UROLOGY JOURNAL
Year:2004 | Volume:1 | Issue:3|Papers Count:18

Purpose: According to a survey, the Massachusetts Male Aging Study, 52% of men beyond 40 years of age may have some degrees of erectile failure, and it is projected to affect 322 million men worldwideby 2025. We present a framework for the evaluation, treatment, and follow-up of the male patient who presents with erectile dysfunction. Materials and Methods: A comprehensive review of the literature was conducted using the MEDLINE database for all articles from 1975 through 2004 on male sexual dysfunction and the most pertinent articles are discussed. Results: Remarkable progress has been made in the treatment of erectile dysfunction (ED). Erectile dysfunction is a common condition associated with aging, chronic illnesses and various modifiable risk factors. Erectile dysfunction can be due to vasculogenic, neurogenic, hormonal, and/or psychogenic factors as well as alterations in the nitric oxide/cyclic guanosine monophosphate pathway or other regulatory mechanisms. The number of consultations from new patients presenting with erectile dysfunction and resulting costs for health care systems are increasing. Urologist should be the evaluating physician who supervises the surgical, medical, and hormonal treatment and who refers the patient, as necessary, to other members of the multidisciplinary team. Conclusion: Erectile dysfunction has a significant negative impact on quality of life. Male sexual dysfunction, especially erectile dysfuncti6n, necessitates a comprehensive medical and psychologic evaluation involving both partners. All possible risk factors should be outlined and corrected, when feasible.

Purpose: To describe the work that the B~kent University Faculty of Medicine has done to increase kidney donors number in Turkey and also to discuss the major effects that donor-organ shortage is currently having worldwide. Materials and Methods: From 1975 through 2003, our tran~plantation team at Hacettepe University Hospital and later at the B~kent University Transplantation Center (BUTC) performed 1451 kidney transplantations. Cadaver donation and patient and graft survival rates for various groupings of transplantation types were compared. Results: Of all the renal transplantations completed in Turkey from 1975 to January 2004, 20% were performed by our team in our center. For the years 1990 through 2003, the 1-, 3-, and 5-year patient survival rates in the first-degree-living-related kidney transplantation group were 96%, 93%, and 91%, respectively, and the corresponding graft survival rates were 93%, 84%, and 81%. In the second-degree living-related group, the 1-, 3-, and 5-year patient survival rates were 94%, 90%, and 87%, respectively, and the corresponding graft survival rates were 93%, 86%, and 84%. For living-unrelated transplantations, the 1-, 3- and 5-year patient survival rates were 93%, 90%, and 83%, respectively, and the corresponding graft survival rates were 83%, 78%, and 76%. In the cadaver-kidney transplantation group, the 1-, 3- and 5-year patient survival rates were 85%, 78%, and 70%, respectively, and the corresponding graft survival rates were 82%, 64%, and 53%. During this same period, the 1-, 3-, and 5-year graft survival rates for our cadaver donors and living donors older than 55 years of age were 80%, 52%, 46% and 88%, 69%, 61%, respectively. Conclusion: Vigorous efforts by our group at B~kent University and by other transplant surgeons across the nation have increased the numbers of transplantations performed each year. As well, since the NCC was established in 2001, the number of cadaver-kidney transplantations has more than doubled. The initial results with this new nationwide organ-sharing system are promising, and there is every indication that this approach will continue to raise the number of transplant operations performed across Turkey each year.

Purpose: To compare clinical and radiological outcomes, complications, and hospital stay in laparoscopic and open pyeloplasty. Materials and Methods: From February 2002 to February 2003, 69 patients with ureteropelvic junction obstruction (UPJO) were assigned into two groups. Thirty-seven patients underwent transperitoneal laparoscopic pyeloplasty and 32 underwent open surgical pyeloplasty. Clinical symptoms were assessed before and after surgery, subjectively. Radiological assessment was also done three months postoperatively. Results: Mean operative time was 3.2 hours and 2.2 hours in laparoscopic and open pyeloplasty groups, respectively. Intraoperative bleeding was trivial in both groups and no complication or conversion to open surgery occurred. Postoperative complication rates were 24% and 6%in laparoscopic and open pyeloplasty groups, respectively. Mean hospital stay was similar (6.2 days) in the two groups. Mean follow-upwas 16.5 months versus 11.4 months. Clinical and radiological success rates were 89% and 83.8% for laparoscopy group versus 96.5% and 87%for open pyeloplasty group. Due to recurrence of stricture, repeated surgery was performed in 4 patients of laparoscopy and 1 of open pyeloplasty groups. Conclusion: Laparoscopic pyeloplasty is a less invasive method with less pain, cosmetic advantages, no long incision, and outcome comparable with open surgery. Hospital stay js also not longer than that jn open surgerjes. Hence, laparoscopjc pyeloplasty can be a substjtute for skilled surgeons.

Purpose: To evaluate the result of simple renal cyst ablation by endoscope and compare the results with other techniques of renal cys~ treatment. Materials and Methods: A prospective study was performed at Shaheed Faghihi hospital from January 2001 to January 2003. Ten patients with symptomatic simple renal cyst were selected for this study. The exclusion criteria were history of previous renal surgery, parapelvic cyst,~nd cyst size less than 50 mm. Urinalysis, urine culture, serum electrolytes, ultrasonography, and CT scan were done before operation. The patients underwent endoscopic renal cyst ablation and cytology of cyst fluid and histopathological examination of cysts walls were done in all patients. The patients were followed with ultrasonography after two weeks and 2, 6, and 12 months postoperatively. Disappearance of the cyst or decreasing its size to less than 50% of its primary size was considered as improvement. Results: All the patients were female with a mean age of 55 (range 22 to 75) years. The operation was successful in 9 patients with no major complications. Perinephric hematoma and excessive leakage were seen in two patients. The operative time was 38:t1O.8 minutes and hospital stay was 3:t1.3 days. Mean size of cyst before operation was 75:t19.7 mm and changed to 12.7:t15.3 mm after operation (p

Purpose: Several therapeutic methods are used in the management of lower pole caliceal calculi. This survey has been conducted to evaluate the safety and efficacy of percutaneous nephrolithotomy in the management of lower pole calculi. Materials and Methods: Fifty-fiVe patients, 43 males and 12 females with a mean age of 41.5 (range 11 to 75) years, who had suffered from lower pole caliceal calculi and treated by standard percutaneous nephrolithotomy (PCNL) between 1997 and 2001, were enrolled in this study. The stones were classified as follows: small Oess than 25 mm), intermediate (25 to 34 mm) and large (more than 35 mm). Mean follow-up was 6.2 months (range 2 weeks to 34 months). Results: The stones were completely extracted by one session PCNL in 43 patients (79%). Repeat PCNL was needed in one patient and another method was used for stone extraction in another patient. Regarding the size of stone, 88%, 79%, and 74%of small, intermediate, and large stones were completely extracted, respectively. No major complication was noted. Conclusion: PCNL has high success rate in patients with stones larger than 2 cm and its morbidity would be low, provided that it is performed by skilled surgeons.

Purpose: To evaluate the relationship between histological grade and apoptotic index (AI) in transitional cell carcinoma (TCC) of urinary bladder. Materials and Methods: Formalin-fixed and paraffin-embedded tissue blocks from 75 patients with TCC, who undergone transurethral resection (TUR) were studied. One 3-micron section was provided from each TUR samples. In one section after hematoxylin and eosin (H&E) staining, tumor grade was determined according to World Health Organization/International Society of Urology and Pathology (WHO/IS UP) criteria. The apoptotic cells were determined using a terminal deoxynucleotidyl transferase (TdT) mediated dUTP biotin nick end labeling (TUNEL) technique. Apoptotic index was then obtained as the percent of TUNEL positive cells from observations of at least 1000 cells in each section. Results: Forty-nine patients were men and 26 were women. Mean age was 56.34:t9 years. Mean AI was 2.30:t0.50. The relationship between grade and AI was significant (p=O.OOO,r=0.551); a higher grade was associated with a higher AI. Conclusion: Apoptosis index has a positive correlation with bladder TCCs grade. Further studies are needed to better determine the effect of apoptosis index on prognosIs.

Purpose: To evaluate patient and graft survivals in kidney recipients and factors impacting on survival rates at Kermanshah. Materials and Methods: This study was done on 712 kidney transplants from 1989 through 2001 in Kermanshah. One of the most important applications of survival analysis is assessing the role of explanatory factors in the studied event. In this study Kaplan-Meier method was used to calculate patient and graft survivals and in order to determine the factors affecting survival, Cox proportional hazard model was used. The iterations in Cox model was four times and the inclusion and exclusion criteria, calculated by forward conditional method were less than 5% and 10%, respectively. Results: Of the recipients, 47.6%were female and most of them (94.4%) had received kidneys from living unrelated donors. One-year patient survivals in recipients from living unrelated donors (LURD) and living related donors (LRD) were 89.4% and 100%, 3-year survivals were 82% and 97.4%, and lO-year survivals were 61.4% and 72%,respectively. In addition, graft survival rates in one year were 85.6% and 97.4%, in three years were 77.2%and 92.3%, and in 10 years were 33.3% and 60.6% in LURD and LRD, respectively. In Cox model, four factors, including the presence of surgical or other complications, known primary disease, and donor-recipient relationship had significant association with patient survival and seven factors, including the presence of surgical complications, known primary disease, donor-recipient relationship, gender, weight, same side transplanted kidney, and donors age had significant relationship with graft survival. Conclusion: In summary, it can be concluded that patient and donor demographic characteristics and transplantation conditions may affect patient and graft survival. With the use of multtvariate regression analysis methods, the characteristics that have high probability for survival can be determined. Controlling these situations, where they have high survival probability, effectively help better treatment and high survival rate.

Purpose: To evaluate the patency and efficacy of expanded Polytetrafluoroethylene (ePTFE) vascular graft in hemodialysis patients. Materials and Methods: In a prospective study from January 1999 to January 2001 at Sina hospital 41 patients underwent implantation of 6-mm vascular grafts and 42 underwent implantation of 8-mm grafts in order to make vascular assess for hemodialysis. They were followed up to 12 months, observing the complications. Results: Mean patients age was 52.2 years. Thirty-seven of them were females and 46 were males. Over a 12 months period of follow-up, 12 cases of graft infection (14.5%), 21 cases of thrombosis (25.3%), 7 cases with both complications (8.4%), and 1 case of pseudo aneurism (1.2%) were observed. One-year patency rate was 34.9%. Diabetes was the only factor associated with lower patency rate (27% versus 57%, p<0.05). Conclusion: ePTFE vascular graft seems to be an appropriate substitute for arteriovenous fistula as a vascular assess in hemodialysis patients. Educating patients and good care can decrease the rate of infection, thrombosis, and other complications, resulting in a better patency and lower morbidity rate.

Purpose: To analyze urinary calculi composition and its relationship with gender, age, calculus weight, color, and location. Materials and Methods: Two hundred and forty one patients with urinary calculus, who had undergone open lithotomy from June 1999 to April 2001, were enrolled in this prospective study which was performed by Tehrari and Oroomieh Medical Sciences Universities. The calculi compositions were analyzed by infrared spectroscopy in Bonn University. Statistical analyses were made by paired t test Results: One hundred and forty five males with a mean age of 40.4 years and 96 females with a mean age of 42.5 years were enrolled in this study. Mean. calculus weight was 4.28 gr. Mean calculus number was 4.33. Thirty four (14.1%) calculi were pure (carbonate apatite: 2, brushite: 1, uric acid: 19, cystine: 3, weddellite: 6, mono- NH4-urate: 2, struvite: 1), 207(85.6%) were mixed and none of them contained octa-caphosphate, apatite, newberyte, 2,8-dihydroxyadenine, mono-Na-urate, or xanthine. Weddellite was found in 77% of calculi. It comprised more than 50% of them in 26% of cases. Whewellite crystals were found in 78%of calculi. It comprised more than 50% of them in 46% of cases. The most common pure calculus was uric acid and the most common component of calculi was whewellite followed by weddellite. Conclusion: Although there is no comprehensive study on urolithiasis incidence and prevalence in Iran, it can be concluded that whewellite and weddellite may be the most common components of urolithiasis in Iran and uric acid calculi are the most common pure calculi. There was no significant difference in calculi composition in our study.

Purpose: To evaluate the safety and efficacy of acupuncture in comparison with intravenous (IV) sedation in extracorporeal shock wave lithotripsy (ESWL). Material and Methods: One hundred patients, who were scheduled for ESWL, were divided randomly into two groups of fifty patients (acupuncture and IV sedation). In the first group, acupuncture was carried out with special needles (0.30 x 18 mm), in two points 30 minutes before the procedure: point of 36 from the stomach meridian with an angle of 90 degrees and point of 60 from the urinary bladder meridian with an angle of 90 degrees. In the IV sedation group morphine 0.1 mg/kg was injected intramuscularly 30 minutes and intravenous diazepam 0.1 mg/kg for muscle relaxation and anti-anxiety, one minute before the procedure. The two groups were similar in terms of confounding factors. Pain (scored in 4 levels), blood pressure, heart rate, respiratory rate, and arterial blood oxygen saturation were recorded prior to IV sedation or acupuncture, 30 minutes after each, at the beginning of ESWL, 10 minutes after ESWL, and at the end of the procedure (times 1 to 5). Results: In acupuncture group the pain intensity was less than IV sedation group (for time 3, p=0.019, for time 4, p=0.002, for time 5, p=0.05). Considering the pain incidence (each pain score except zero), there was a significant difference at time 4 (p=0.012). None of the procedures was stopped because of pain and none of the patients experienced complications during operation. Arterial blood oxygen saturation was between 95% and 100%for all of the patients in acupuncture group and recovery time was shorter (p

Purpose: To evaluate the intracutaneous injection of sterile water in the treatment of renal colic. Patients and Methods: One hundred patients with renal colic were randomly divided irito two groups of 50 patients and underwent the treatment. In the first (study) group 0.5 ml of sterile water and in the control group, 0.5 ml of normal saline was intradermally injected. The severity of pain was assessed by visual analogue scale (VAS) system before and 30 and 90 minutes after the injection. Patients in whom the presence of stone was not proved were excluded from the study. Results: Before the treatment mean pain severity in the study group was 9.86:tOA and in the control group was 9.96:t0.19, so that the difference was not statistically significant (p=0.12). Thirty and 90 minutes after the injection, the means were 0.76:t2.3 and 1.02:t2.63 in study group and 5.94:t4 and 6.7:t4.19 in control group, respectively. The results in 30 and 90 minutes between the two groups were statistically significant (p=O.OOOand p=O.OOO,respectively). Pain in all patients in the study group was relieved; however, only %34 of the patients in the control group reported a decrease in pain. There was no complication among the patients of both groups and only a severe and transient pain during injection was reported by the patients. Conclusion: This study along with many other existing studies indicates the efficacy of intradermal injection of sterile water for the treatment of severe pain syndromes such as renal colic. The advantages of this method are its efficacy, availability, cost benefits, and easy application. We recommend the use of this approach for the treatment of renal colic.

Purpose: Considering the high prevalence of urinary ~ystem stones and that nonmedical treatments have more costs ana side effects, we decided to evaluate the effect of theophylline in the passage of ureteral stones. Materials and Methods: One hundred and fifty patients with ureteral stones were assigned into groups A and B, whose 1ige,sex, size of stone, and location of stone were matched together. Patients ages ranged from 17 to 67 years. In group A theophylline (200 mg BID) was administered and group B received placebo for six weeks. Both groups were followed up by visits every fortnight and radiological assessment was performed at the end of the sixth week. The proportion of patients whose stones were passed was compared between the two groups. Result: In group A with theophylline consumption 46 out of 75 (61.3%) passed their stones. The mean duration between the initiation of the treatment with theophylline and stone passage was18.3 days. In group B with placebo, the stone passage occurred in 31 out of 75 (41.3%) patients (p<0.032) and the mean duration was 24.8 days (p<0.05). Conclusion: With regard to the findings of this study, it seems that theophylline can increase the rate of ureteral stone passage and as well, accelerate it.

Purpose: To evaluate the efficacy and safety of endoscopic resection of lower ureter in upper urinary tract tumor cases. Materials and Methods: Five patients with transitional cell carcinoma (TCC) of the upper urinary tract were enrolled in this study. Nephrectomy was carried out through a flank incision and distal ureter with a cuff of bladder, which was removed using endoscopic approach. Complications and recurrence rate were evaluated. Results: A total of 5 patients with upper urinary tract tumor underwent the endoscopic resection of lower ureter. All the patients had grade I transitional cell tumor. Two patients had suffered from bladder TCC treated previously. During the follow-up two cases developed bladder tumor: one, 18 months and another, one year postoperatively, both in the base of bladder, which was managed successfully by transurethral resection (TUR). Conclusion: Endoscopic resection of lower ureter in selected patients with upper urinary tract tumors can lead to lower morbidity, shorter operation time, and higher patients satisfaction. Despite the minority of cases in this study, it seems that this method is applicable in selected cases.