UROLOGY JOURNAL
Year:2008 | Volume:5 | Issue:3|Papers Count:17

Introduction: Helicobacter pylori (H pylori) infection is a focus of attention nowadays. It has been found to cause gastrointestinal disorders and also extraintestinal disorders. The aim of this paper is to explore the role of H pylori in urological diseases and to keep urologists up to date in this subject.Materials and Methods: Medline and PubMed were searched from 1950 to December 2007 for the following combined terms: Helicobater pylori together with urology, urological diseases, kidney, kidney cancer, ureter, bladder, bladder cancer, prostate, prostate cancer, benign prostatic hyperplasia, urethra, seminal vesicle, testis, and testicular cancer.Results: Accumulating evidence is appearing in the literature relating H pylori infection to urological diseases. The most obvious is the implication of H pylori in inducing chronic cystitis leading to bladder lymphoma. In addition, some epidemiological studies have shown significant associations between infective chronic prostatitis and prostatic carcinoma. Conclusion: A simple hypothetical model relating H pylori infection to prostate and bladder diseases is proposed to stimulate the collaborative work between the urologists and scientists to explore this field which is underinvestigated to date. If H pylori is found to have a significant role in urological diseases, prevention of bladder and prostate cancers by eradication of H pylori infection may become a reality like what happened in the treatment of peptic ulcer disease and gastric cancer.

Lymphocele is a lymphatic collection around a transplanted kidney. Diagnosis is made when there is a pelvic collection with similar properties to the plasma.This can be confirmed with biochemical analysis of the fluid that shows similar electrolyte content compared with the plasma with low protein level. On microscopic evaluation, presence of lymphocytes can be a useful clue….

Introduction: The aim of this study was to investigate the effects of thymoquinone, a major component of Nigella Sativa seeds on ethylene glycolinduced kidney calculi in rats.Materials and Methods: Sixty male Wistar rats were randomly divided into 6 groups (intact control, ethylene glycol control, and 4 experimental groups) and treated for 28 days according to the protocol of the study. The rats in experimental groups received ethylene glycol and intraperitoneal injection of thymoquinone either from the first day of the study or the 15th day, with either doses of 5 mg/kg or 10 mg/kg. Blood and 24-hour urine samples were collected at baseline and on day 28. Urine oxalate and citrate and serum electrolytes were also measured. On day 29, all rats were decapitated and their kidney specimens were studied.Results: On day 28, urine oxalate concentration significantly decreased in the experimental groups compared to the ethylene glycol group (P < .001). Also, serum calcium levels were significantly higher in the experimental groups (P = .001). Calcium oxalate deposits were smaller in the experimental groups than the ethylene glycol group. The mean number of deposits was lower in these groups, too (P < .001). Treatment with the lower dose of thymoquinone was associated with fewer deposits.Conclusion: Thymoquinone significantly decreased the number and size of calcium oxalate deposits in the renal tubules. The dose and duration of treatment, however, does not have a linear relation with the outcomes. Further studies on thymoquinone as a preventive and therapeutic drug for kidney calculi are suggested.

Introduction: In a cross-sectional study, we evaluated the prevalence of symptomatic urinary calculi in Kerman, Iran.Materials and Methods: A total of 2431 citizens of Kerman were surveyed from September of 2005 to April 2006. The study population was selected by cluster method from 5 different areas, and 100 houses in each area were randomly approached. Questions on the urinary symptoms consisted of flank pain, urogenital pain, dysuria or any difficulty in urination, and alterations in urine color. Individuals with a suspicion of urinary calculi based on their symptoms were evaluated by physical examination, laboratory investigations, and plain abdominal radiography. Ultrasonography and intravenous urography were done if required to confirm the diagnoses. Results: Of 2431 individuals, 196 (8.1%) had symptoms in favor of urinary calculus diagnosis, of whom 47 (24.0%) had urinary calculi (prevalence of symptomatic urolithiasis was 1.9%). Of the patients, 35 (74.5%) were underweight. Compared to the other participants, the patients with urinary calculus were younger (P = .001) and a larger proportion of them had a positive family history of urinary calculi (14.9% versus 6.5%; P = .02) and were rug weavers and office employees. Dependency on opium and its derivative was significantly more frequent in patients with urinary calculi (25.5% versus 0.2%; P = .001).Conclusion: This study showed that the prevalence of symptomatic urinary calculi in this hot and dry area is relatively high. According to our findings, the other factors including specific occupations, malnutrition, and substance use may also have influence on the rate of urinary calculus formation.Therefore, to prevention and early treatment of urinary calculi, evaluation of potential predisposing conditions should be considered with special attention to regional factors.

Introduction: Saffron has been suggested to have inhibitory effects on tumoral cells. We evaluated the cytotoxic effect of aqueous extract of saffron on human transitional cell carcinoma (TCC) and mouse non-neoplastic fibroblast cell lines.Materials and Methods: Human TCC 5637 cell line and mouse fibroblast cell line (L929) were cultivated and incubated with different concentrations of aqueous extract of saffron stigma (50 mg/mL to 4000 mg/mL). Cytotoxic effect of saffron was evaluated by morphologic observation and 3-(4,5- dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide colorimetric assay after 24, 48, 72, and 120 hours in each cell line.Results: After 24 hours, morphological observations showed growth inhibitory effects at saffron extract concentrations higher than 200 mg/mL for L929 cells and at concentrations of 50 mg/mL to 200 mg/mL for the TCC cells. These changes became more prominent after 48 hours. However, significant growth inhibitory effects of the extract were shown at concentrations of 400 mg/mL and 800 mg/mL. Higher concentrations of saffron correlated inversely with cell population of both cell lines. Significant reduction of the survived cells was seen at concentrations of 400 mg/mL and 2000 mg/Ml for TCC and L929 cell lines, respectively. After 120 hours, decrease in the percentage of survived cells at higher concentrations of saffron extract was seen in both cell lines. At a concentration of 800 mg/mL, the survived L929 cells plummeted to less than 60% after 120 hours, while no TCC cells survived at this time. No L929 cells survived at 2000 mg/mL.Conclusion: Saffron aqueous extract has inhibitory effects on the growth of both TCC 5637 and normal L929 cell lines. This effect is dose dependent.

Introduction: Preservation of the gonadal vein while dissecting the ureter for donor nephrectomy may decrease the distal ureteral ischemia and urological complications in kidney transplant recipients. In this study, we compared the outcome of kidney allografts harvested with preservation of the gonadal vein while dissecting the ureter with allografts harvested without preserving the gonadal vein.Materials and Methods: We reviewed 167 consecutive kidney transplantations between April 2003 and April 2004. During donor nephrectomy, we preserved the gonadal vein in 106 harvested kidneys (group 1), while we did not preserve this vein in 61 allografts (group 2). The recipients in each group were followed up for a 2-year follow-up on average, and the outcomes including ureteral complications, graft loss, and patient and graft survival were compared between the two groups.Results: Urine leakage was noted in few patients (2 in group 1 and 3 in group 2) and its frequency was not significantly different between the two groups (P = .26). Ureteral stricture was not seen in any of the kidney allograft recipients. No differences were found in the frequencies of acute rejection episodes, graft loss, and death between the two groups.Conclusion: Preservation of the gonadal veins did not significantly decrease the frequency of ureteral complications in the kidney transplant recipients.We recommend meticulous handling of the ureter in donor nephrectomies to prevent further remote complications regardless of the approach to the gonadal veins while nephrectomy.

Introduction: Polyuria and hypernatremia are common problems during the pretransplant care of brain-dead donors. They have not only important role in hemodynamic stability, but also may influence organ transplantation outcomes. The influence of donor hypernatremia in liver transplantation was reported. This study aimed to determine these effects on kidney allograft. Materials and Methods: We retrospectively studied on 57 transplanted kidney allografts from cadaveric donors. The effects of the urine output volume and serum level of sodium of the donors were on the recipients’ serum creatinine levels 1 week after transplantation and at the last follow-up visit were assessed.Results: Of the donors, 58% had polyuria and 45% had hypernatremia. The median pretransplant urine output of the donors was 130 mL/h (range, 35 mL/h to 450 mL/h), and their mean serum sodium level was 152.0±13.0 mEq/L. Serum creatinine concentrations in the recipients at the 1st post transplant week correlated significantly with the recipients’ age (r = 0.355, P = .02) and the donors’ urine output volume (r = 0.329, P = .04). The serum creatinine measured in the last follow-up visit significantly correlated only with the donors’ serum sodium levels (r = 0.316, P = .02) and the donors’ age (r = 0.306, P = .02). Multivariate regression analysis showed that the donors’ serum levels of sodium and potassium were the predictors of the last measured serum creatinine level.Conclusion: Polyuria and hypernatremia in brain-dead donors are frequent. Elevated serum level of sodium and polyuria in the donor can have adverse effects on kidney allograft function.

Introduction: The impact of pretransplant hepatitis C virus (HCV) infection on the outcome of kidney transplantation is controversial. This study was designed to determine the impact of pretransplant minimal HCV infection on the patient and graft survival at a single center in southwest of Iran.Materials and Methods: We designed a historical cohort study on 337 kidney transplant recipients and selected 35 patients with HCV infection and a histological activity index score less than 4 (minimal HCV infection). A group of kidney recipients with negative anti-HCV antibody were compared with the anti-HCV-positive patients in terms of acute allograft rejection, graft loss, mortality, causes of death, and patient and graft survival. The controls were matched for age, sex, donor source, pretransplant dialysis duration, and panel reactive antibodies test. All of the participants had a follow-up period of at least 5 years.Results: There were no significant differences in terms of early and late acute allograft rejection episodes between the groups. Although patient and graft survival rates were lower in HCV-positive patients at 2 and 5 years, the differences between the two groups were not significant. The main causes of death among patients with and without HCV infection were sepsis and cardiovascular events, respectively.Conclusion: Our findings suggest that pretransplant minimal HCV infection had no detrimental effect on the short-term patient and graft survival. However, we suggest that kidney transplant recipients with minimal HCV infection be monitored for severe systemic bacterial infections.

Introduction: We studied the safety and efficacy of flexible cystoscopyguided internal urethrotomy in the management of obliterative urethral strictures.Materials and Methods: Forty-three flexible cystoscopy-guided internal urethrotomies were performed between 1999 and 2005. The indication for the procedure was nearly blinded bulbar or membranous urethral strictures not longer than 1 cm that would not allow passage of guide wire. Candidates were those who refused or were unable to undergo urtheroplasty. By monitoring any impression of the urethrotome on the monitor through the flexible cystoscope, we were able to do under-vision urethrotomy. All of the patients were started clean intermittent catheterization afterwards which was tapered over the following 6 months. Follow-up continued for 24 months after the last internal urethrotomy.Results: Seventeen patients were younger than 65 years with a history of failed posterior urethroplasty, and 26 were older than 65 with poor cardiopulmonary conditions who had bulbar urethral stricture following straddle or iatrogenic injuries. Urethral stricture stabilized in 16 patients (37.2%) with a single session of urethrotomy and in 17 (39.5%) with 2 urethrotomies. Overall, urethral stricture stabilized in 76.7% of patients with 1 or 2 internal urethrotomies within 24 months of follow-up. No severe complication was reported.Conclusion: Flexible cystoscopy-guided internal urethrotomy is a simple, safe, and under-vision procedure in obliterative urethral strictures shorter than 1 cm. It can be an ideal option for patients who do not accept posterior urethroplasty or are in a poor cardiopulmonary condition that precludes general anesthesia.

Urolithiasis in horseshoe kidney presents a unique challenge in decision-making and technical aspects of calculus treatment. We present our experience with a group of patients with symptomatic calculi in their horseshoe kidneys. We had 8 patients with 9 horseshoe kidneys bearing calculi. They all underwent percutaneous nephrolithotomy. The median size of the calculi was 21 mm (range, 12 to 45 mm). Auxiliary therapeutic procedures were required in 2 patients who had residual calculi on control imaging. The stone-free status was observed in 6 patients (75.0%) at discharge, and in 7 (87.5%) after 3 months of follow-up. Surgical complications included bleeding in 2 patients that was controlled with complete bed rest and blood transfusion, and pleural injury in 1 which was managed conservatively.

Bilateral synchronous laparoscopic nephrectomies are rare procedures usually performed to treat uncontrolled hypertension and polycystic kidney disease in patients on dialysis and kidney transplant recipients.

Epithelial tumors originating from the renal pelvis are uncommon, and adenocarcinomas account for less than 1% of malignancies which arise from renal pelvic epithelium.(1) Primary mucinous epithelial tumors occurring in the kidney are presumed to originate from the multipotential renal pelvic epithelium. Most reported cases are malignant.(2) Only isolated cases have been reported where the epithelial lining of the tumor was benign.(3) We report 2 cases of mucinous cystadenoma arising from the renal pelvis and discuss the histogenesis of this rare lesion.

In 1964, Pfeiffer described an acrocephalosyndactyly syndrome consisting of bicoronal craniosynostosis, midface hypoplasia, broad thumbs, broad big toes, and partial and variable soft-tissue syndactyly of the hands and feet.(1) Autosomal dominant inheritance with complete penetrance is the main characteristic despite variable expressivity related to the presence or absence of syndactyly and its degree of severity. Based on the severity of the phenotype, Cohen proposed a classification of Pfeiffer syndrome into 3 clinical subtypes.(2) We report, a case of Pfeiffer syndrome type 2 with high-grade bilateral vesicoureteral reflux (VUR), and discuss the importance of surveillance for urogenital problems in patients with this syndrome….

Incidence of prostate rhabdomyosarcoma in adults is not yet known. Together with other sarcoma subtypes they cover less than 0.1% of the primary prostate malignancies.(1) We report an adult patient diagnosed with localized rhabdomyosarcoma treated with radical prostatectomy alone….

Spermatocele, a retention cyst of the scrotum which is or has been in communication with the semen-carrying system,(1) is a relatively common clinical entity. It presents typically as an intrascrotal paratesticular mass, but it usually has few subjective symptoms. Here, we report a case of spermatocele manifested with acute scrotum due to its unique feature...

The polycomb group of transcriptional repressors is associated with tumor progression and metastasis in varying types of malignancies. In Volume 5 Number 2 of the Urology Journal, Shafaroudi and colleagues reported that increased urinary BMI1, but not BMI2, is associated with bladder cancer staging.(1) The question of whether patients with bladder cancer harbor genetically different features is an important issue, but the clinical relevance may be limited until such time as genetic profiling and individualized molecular treatment enter clinical settings. The 5-year survival after curative surgery for bladder cancer remains 50% to 60%, despite recent refinement of various therapeutic strategies, including surgery, radiotherapy, and chemotherapy.(2,3) Therefore, better identification of targeting genes associated with progression of bladder cancer is now mandatory to improve patient survival with this type of refractory cancer. In recent years, several new specific biomarkers have been identified for predicting prognosis of patients with bladder cancer. For example, expression of E-cadherin, beta-catenin, plakoglobin, and vimentin are associated with the clinicopathologic variables of grade and stage.(4) Overexpression of HER-2/neu is associated with tumor progression and poor prognosis.(5) In the present study, BMI1 was mainly stained in the nuclei of tumor cells, whereas no normal cell showed BMI1 staining. (1) Overexpression of BMI1 was roughly associated with advanced pathological stage and higher tumor grade of bladder cancer.(1) Although the major limitation of this study is a weakness in the number of patients, the finding that BMI expression intensity correlates with cancer stage, suggests BMI1 may be a potential molecular target in patients with bladder cancer.Statistical evaluations will reveal whether BMI1 overexpression is associated with an increased probability of bladder cancer-specific survival and recurrence-free survival. We hope that this article leads to additional studies.

The article by Basiri and coworkers details their experience with a patient with low-grade ureteral cancer on whom they performed laparoscopic distal ureterectomy with a subsequent reconstruction using the Boari flap.(1) The present article helps to add evidence regarding feasibility and safety (technical and functional) of pure laparoscopic partial ureterectomy. Although it is evident that open nephroureterectomy has been standardized and can, to date, guarantee acceptable perioperative morbidity, allowing reproducible long-term oncologic results for ureteral cancer, it appears from their experience that when the candidates for surgery are appropriately selected and there is a dedicated surgical team for laparoscopy, these goals are achievable. Roupret and colleagues retrospectively reviewed 6 patients with lowgrade upper urinary tract transitional cell carcinoma treated laparoscopically, concluding that laparoscopic distal ureterectomy with reimplantation is technically possible for low-risklow-grade upper urinary tract transitional cell carcinoma.(2) At this point, the exact role of laparoscopic partial ureterectomy is still under careful evaluation, as data from the literature are limited, especially regarding important issues such as long-term results and the feasibility of urinary reconstruction, which remains technically challenging.(3) Their report is noteworthy since they give us information about subsequent laparoscopic Boari flap, detailing important surgical steps. Apparently, initial goal will be to provide the same outcome as in a standard open procedure with the hope that in the future, as we gain more experience, learning curve will provide an improvement in terms of less blood loss and a decrease in length of hospital stay.