 minutes). Urinary leakage occurred in 2 patients, 1 from each group. The mean tumor diameter was 3.2 cm in the clamped and 1.9 cm in the nonclamped group (P <0.05). In 2 patients (12.5%) in the nonclamped and 1 patient (3.4%) in the clamped group, the surgical margins were focally positive for tumor. The mean warm ischemia time was 28 minutes, and dimercaptosuccinic acid scans performed in 18 patients showed normal ipsilateral renal function (mean relative function 48%). CONCLUSIONS: LPN without vascular clamping is feasible in selected cases. However, clamping of the artery seems to be associated with reduced blood loss and a lower incidence of positive margins. Moreover, according to the postoperative dimercaptosuccinic acid scan findings, limited warm ischemia does not seem to result in permanent renal damage. We suggest that clamping of the renal artery should be considered during LPN, even for very small, superficial tumors.

Adult↗
PubMed2005

Is frozen section analysis in nephron sparing surgery necessary? A clinicopathological study of 301 cases.

PURPOSE: One of the basic principles of nephron sparing surgery for renal cell carcinoma is resection of the tumor with normal tissue margins verified by frozen section analysis. In cases of positive tumor margins the surgeon is committed to complete the local resection or to perform radical nephrectomy. In this study we retrospectively evaluated the yield of frozen section analysis performed during nephron sparing surgeries, especially concerning compatibility with the final histological report and the long-term oncological outcome. MATERIALS AND METHODS: Between 1988 and 2003, 172 men and 129 women with a mean age of 59 years (range 16 to 83) underwent nephron sparing surgery due to suspected renal tumors. Mean tumor size was 3.56 cm (range 1 to 12.5). Frozen section analysis was routinely performed during surgery. RESULTS: Positive tumor margins in frozen section analysis were found in 2 cases (0.7%). In both cases the tumor was centrally located. Those 2 patients underwent immediate radical nephrectomy but no residual tumor was subsequently found in the radical nephrectomy specimens. Paraffin sections disclosed positive tumor margins in 4 other cases (1.3%) in whom the frozen section analysis had shown tumor negative margins. Of the 4 patients 1 underwent radical nephrectomy for tumor recurrence after 9 months. The other 3 patients showed no evidence of disease recurrence after 26, 59 and 120 months of followup. CONCLUSIONS: Our results suggest that frozen section analysis during nephron sparing surgery has minimal clinical significance and hence routine incorporation in urological practice should be reconsidered.

Adolescent↗
PubMed2005

Sedation during voiding cystourethrography: comparison of the efficacy and safety of using oral midazolam and continuous flow nitrous oxide.

PURPOSE: We compare the efficacy and safety profile of oral midazolam and continuous flow 50% nitrous oxide (N(2)O) for alleviating anxiety and pain during voiding cystourethrography (VCU) in children. MATERIALS AND METHODS: This prospective, randomized clinical trial study was conducted in the radiology unit of a tertiary care center. Children older than 3 years scheduled for VCU were given either 0.5 mg/kg midazolam orally or continuous flow 50% N(2)O. Main outcomes were degree of anxiety and pain as assessed by the attending nurse and radiologist performing the test using a behavioral anxiety score, a distress score and an overall satisfaction score, side effects and recovery profile. RESULTS: The study included 47 children (89% girls) with a mean age of 6 years (range 3 to 15). There were 24 subjects in the midazolam group and 23 in the N(2)O group. Midazolam and N(2)O provided adequate anxiety and pain relief to perform the examination, yet children given N(2)O required less restraining and experienced a significantly shorter recovery time (29 +/- 10 vs 63 +/- 25 minutes, p <0.001). CONCLUSIONS: Continuous flow 50% nitrous oxide and oral midazolam are comparably safe and effective in reducing anxiety and distress during VCU in children older than 3 years. However, N(2)O provides a more rapid onset of sedating effect and has a shorter recovery time.

Administration, Inhalation↗
PubMed2005

Inhibition of Wilms tumor xenograft progression by halofuginone is accompanied by activation of WT-1 gene expression.

PURPOSE: Wilms tumor (WT) is the most common malignant neoplasm of the urinary tract in children. Although it is curable with long-term survival, the combination of surgery, chemotherapy and often radiotherapy in some cases results in severe complications in adulthood. Therefore, novel therapeutic strategies that would decrease treatment burden and improve outcome for high risk patients are required. We evaluated the efficacy of halofuginone, an inhibitor of collagen type I synthesis and angiogenesis, to inhibit WT development in xenografts models. MATERIALS AND METHODS: WTs derived from 2 patients with favorable histology at different disease stages were implanted subcutaneously or orthotopically in the kidneys of nude mice. Halofuginone was administered intraperitoneally (2 mug per mouse every other day) or given in the diet (1 part per million). RESULTS: Independent of disease stage, tumor location or administration route, halofuginone caused a decrease in angiogenesis that resulted in marked inhibition of tumor development. This result was accompanied by a reduction in collagen synthesis, reduced levels of hepatocyte growth factor receptor MET and increased levels of the tumor suppressor protein WT1. In culture halofuginone increased the synthesis of WT1 in the human WT cell-line SK-NEP-1 and in other cancer cell lines such as hepatocellular carcinoma and prostate cancer. In SK-NEP-1 halofuginone also lowered erb B2 levels and reduced cell proliferation. CONCLUSIONS: These results suggest that halofuginone is a potent inhibitor of WT progression. Because of its unique mode of action, halofuginone may decrease the treatment burden when combined with chemotherapy.

Angiogenesis Inhibitors↗
PubMed2005

The role of indirect radionuclide cystography during the acute phase of pyelonephritis in young women.

OBJECTIVE: To review our experience using dynamic 99mTc-diethylenetriamine penta-acetic acid renal scintigraphy combined with indirect radionuclide cystography (IRC) in the acute phase of pyelonephritis, as a possible alternative to the conventional imaging, as investigating acute pyelonephritis usually includes imaging the upper urinary tract during the acute phase, to exclude obstruction, and delayed voiding cysto-urethrography (VCUG) when underlying vesico-ureteric reflux (VUR) is suspected. PATIENTS AND METHODS: Between 1997 and 1999, 47 young women (median age 22 years, range 18-37) were hospitalized for acute pyelonephritis. The combined study was used during the acute phase of the disease, usually within 24 h of hospitalization. The principle of IRC is based on the reappearance of radioactivity in the ureters or kidneys after previously detecting renal clearance of an intravenously injected radioisotope. The increase in radioactivity over the ureters or kidneys indicates VUR. The subsequent follow-up included VCUG, after recovery and at least 6 weeks after discharge. RESULTS: Overall, 47 patients had early IRC studies; obstruction of the urinary tract during the acute phase of the disease was excluded in all. In 13 (28%) of the patients early IRC studies showed VUR involving 21 upper tract units. The renal parenchymal scan was impaired in 17 (36%) patients, and six of these 17 also had detectable concomitant reflux on IRC. Overall, 24 IRC studies (51%) were considered positive, showing VUR, renal parenchymal pathology or both; 23 (49%) were normal. Follow-up VCUG was used in 32 patients (68%); only three (9%) detected VUR. All of the patients with VUR on follow-up VCUG had also had an abnormal early IRC study, showing either reflux (two) or findings suggestive of pathological renal parenchyma (one). CONCLUSIONS: In addition to the well-established role of renal scintigraphy in excluding obstruction of the collecting system, early IRC is characterized by high sensitivity and accurate negative predictive value for detecting VUR. It can therefore be used to screen adults presenting with acute pyelonephritis for the presence of VUR. Patients with an abnormal IRC require follow-up VCUG after complete recovery, while those with a negative study may be managed expectantly, with no further radiological evaluation. This proposed strategy may avoid up to half of the delayed VCUG studies, preclude the related inconvenience, and substantially reduce the costs.

Acute Disease↗
PubMed2005

Complications of circumcision in Israel: a one year multicenter survey.

BACKGROUND: In Israel, virtually all children undergo circumcision in the neonatal period. Traditionally, it is commonly performed by a "Mohel" (ritual circumciser) but lately there is an increasing tendency among the educated secular population to prefer a medical procedure performed by a physician and with local anesthetic injection. OBJECTIVES: To evaluate the outcome of this procedure and to compare the complication rate following circumcisions performed by ritual circumcisers and by physicians. METHODS: In 2001, of the 19,478 males born in four major medical centers in Israel 66 had circumcision-related complications. All the children were circumcised in non-medical settings within the community. The patients were medically evaluated either urgently due to immediate complications or electively in outpatient clinics later on. Upon the initial assessment a detailed questionnaire was filled to obtain data regarding the procedure, the performer, and the subsequent complications. RESULTS: All the circumcisions were performed during the early neonatal period, usually on day 8 of life (according to Jewish law). in 55 cases (83%) it was part of a ritual ceremony conducted by a ritual circumciser (Mohel), while in 11 babies (17%) physicians were involved. Acute bleeding after circumcision was encountered in 16 cases (24%), which required suturing in 8. In addition, we found two cases of wound infection and one case of partial amputation of glans penis in which the circumcision was performed by a ritual circumciser. Among the late complications, the most common was excess of skin in 38 cases (57%); 5 children (7.5%) had penile torsion and 4 children (6%) had shortages of skin, phimosis and inclusion cyst. The overall estimated complication rate of circumcision was 0.34%. CONCLUSIONS: Complications of circumcision are rare in Israel and in most cases are mild and correctable. There appears to be no significant difference in the type of complications between medical and ritual circumcisions.

Ceremonial Behavior↗
PubMed2005

Laparoscopic nephrectomy: initial experience in Israel with 110 cases.

BACKGROUND: Data during the last decade show that laparoscopic nephrectomy is becoming an accepted and advantageous minimally invasive alternative to the open procedure. OBJECTIVE: To evaluate the efficacy, safety and reproducibility of laparoscopic nephrectomy in a series of 110 consecutive procedures. METHODS: A total of 110 patients underwent laparoscopic nephrectomy in our institution during the last 3 years. Their data were entered into a database and analyzed, including age, gender, indications for surgery, operative time, blood loss, intraoperative complications, conversion rates, and postoperative complications (defined as complications occurring up to 1 month after surgery). Histologic results and outpatient follow-up were also recorded. RESULTS: Mean age at surgery was 63 years (range 21-89 years). The indications for surgery included solid renal masses in 64 cases, non-functioning kidneys in 35, and collecting system or ureteral tumors in 11; and the procedures performed were radical nephrectomy, simple nephrectomy, or nephroureterectomy, respectively. The mean operative time was 125 minutes (range 70-310 minutes). Intraoperative complications were recorded in eight cases (7.3%), including vascular injuries of the renal artery in two, and of the renal vein, inferior vena cava and right adrenal vein in one case each. Injury of the large bowel and splenic hylus was recorded in one case and malfunction of the vascular endoGIA stapler leading to severe bleeding in one case. Nine cases were converted to open surgery (8.2%), four of them urgently due to intraoperative complications, while in another five cases conversions were elective following poor progression of the laparoscopic procedure. Comparison of the complication rate at follow-up between the initial 50 and the last 60 patients revealed no change. The conversion rate dropped significantly along the learning curve with 7 cases converted among the initial 50 patients, versus 2 in the last 60. There was no perioperative mortality. In two cases we recorded major postoperative complications, including pneumothorax treated by insertion of a thoracic drain and incarcerated inguinal hernia treated by surgery, while minor complications were seen in five patients. Histologic examination showed renal cell carcinoma pT1-T3a in 62 patients, oncocytoma in 5, transitional cell carcinoma T1G2-T3G3N1 in 10, renal sarcoma in 1, metastasis from lung tumor in 1, and end-stage kidney in the remainder. Negative margins were obtained in all cases. CONCLUSIONS: Laparoscopic nephrectomy may be currently considered a routine, safe and effective procedure associated with minimal morbidity. The conversion rate seemed to drop significantly after 50 cases. In view of the inherent benefits for patients, in terms of reduced pain level, faster recovery and improved cosmetic results, the laparoscopic approach has become the standard approach for nephrectomy in our institution.

Adult↗
PubMed2005

[May children and adolescents with a solitary kidney participate in sports activities?].

The presence of a solitary kidney in children and adolescents is not a rare condition, and flank injury in this context may result in renal impairment, with subsequent nephrectomy, dialysis or kidney transplantation. Participation in sports activities commonly results in pediatric injuries, and the kidneys are the most frequently affected organs during blunt abdominal trauma. Nonetheless, the incidence of major renal trauma during sports activities, according to pediatric trauma registries in the United States, is still relatively low. Subsequently, there is an ongoing debate in the literature regarding the safety of participation of children with a solitary kidney in sports activities. The literature review presented reveals that the general recommendation has shifted from a formerly restrictive attitude towards a more permissive one, based upon pooled data and calculated risks.

Abdominal Injuries↗
PubMed2004

The vicious cycling: bicycling related urogenital disorders.

PURPOSE: Bicycle riding is one of the most popular means of transportation, recreation, fitness and sports among millions of people of all ages who ride on road and off road, using a variety of bicycle types. It is also a readily available form of aerobic non-impact exercise with established cardiovascular beneficial effects. Bicycles are also a common source of significant injuries. This review focuses upon the specific bicycling related overuse injuries affecting the genitourinary tract. MATERIALS AND METHODS: MEDLINE search of the literature on bicycling and genitourinary disorders was performed using multiple subject headings and additional keywords. The search yielded overall 62 pertinent articles. We focused primarily on the most prevalent related disorders such as pudendal nerve entrapment, erectile dysfunction and infertility. The potential effect of bicycling on serum PSA level was also discussed in depth in view of its recognized clinical importance. Infrequent disorders, which were reported sporadically, were still addressed, despite their rarity, for the comprehensiveness of this review. RESULTS: The reported incidence of bicycling related urogenital symptoms varies considerably. The most common bicycling associated urogenital problems are nerve entrapment syndromes presenting as genitalia numbness, which is reported in 50-91% of the cyclists, followed by erectile dysfunction reported in 13-24%. Other less common symptoms include priapism, penile thrombosis, infertility, hematuria, torsion of spermatic cord, prostatitis, perineal nodular induration and elevated serum PSA, which are reported only sporadically. CONCLUSIONS: Urologists should be aware that bicycling is a potential and not an infrequent cause of a variety of urological and andrological disorders caused by overuse injuries affecting the genitourinary system.

Bicycling↗
PubMed2004

[Lower urinary tract reconstruction by augmentation cystoplasty and insertion of artificial urinary sphincter cuff only: long term follow-up].

OBJECTIVES: To review retrospectively our long-term experience with augmentation cystoplasty and simultaneously insertion of artificial urinary sphincter cuff only for lower urinary tract reconstruction in cases of mixed bladder and sphincteric dysfunction. We tried to assess the postoperative continence status, as well as the associated morbidity, focusing upon infections, urethral erosion and revision rates. PATIENTS AND METHODS: Eleven patients with urinary incontinence due to a small capacity and low compliant bladder, combined with incompetent outlet, underwent lower urinary tract reconstruction by augmentation cystoplasty and simultaneous insertion of a bladder neck sphincter cuff only (AMS, model AS-800). Mean age was 29 years (range 18-45). The etiology of voiding dysfunction was a seminal cord injury in 6 patients, myelomeningocele in 2 and spinal cord surgery in 1, bladder exstrophy (1) and pelvic trauma combined with spinal cord injury (1). RESULTS: With mean follow-up period of 115 months (range 45-141), 8 patients (73%) achieved continence on clean intermittent catheterization without any further interventions. Two patients required insertion of sphincter pump and reservoir at a second stage to achieve full continence and subsequently one was removed due to erosion (overall continence rate of 82%). In another patient, the cuff located at the level of the bladder neck has eroded and was removed. None of the patients has experienced an infection of the device in the immediate postoperative period, neither thereafter. CONCLUSIONS: Insertion of sphincter cuff only during augmentation cystoplasty may be sufficient to achieve continence in many incontinent patients who may not be cured by bladder augmentation alone. The procedure is technically easy and is not associated with increased risk of injury to the augmented bladder, neither with subsequent infectious complications.

Adolescent↗