UROLOGY JOURNAL
Year:2021 | Volume:18 | Issue:3|Papers Count:19

Background Nephrolithiasis is a rare complication in transplanted kidneys and limited information is available about its therapeutic options. This study aimed to review the conservative management of urinary lithiasis and its outcomes in renal transplanted patients. Methods A systematic review and meta-analysis of the scientific literature were performed in the Medline, Scopus, and Embase databases. Inclusion criteria were studies which include patients with kidney stones in transplanted kidney no matter de-novo or donated stones and use conservative treatment for all or part of their patients. Exclusion criteria were bladder & ureteral stones, full text unavailable, conference paper. (from January 1st, 1980, to the 19th May 2020). The results of included studies, in the final analysis, were combined using a random-effect model and using metaprop method prevalence and 95% CI of renal stone were reported. Results A total of 8 studies (14988 transplant patients) met the inclusion criteria for the final analysis. A total of 195 patients suffered from renal stone and the prevalence of renal stone was 1. 3% (95% CI: 0. 89%-1. 7%). The mean age of these patients was 43 years. analysis, the prevalence of conservative treatment in 195 patients was 35% (95% CI: 19%-51%). The mean stone size ranged from 0. 29 cm to 1 cm. Three studies reported a stone-free rate of %100. Except for two studies that did not report complications, other studies reported zero percent. Conclusion More than one-third of nephrolithiasis were conservatively managed in transplanted patients. Despite limited data, conservative treatment could be done in less than 4 mm stones with high Stone Free Rate (SFR) and very low complications.

Purpose: To explore the efficacy of 5-ARIs in PCA (Prostate Cancer). Methods: Searching through the major medical databases such as PubMed, Science Citation Index, EMBASE, Medline, Web of Science, Cochrane Library for all published studies in English until 2018. The following search terms were used: “ Finasteride” , “ dutasteride” , “ 5α reductase inhibitors” , “ 5-ARIs” , “ prostate cancer” , “ prostate neoplasm” and the additional related studies were manually searched. Newcastle-Ottawa Scale (NOS) assessed the qualities of studies, and the outcome measures were observed by RR or OR with 95% CIs. Results: We included 9 eligible studies for analyses from 2011 to 2017. We found that 5-ARIs group may have fewer progression (OR = 0. 48 95%CI: 0. 37-0. 61 P < 0. 00001, I2=4% p = 0. 39) and lower pathological progression (OR = 0. 46; 95%CI: 0. 29-0. 73; p = 0. 001, I2=0% p = 0. 45), compared with control groups. However, the OS did not show significant difference between two groups (OR=1. 10; 95%CI: 0. 90-1. 35; P = 0. 35, I2 = 93% P <. 00001 ). Conclusion: The use of 5-ARIs could prevent progression in PCA patients both clinical and pathological.

Purpose: Percutaneous-nephrolithotomy (PCNL), is the current modality of choice for large renal stones. Delayed post-op bleeding may herald pseudo aneurysm (PA) or arteriovenous fistula (AVF) necessitating costly and inconsistently available angioembolization, or prolonged hospitalization. The goal of this study is to identify criteria that may predict response to conservative therapy, for delayed bleeding from post PCNL intrarenal vascular lesions. Materials and methods: We reviewed all data on patients re-admitted for post PCNL gross hematuria at our high volume center between 2011 and 2016. Perioperative findings, factors related to the stone and management details, were subjected to multifactorial analysis. Logistic regression for multivariable analysis and ROC curves to find thresholds predicting mandatory angioembolization. Results: Of 4403 PCNLs, 83 (1. 9%) with delayed bleeding were diagnosed with intrarenal vascular lesions: Arteriovenous fistulas in 54 (AVF, 65%) and pseudoaneurysm in 29 (PA, 35%). Overall 49 (59%) responded to conservative management but 34 (41%) eventually required angioembolization. On multivariable analysis, predictive factors for poor response to conservative treatment were requiring transfusion beyond initial stabilization, pseudoaneurysm, history of open renal surgery, longer interval-to-second-admission, and size of vascular lesion. The proposed POPVESL score (short for Post PNL Vascular Embolization selection) when below 11, correctly predicts success of conservative management with 81. 6% sensitivity & 100% specificity. Conclusion: Our findings including the proposed POPVESL score have the potential for clinical application and enhancing practical guidelines on the management of post-PCNL bleeding.

Purpose: In this study, we aimed to find a more accurate predicting constant value of energy per mm3xHounsfield Unit (HU) to ablate urinary stones by endoscopic stone treatment. Material And Methods: The files of 142 patients who underwent rigid or flexible ureteroscopic laser lithotripsy in our clinic between December 2018 and March 2020 were evaluated retrospectively. Total energy administered for the ablation of the stone was obtained from the registry of the Ho: YAG laser and recorded to the follow-up forms. The constant value was calculated for each stone, and the final mean value was figured out by calculation of the mean of all constant values. Results: The study was conducted with 142 patients; 102 males and 40 females. The mean age of the population was 46. 61 ± 14. 58 years. The number of stones was 1. 27 ± 0. 67. The mean constant value of energy needed per mm3xHU for urinary stones was 22. 87 milliwatt. Conclusion: This study was conducted to report a predictive constant value and is the very first study evaluating the energy prediction per mm3xHU. The data of the study showed that the constant value is 22. 87 mW/mm3xHU. Urologists may estimate the required energy and plan the surgery according to the outcomes of the study. As a future aspect of our study, the constant value may represent predictive information about the time and accuracy of the operation.

Purpose: The aim of this study was to evaluate the efficacy of transvesical open prostatectomy (OP) compared with transurethral resection of the prostate (TURP) in patients with benign prostate hyperplasia (BPH) with a prostate weight of 40-65 grams. The short-term and long-term complications of these two procedures were also assessed. Materials and Methods: In this retrospective study, we included 160 consecutive patients with BPH who had undergone TURP (n=80) or OP surgery (n=80) from 2006 to 2017. Inclusion criteria were positive history of BPH, definite indication for prostatectomy, and prostate weight between 40 to 65 grams. Patients were evaluated for duration of hospitalization, need for re-operation, short-term and long-term postoperative complications, urinary flow rate, peak flow rate (Q max) and international prostate symptom score (IPSS). Results: The mean age ± Standard Deviation (SD) of patients’ age was 62. 4 ± 3. 7 and 67. 2 ± 4. 6 years in the TURP and OP groups, respectively. Four (5%) and seven (8. 7%) patients required transfusion in the TURP group and OP groups, respectively. Dysuria was significantly more frequent in the TURP group from week two to 12 months after surgery as compared with the OP group (P <. 001). Hemodynamic changes and decrease in serum sodium level were not reported in either group. However, the urinary retention and need for urinary catheterization in the first year was significantly different between the two groups with 10 cases (12. 5%) in the TURP group and no cases in the OP group (P<0. 001). The need for reoperation in the TURP group was reported (27 procedures on 19 patients) (33. 7%) of patients. Furthermore, retrograde ejaculation (RE) was reported in 65 (81. 2%) and 80 patients (100%) of the TURP and OP group, respectively. Conclusion: Despite the fact that TURP is the standard method of treatment for BPH when the prostate weighs between 40-65 grams, the results of our study showed that OP is a more efficient and safe surgery for these patients and is associated with less complications. Furthermore, the need for re-operation seems to be higher in patients with TURP.

Purpose: To evaluate the feasibility and potential efficacy of nanocurcumin supplementation in patients with localized muscle-invasive bladder cancer (MIBC) undergoing induction chemotherapy. Materials and Methods: In this double-blind, placebo-controlled trial, 26 MIBC patients were randomized to receive either nanocurcumin (180 mg/day) or placebo during the course of chemotherapy. All patients were followed up to four weeks after the end of treatment to assess the complete clinical response to the chemotherapy as primary endpoint. Secondary endpoints were the comparisons of chemotherapy‐ induced nephrotoxicity, hematologic nadirs, and toxicities between the two groups. Hematologic nadirs and toxicities were assessed during the treatment. Results: Nanocurcumin was well tolerated. The complete clinical response rates were 30. 8 and 50% in the placebo and nanocurcumin groups, respectively. Although nanocurcumin was shown to be superior to placebo with respect to complete clinical response rates as the primary endpoint, there was no significant difference between the groups (p = 0. 417). No significant difference was also found between the two groups with regard to grade 3/4 renal and hematologic toxicities as well as hematologic nadirs. Conclusion: These preliminary data indicate the feasibility of nanocurcumin supplementation as a complementary therapy in MIBC patients and support further larger studies. Moreover, a substantial translational insight to fill the gap between the experiment and clinical practice in the field is provided.

Purpose: To systematically analyze histopathologic features of pseudocapsule in small renal cell tumor (diameter ≤ 4cm), assess the integrity of pseudocapsules by Computed Tomography (CT), and provide theoretical basis for the safety of nephron sparing surgery. Materials and Methods: The pathological data of 116 patients who underwent surgery with clear cell renal cell carcinoma admitted from May 2010 to October 2017 were retrospectively analyzed. All patients underwent a CT scan of the abdomen including an unenhanced and three-phase (arterial, nephrographic and excretory) post contrast series. Thorough gross examination and histological sections were used to determine the integrity of the pseudocapsule by two uropathologists. The consistency between pathological findings and CT imaging were evaluated by Kappa consistency test. Results: The mean diameter of tumor was 3. 0cm, range (2. 6 ± 0. 8) cm. On CT the pseudocapsule can present with one of the three following feathers: 1) A regular and distinct halo; 2) lobulated clear margins; 3) blurred margins. On histopathology, complete psuedocapsule was found in 85 tumors, incomplete psuedocapsule in 25 and no psuedocapsule was found in 6 tumors; CT scan findings demonstrated a regular halo in 82 tumors, lobulated clear margins in 26 and blurred margins in 8 tumors(Kappa = 0. 833, P = 0. 000). Conclusion: Most small renal cell tumors have an obvious psuedocapsule. Preoperative determination of the psuedocapsule’ s integrity is particularly important. CT scan can reliably evaluate the tumor margins and demonstrate the psuedocapsule when present. The imaging results are well correlated with the pathologic findings.

Purpose: To investigate biopsy needle tip culture after prostate biopsies for bacteria prediction and antibiotics selection. Materials and Methods: From May 2017 to April 2019, 121 patients who underwent a prostate biopsy were enrolled. All biopsy needle tips were sent for aerobic and anaerobic culture. Patients were divided into positive and negative culture groups. Perioperative data were recorded and compared between the two groups. The culture time and susceptibility of febrile patients were analyzed. Blood cultures were conducted for all patients who experienced fever after biopsy. The time and results of the needle and blood cultures were recoded for descriptive analysis. Results: There were 59 (48. 8%) positive needle cultures. Other than fever (p = 0. 023), there were no statistical significances in clinical data between the two groups. Fever occurred in eight patients, and seven febrile patients had positive needle cultures, six of whom had positive blood cultures. These six needle and blood cultures were consistent with the susceptibility test results. As compared to the waiting time for blood cultures, target antibiotics were administered at an average of 48. 0 h earlier based on needle cultures. None of the patients with positive anaerobic cultures developed a fever, while all eight febrile patients had negative anaerobic cultures. Conclusion: Fevers developed at statistically significant higher rate among those who had positive needle cultures. Needle and blood cultures were consistent with the susceptibility test results. Needle cultures can help us administer target antibiotics earlier to febrile patients without the need to wait for blood cultures.

Purpose: To report the 1-year functional outcomes, oncologic outcomes, and postoperative complications in patients who underwent modified robot-assisted radical prostatectomy (RARP) procedures for achieving early recovery of continence and potency postoperatively. Materials and Methods: This study included 165 patients who underwent RARP. Overall, 98 patients underwent RARP using our modified detrusorrhaphy and intrafascial nerve-sparing techniques (group 1) and 67 underwent standard RARP (group 2). Continence and potency rates were assessed at 1 week, 1, 3, 6, and 12 months after RARP. Oncologic outcomes comprised positive surgical margins (PSMs) and biochemical recurrence (BCR) rate. Results: The continence rates were 61. 2% and 6. 0%, 72. 5% and 11. 9%, 79. 6% and 20. 9%, 91. 8% and 58. 2%, and 97. 9% and 74. 6% at 1 week, 1, 3, 6, and 12 months in group 1 and 2, respectively. The potency rates were 66. 3% and 11. 9%, 78. 6% and 38. 8%, 85. 7% and 50. 8%, 92. 9% and 70. 2%, and 95. 9% and 79. 1% at 1 week, 1, 3, 6, and 12 months in group 1 and 2, respectively. Overall postoperative complication rates (< 10%) were similar between the groups. The PSMs rate was 17. 4% and 16. 4% in the two groups. The rate of PSMs in the cohort of patients with stage pT2 disease decreased to 13. 6% and 12. 5% in groups 1 and 2, respectively. BCR rate was 5. 1% and 6. 0% in groups 1 and 2, respectively. Conclusion: The use of detrusorrhaphy and intrafascial nerve-sparing techniques is safe and feasible, with our results demonstrating early return to continence and potency. Further studies should be conducted.

Purpose: Among the more serious problems in urological interventions among the pediatric age group is the requirement of general anesthesia. The advantages of removing a double-J stent (DJS) without anesthesia in ureteroneocystostomy (UNC) operations among children were investigated in this study. Patients and Methods: In all, 25 patients who underwent UNC surgery between November 2016 and November 2018 were retrospectively divided into two groups according to the method used for the removal of the DJS. In Group 1, the stent was tied to the urethral catheter by a suture and retrieved postoperatively on the fourth day without anesthesia and cystoscopy. In Group 2, we inserted the stent according to the classical method with no suturing to the catheter and removed it 3 to 4 weeks after the first operation, with cystoscopy under anesthesia. Results: A total of 16 girls and 9 boys were included in the study. The mean age was 4. 3 and 6. 3 years in groups 1 and 2, respectively. We did not observe statistically significant difference between the groups in long-term renal function or hydronephrosis regression. Conclusion: We consider that the removal of a stent placed in pediatric intravesical UNC operations without anesthesia and cystoscopy is less invasive and affords safety and long-term results comparable to the standard method.

Purpose: There is a need for developing a standard and approved tool to assess chronic pelvic pain (CPP) in Iranian women. The aim of this study was to investigate the reliability and validity of the Persian version of the pelvic pain and urinary/frequency (PUF) questionnaire in Iranian women with CPP. Materials and Methods: This cross-sectional study was performed on 50 females with CPP referred to the urology clinic of Kerman University of Medical Sciences from 2018 to 2019. Initially, the PUF questionnaire was translated into Persian and then back translated into English. The face validity of the tool was evaluated by being tested on 50 patients who had different literacy levels to ensure its understandability and acceptability by patients. The construct validity was evaluated through both exploratory and confirmatory factor analyses. The internal consistency was also analyzed by determining Cronbach's alpha coefficient and test-retest method. Results: The Persian version of the questionnaire was compatible with the original English version. The Kisser sampling adequacy index was calculated on the data before extracting the factors indicating good factor accessibility of the questionnaire statements. The construct validity of the questionnaire was confirmed using exploratory and confirmatory factor analyses. The internal consistency parameters were also acceptable. Cronbach's alpha coefficient of the whole questionnaire, as well as the coefficients of the "signs/symptoms" and "unpleasant feelings" domains were 77%, 74%, and 78%, respectively. Conclusion: The developed Persian version of the PUF questionnaire retrieved a good validity and reliability.

Purpose: The present study aims to assess and compare the effects of carvedilol and terazosin plus enalapril on lower urinary tract symptoms (LUTS), urine flow, and blood pressure (BP) in patients with moderate hypertension (HTN) and benign prostatic hyperplasia (BPH). Materials and Methods: In this randomized crossover trial, a total of 40 men with HTN and LUTS symptoms were enrolled. The first group was treated with carvedilol, and the second group received terazosin plus enalapril. After eight weeks of treatment, the patients experienced a one-month washout period, and the treatments changed and were continued for eight weeks. To diagnose BPH in the study, the international prostate symptom score (IPSS) questionnaire was used. Moreover, the prostate-specific antigen (PSA), the post-void residual (PVR) urine volume, and the maximum urinary flow rate (Q-max using the uroflowmetry test) were measured. Results: Effect assessment results in this crossover trial illustrated neither carryover effects nor significant treatment effects on all primary outcomes (P > 0. 05). Moreover, the results for the period effect indicated a significant reduction in BP (systolic and diastolic), PVR, and IPSS, yet a significant raise in Qmax. Conclusion: The effects of carvedilol are similar to those of the combination of terazosin and enalapril in patients with moderate HTN and BPH in controlling LUTS. Carvedilol could be used as an appropriative drug in patients with moderate HTN and cardiac problems with LUTS of BPH. Further studies are recommended to be conducted to investigate and compare the efficacy of carvedilol with that of other alpha-blockers with a larger sample size and over a longer period of time.

Epidermoid cyst (EPC) of the clitoris is a very rare cause of non-hormonal acquired clitoromegaly. Clitoral EPCs are extremely uncommon without prior history of genital surgery, trauma, circumcision, or piercing. Surgical removal with special care to avoid compromising neurovascular bundle of the clitoris is the preferred treatment. To our best knowledge, only three cases of adult female clitoral EPC without history of genital surgery, female circumcision, or medications including oral or implantable contraceptives have been reported. Herein, we describe three cases of primary EPC of the clitoris, their management, unique histopathology report, safe surgical approach, and their follow up course.

Surgical conditions represent 28% to 32% of the global burden of disease(1). Access to timely, safe, and cost-effective surgical care has been considered as an “ indivisible and-indispensable part of health care” worldwide(2). Current procedural terminology (CPT) attempts to offer a universal language for describing diagnostic, medical, and surgical services and therefore, considered to be an effective tool of communication between physicians and other health care providers, patients, and third parties(3). American Medical Association first developed CPT in 1966, which mostly included surgical procedures. The code book of CPT is being updated every few years and expanded to include therapeutic and diagnostic and also internal medicine procedures. CPT was accepted as a part of Centers for Medicare & Medicaid Services in 1983. Today, CPT is the primary way of communication between providers and payers for reimbursement....

Prostate cancer (PCa) is the most common and the second cause of cancer-related deaths among men, with increasing incidence and burden, nationally and globally. (1, 2) Radical prostatectomy (RP) has substantially influenced PCa management, providing excellent results in treating the patients. (3) However, likelihood of biochemical recurrence (BCR) remains high, especially in patients with adverse pathological features and these patients should receive postoperative adjuvant radiation therapy (ART) according to the guidelines. There are some uncertainties about receiving immediate ART after RP in men with adverse pathological features versus salvage radiation therapy (SRT) after BCR. Unlike ART, SRT provides time for urinary and sexual recovery, though it might be associated with undertreatment and risk of disease progression in a subset of patients. In the era of personalized medicine, molecular diagnosis has the potential to distinguish patients with higher risk of progression and metastasis who may benefit from ART....

Chronic prostatitis/Chronic pelvic pain syndromes (CP/CPPS) are a widespread pathology with unknown etiology without a proved treatment algorithm. Neurologic, endocrine and immune systems, and oxidative stress, infections are ranked in the physiopathology. Anogenital distance (AGD) as a marker for the degree of antenatal exposure of androgens that link to some disorders of androgen-sensitive tissues especially of urogenital system. In this study, we aimed a construct a hypothesis that improper development of perineum and pelvic bottom due to the insufficient embryologic androgen exposure, which can be detected by reduced AGD, can form histologic/clinic CP in adulthood through the physical forces that resulted in stretched prostate via chronic hypoxia induced oxidative stress and failed immune mechanisms. AGD, unlike the previous published ones, suggested as a real physical scale to detect narrowed pelvic bottom other than an endocrine related biomarker.

The SARS-CoV-2 infection has resulted in an unprecedented pandemic and with it, lots of international efforts have been made to guide health care workers and to optimize resources to address this crisis(1). One of the most important efforts is graphed in the European Association of Urology’ s guideline (April, 2020) followed by many countries, but recently called into question by A. Kashi in its last editorial article(2). Due to this guideline, many elective surgeries had to be suspended or postponed, providing only time-dependent surgeries, such as emergency surgical pathologies or oncological surgeries(3)....

Dear Editor, A portion of the patients might experience spermatogenic failure and impairment of follicular and luteal processes after SARS‐ CoV‐ 2 infection. Although the exact pathophysiology is poorly understood, these effects are hypothetically mediated through an alteration in the ACE2 cascade(1). In addition to the adverse effects of SARS‐ CoV‐ 2 infection on gametogenesis, several other factors may also indirectly affect the fertility in men and women during COVID-19 pandemic. Patients with other causes of infertility are not willing to seek medical care due to fear and anxiety associated with the pandemic(2). In addition, several institutions suspended elective surgeries and interventions related to infertility. Overall, this situation would result in irreversible consequences and higher rates of infertility. Therefore, researchers and health policy makers should assess factors that indirectly increase the rate of infertility in the era of COVID-19. These factors may also have a greater impact and should be addressed through multiple pathways, including: 1) ensuring safe access to health care for those who are suffering from infertility, 2) reassuring patients through media to decrease the anxiety related to the pandemic, 3) focusing on treatments that are effective and has the potential to reduce the harmful effects of the SARS‐ CoV‐ 2 infection.

Request for kidney transplantation (K. T. ) is increasing rapidly because of the worldwide pandemic of end-stage renal disease, and the most critical issue is organ shortage. The available deceased donors will not resolve the continuing scarcity of organs. It is now professionally and ethically acknowledged and is vital to pay money to the donors for excluding disincentives of living organ donation. Living organ donation should be a vital part of the K. T. Program of any country....