UROLOGY JOURNAL
Year:2021 | Volume:18 | Issue:5|Papers Count:13

Purpose: Lower urinary tract dysfunction (LUTD) is the most common problem of the referral children to the pediatric urology clinics. If this condition does not treat early in life, it will be a lifelong problem. During recent decades, electrical stimulation therapy has been expanded and extensively used for the treatment of LUTD in both adults and children. The aim of this review is to suggest clinicians an updated understanding of effects of interferential (IF) electrical stimulation therapy in management of LUTD in children. Materials and methods: The search was performed in databases of Medline, PubMed, Google Scholar, , and Scopus for information about IF electrical stimulation and its application using search words such as “ IF electrical stimulation” , “ transcutaneous IF electrical stimulation” , “ IF therapy ” , “ electrical stimulation” , “ voiding dysfunction” , “ LUTD” , “ urinary incontinence” and “ children” . As this review focuses on the answer of this question “ Does transcutaneous IF electrical stimulation has effect on management of LUTD in children? ” we included the reference list of articles identified by this search strategy and selected those we judged relevant according to our keywords. Clinical trial studies in English were included. Categorical data were reported as frequencies and percentages. Results: Eleven studies were included in this review. The success rate of IF therapy in these studies has been reported from 61% to 90% of children with LUTD and urinary incontinence. Conclusion: IF electrical stimulation is an effective, safe and reproducible option to manage LUTD and urinary incontinence in children.

Purpose: To examine the correlation between prostate specific antigen (PSA) and the risk of Gleason sum upgrading (GSU) from biopsy Gleason sum (bGS) to prostatectomy Gleason sum (pGS). Materials and Methods: Five electronic databases (Web of Science, Ovid Medline, Ovid Embase, SCOPUS and the Cochrane Library) were searched from inception until March 2020. Studies were included if they focused on the relationship between PSA and GSU analyzed in multivariable analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized. Quality of included studies was appraised utilizing the Newcastle-Ottawa Quality Assessment Scale (NOS) for case-control studies. The publication bias was evaluated by funnel plot and Egger’ s test. Results: Our search yielded 19 studies with high quality including 42193 patients. GSU was found in 28. 2% of patients. Higher PSA level was associated with a significant increased risk of GSU (pooled OR = 1. 14, 95% CI: 1. 10– 1. 18; P <. 05; I2 = 92%). For the definition of upgrading from bGS ≤ 6 to pGS ≥ 7, the odds of upgrading with higher PSA level as opposed to lower PSA level was 1. 12 (95% CI: 1. 11– 1. 14; P <. 05; I2 = 13%), while the odds of upgrading with other definitions were 1. 11 (95% CI: 1. 05– 1. 18; P <. 05; I2 = 89%). Conclusion: Patients with high level of serum PSA are at high risk of undergoing pathologic upgrading at prostatectomy. Combined with other risk factors, PSA prompts risk reclassification and improve confidence of urologists in management decisions for optimal therapy. Nevertheless, further robust studies are necessitated to confirm these results.

Purpose: Experts recommend us to keep a safety guidewire during the process of upper urinary tract endoscopy, though there is a lack of high-level evidence to support the efficacy and safety of this opinion. This study was conducted to compare the outcome of ureteral stone breakage in the presence or absence of a safety guidewire. Materials and methods: Patients candidate for endoscopic breakage of ureteral stone using a semi-rigid ureteroscope, were randomly assigned in two groups based on keeping a safety guidewire (group1) or removing the guidewire (group2) before the process of breaking ureteral stone by lithoclast. Demographic factors, history of previous stone treatment, kidney function, stone location, symptoms duration and severity were recorded for each patient. Primary outcomes included success rate of stone treatment and secondary outcomes included number of attempts to enter to ureter, success rate of ureteral entry, success rate of stone achievement, stone migration rate and the success rate of ureteral stent insertion. The recorded data were entered to the SPSS software and descriptive statistical analysis including power calculation and non-inferiority design for the primary and secondary outcomes, was performed. P-value less than 0. 05 was considered significant. Results: From January 2016 till May 2018, 320 patients were randomized with 160 patients in each arm. Considering the cases who were missed due to follow-up loss, there were 153 patients in group 1 and 147 patients in group 2 at the end of the study. Baseline data were equally distributed in both groups. Based on the initial analysis, the studied variables had no significant difference between two groups; though, according to the subgroup analysis of patients with proximal ureter stones, patients in Group 1 had higher rates of ureteral injury comparing to the patients in Group 2 (p = 0. 03). Conclusion: According to our findings, keeping the safety guidewire through the process of endoscopic stone breakage (stone size: less than 1. 5Cm) seems to add no significant benefit to the procedure outcome, while it increases the ureteral injuries in the proximal ureter stones, but not in mid or distal ureter stones.

Purpose: Usual laparoscopic surgery of localized prostate cancer uses antegrade dissection. We describe and evaluate the original RELP (Retrograde Extraperitoneal Laparoscopic Prostatectomy). Materials and Methods: A prospective cohort of 1005 patients with clinically localized cancer prostate who were operated on from December 1999 to September 2013, in Lyon (France), and followed up to 172 months (median: 60 months). Patients encountered a RELP procedure, a totally extra-peritoneal approach with a retrograde dissection from the apex to the bladder neck, and ascending dissection of the erectile neurovascular bundles, facilitated by the 30° optic telescope. Adjunctive treatments were: immediate radiotherapy (9. 2%), salvage radiotherapy (13. 4%), androgen deprivation therapy (10. 8%), chemotherapy (1. 4%), no treatment (75. 8%). Results: The mean age was 63. 4 years, the Gleason score was 4+3 or worse in 24. 9%, there were 2. 3% unifocal tumors. The pathology stages were pT2A (8. 71%), pT2B (2. 80%), pT2C (69. 0%), pT3A (13. 1%), and pT3B (6. 41%). There were 60. 8% negative margins (R0) in total (90. 1% for basal locations, and 75. 8% for apical locations). The mean operating time was 115 minutes for the last 100 patients. The BPFSR (biological progression free survival rate, PSA ≤ 0. 10 ng/ml) was 71. 9% at 5 years, and 61. 4% at 10 years. The cancer specific survival rate was 99. 4% at 5 years, and 98. 3% at 10 years. After 12 months, 88. 6% of patients did not require an incontinence pad, and 67. 0% retained the pre-operative quality of their erection. Conclusion: RELP yields good oncologic results and quality of life, as good as robot-assisted surgery.

Purpose: Previous reports showed that targeted therapy efficacy varied due to different metastatic organs in patients with metastatic renal cell carcinoma (mRCC). This study aimed to further evaluate the response and progression-free time (PFT) of individual metastatic organs. Materials and Methods: Data from mRCC patients, who were treated with sunitinib between January 2008 to December 2018, were retrospectively reviewed. Individual metastatic organs were assessed separately by The Response Evaluation Criteria in Solid Tumors criteria. Results: We evaluated response heterogeneity and PFT as characteristics of 281 individual organs affected by mRCC in 213 patients. The objective response rates in these organs were 72. 7% in pancreas, 63. 7% in spleen, 14. 3% in adrenal glands, 13. 5% in bone and soft tissue, 11. 6% in lymph nodes, 11. 6% in lungs, and 9. 1% in liver. The median PFT was 15. 2 months (95% confidence interval [CI] 2. 7– 27. 7 months) for adrenal glands, 13. 2 months (95% CI 3. 5– 22. 9 months) for bone and soft tissue, 9. 0 months (95% CI 7. 6– 10. 4 months) for lymph nodes, 8. 6 months (95% CI 6. 3– 10. 9 months) for lungs, and 5. 2 months (95% CI 2. 9– 7. 5 months) for liver. Median PFT was not reached in pancreas and spleen, but was > 22. 8 months and > 20. 6 months, respectively. Conclusion: Our results indicated that organs affected by metastasis may have individual responses to sunitinib treatment. The pancreas and spleen may have the best responses, and liver may have the worst response. Further research is needed to verify these findings.

Purpose: The conventional Trans-Peritoneal Radical Cystectomy (TPRC) harbors numerous postoperative complications, the most prevalent of which are Gastrointestinal (GI) problems. To reduce these morbidities we introduced our own version of extra-peritoneal approach and compared it with the conventional method. Materials and Methods: In a cross-sectional observational retrospective design, eligible bladder cancer patients whom underwent Extra-Peritoneal Radical Cystectomy (EPRC) or TPRC in our center, were considered for this study and were compared for early post-operative complications. Results: Ninety-nine patients in TPRC and 81 in EPRC were compared. The two techniques differed in their mean operation time (298. 2 ± 37. 8 min TPRC vs. 262. 8 ± 37. 2 min EPRC, P: 0. 001). Early GI complications were lower in EPRC groups, including oral intake intolerance ( 21 vs. 8, P: 0. 04), ileus (19 vs. 8, P: 0. 04), intestinal obstruction (3 vs. 0, P: 0. 04), and anastomosis leakage (8 vs. 1, P: 0. 01). Urine leak (14 vs. 7, P: 0. 02) and wound related complications (19 vs. 6, P: 0. 02) also favored EPRC group. Conclusion: The extra-peritoneal technique is beneficial in reducing postoperative morbidity, especially the more prevalent GI complications. This approach is functionally safe and allows preservation of the peritoneal integrity.

Purpose: In this study, we aimed to determine whether there is a significant difference in endocan expression levels between prostate adenocarcinoma and prostate hyperplasia tissues by using an immunohistochemical method. Materials and Methods: All 51 patients, who were getting treatment for the last 5 years, participated in the study. 31 of 51 patients underwent transrectal sonography (TRUSG)-assisted prostate biopsy because of prostate adenocarcinoma as diagnosed with elevated PSA levels and histopathological examination. The remaining 20 patients comprised the control group. The control group included patients with benign prostate hyperplasia based on pathological examination. Results: It was found that there was strong positive epithelial staining in 74. 2% of patients with prostate cancer while in 5% of controls, indicating a statistically significant difference (P <. 001). It was also found that the rate of strong positive endothelial staining was 77. 4% in the patient group whereas 5% in the control group (P <. 001). Also, the rate of strong positive stromal staining was 64. 5% in the patient group while 5% in the control group (P <. 001). Conclusion: We found that tissue endocan expression level was statistically significantly higher in patients with prostate cancer compared to those with benign prostate hyperplasia by using an immunohistochemical method.

Purpose: To assess the long-term outcomes of patients treated for distal hypospadias. Assessment of long-term follow-up for a homogeneous population with hypospadias is difficult and there has consequently been a paucity of publications in this regard. Materials and Methods: A retrospective review was carried out to compile cases of distal hypospadias operated at our center between 1990 and 1999 according to the MAGPI procedure. Four parameters were evaluated based on four validated questionnaires: Health-related quality of life (SF-36), Genital self-perception (PPS), Self-esteem (Rosenberg Self-Esteem Scale), and Erectile function (IIEF). Results: A total of 77 patients who had undergone MAGPI surgery for hypospadias during the specified period were selected. Sufficient clinical data were available for 51 patients and only 15 of these patients were included, after a median follow-up of 22 years (20-26). Their outcomes were compared with those for a population of 15 matched circumcised men and 15 matched uncircumcised men. No significant difference was found between the patients and the control groups in terms of the score for quality of life (p =. 29). There were, however, significant differences in the scores for self-perception of the penile cosmetic appearance (13. 3 vs. 15. 8; p <. 01), self-esteem (30. 6 vs. 35. 8; p <. 01), and erectile function (31. 4 vs. 33. 7; p =. 04) between the patients and the controls. Lower self-esteem correlated with poor genital self-perception (r =. 92). Conclusion: This study confirms that adult patients operated for distal hypospadias have poor genital self-perception. This poor genital perception correlated with lower self-esteem.

Purpose: SNRIs (serotonin and norepinephrine reuptake inhibitors) like duloxetine are known to have a role in the treatment of anxiety disorder and stress urinary incontinence. According to the correlation of anxiety disorder and overactive bladder, this study aimed to evaluate the clinical efficacy and complications of duloxetine (SNRI) as a medication in the treatment of overactive bladder in female patients. We were interested to know the probable therapeutic effect and side effects of duloxetine in overactive bladder. Materials and Methods: In this single-blinded interventional randomized clinical trial, 60 female patients with idiopathic overactive bladder (hyperreflexia) referred to the urology clinic, were divided into two groups as pilots. The first group was treated by 10mg/daily solifenacin and the second group received 20mg/daily duloxetine. The patients were evaluated by the ICIQ-OAB Questionnaire before and after a one-month follow-up period. The intervention primary outcomes were evaluated by the patient’ s presentation of the frequency, nocturia, urgency, urge urinary incontinence and the drugs side effects as secondary outcomes were checked. Results: Sixty women with confirmed overactive bladder disease were evaluated. Solifenacin and duloxetine had the same effect on the treatment of overactive bladder (p value = 0. 148). The clinical symptoms were obviously relieved in both groups after treatment. Side effects were insignificantly more common in the solifenacin group (p value > 0. 05). However, the different frequency of blurred vision in the two groups was statistically significant (p value = 0. 04). The most common complication in the solifenacin and duloxetine groups was anxiety. Conclusion: The results showed that solifenacin and duloxetine improved overactive bladder symptoms. According to this evaluation, duloxetine can be a suitable alternative option for overactive bladder treatment, due to the acceptable therapeutic effect and side effects.

Purpose: Male infertility accounts for about half of all infertility cases. Asthenoteratozoospermia is a severe form of male infertility. Free radicals play an important role in infertility. In a previous study we found that asthenoteratozoospermic men had a lower mean percentage of sperm HSPA2+ and higher intracellular anion superoxide than normozoospermia. Antioxidants are thought to be able to counteract the negative effects of free radicals. We explored the efficacy of vitamin E in combination with Se on the level of sperm HSPA2+, intracellular anion superoxide, and chromatin integrity in these patients. Materials and methods: 60 patients entered the study. They were randomized to the treatment group of oral Se (200 μ g) in combination with vitamin E (400 units) for 3 months (n = 30) or placebo (n = 30). Semen samples were obtained and assessed for sperm parameters, intracellular O2-, protamine deficiency, sperm HSPA2+ and apoptotic spermatozoa at baseline and after the treatment phase. Results: There were no significant differences in baseline semen parameters, intracellular O2-protamine deficiency, sperm HSPA2+ and apoptotic spermatozoa between the treatment and placebo groups. There was a statistically significant decrease in sperm apoptosis and the level of anion superoxide (P =. 001) and an increase in sperm motility and viability (P =. 001) in the treated group, but no significant difference was found in the percentage of sperm HSPA2+ and sperm protamine deficiency compared with baseline. Moreover, no significant change was found in these parameters in the placebo group after 3 months. Conclusion: Our results showed that administration of vitamin E and selenium for three months may improve sperm motility and viability by decreasing intracellular anion superoxide and sperm apoptosis in asthenoteratozoospermic infertile men. We suggest that consuming these supplements before assisted reproductive technology (ART) may improve outcomes in these patients.

Purpose: To compare the clinical effects of three methods of circumcision: modified circumcision, traditional circumcision, and disposable suturing device circumcision. Materials and Methods: Male patients (n = 241) with redundant prepuce and/or phimosis were included in a clinical trial from January 2019 to March 2020. Patients were divided into 3 groups based on the surgical method: group A, traditional circumcision (n = 79); group B, modified circumcision (n = 80); and group C, disposable suturing device circumcision (n = 82). Results: The operation times in groups A, B, and C were 25. 2 ± 3. 3 min, 10. 2 ± 2. 7 min, and 6. 7 ± 1. 4 min, respectively. The volumes of intraoperative blood loss in groups A, B, and C were 12. 7 ± 2. 3 mL, 8. 1 ± 3. 4 mL, and 2. 2 ± 0. 8 mL, respectively (P < 0. 05). Groups A and B were superior to group C in terms of the 6-h postoperative visual analog scale score and appearance satisfaction (P < 0. 05). There were no obvious differences in the 7-day postoperative pain score and total healing time (P > 0. 05). The operating expenses in groups A and B were lower than that in group C (P < 0. 05). Conclusion: Modified circumcision, with its advantages of shorter operation time, less blood loss and pain, lower cost, and better postoperative penile appearance, is easily accepted by patients and deserves wide clinical application.

Purpose: Benign prostatic hyperplasia (BPH) significantly reduces the quality of life. However, the biological mechanisms of BPH development remain largely unknown. We aimed to investigate the essential genomic and immunogenic features in BPH. Materials and Methods: Transcriptome profiling and clinical data of BPH and normal prostate samples were acquired from GEO datasets. The discovery sets were composed of GSE119195, GSE7307, GSE101486, while the validation set was GSE132714. ESTIMATE and CIBERSORT were used to investigate the immunogenic features. Furthermore, transcriptional and weighted gene co-expression network analysis (WGCNA) was used for further analysis. Results: BPH samples presented a higher immune score. Meanwhile, CIBERSORT deconvolution revealed that BPH exists significantly abundant M2 Macrophages, follicular T helper cells, resting mast cells, and fewer plasma cells, activated CD4+ memory T cells, and activated mast cells. WGCNA analysis also revealed significantly enriched immune-related modules in BPH. Transcriptomic analysis identified SOCS3, IL6, C3, IGF1, NOTCH1, and VCAN as key regulators of immunogenic phenotype in BPH. Moreover, we generated an immunological gene signature for BPH, which worked well in the validation cohort. Conclusion: In our study, BPH samples exhibited a distinct immune infiltration pattern, represented by an immunological gene signature. This genomic-based assessment model reveals the potential transcriptomic patterns during BPH development.