UROLOGY JOURNAL
Year:2008 | Volume:5 | Issue:4|Papers Count:16

Introduction: The main objective of the present review article was to study the different aspects of reconstructive surgery for posterior urethral defects by reviewing the published articles and presentation of our experiences in the reconstructive urology division at Shohada-e-Tajrish hospital. Materials and Methods: The Medline was searched with the keywords of posterior urethroplasty, end-to-end anastomosis, excisional urethroplasty, anastomotic urethroplasty, pelvic fracture, bulboprostatic anastomosis, and urethral repair. The search was limited to papers published from 1980 to September 2008. We selected the relevant published articles in this database and also presented our experience at our reconstructive urology division. Results: Of over 5000 search results, we selected 38 relevant articles with substantial contribution to the subject. Pelvic fracture due to accidents was the most common etiology of pelvic fracture urethral distraction defect that usually involved the membranous urethra. Surgical treatment of this disorder with perineal anastomotic urethroplasty was accompanied by a success rate of 82% to 95% in different studies. The most important complications of this surgery include urinary incontinence and impotence; however, the incidence of these complications has been reduced by using new surgical techniques. Conclusion: Complete preoperative assessment, the use of suitable reconstructive techniques, and in particular, the use of flexible cystoscopy can lead to acceptable outcomes of the surgical repair of pelvic fracture urethral distraction defects.

Introduction: The aim of this study was to evaluate the cause, diagnosis, and management of intravesical foreign bodies in patients treated at our hospital and to review and update management of intravesical foreign bodies reported in the current literature. Materials and Methods: Sixteen patients had been treated for intravesical foreign bodies at Nishtar Medical College Hospital, Multan, Pakistan during a 5-year period. Records of these patients were analyzed retrospectively for etiology, presentation, diagnosis, and management. Results: The age of the patients ranged from 14 to 70 years and 10 of them were men. Seven patients (43.8%) had iatrogenic intravesical foreign bodies, 5 (31.3%) had migrated foreign bodies from the adjacent organs, and 4 (25.0%) had self-introduced foreign bodies into the bladder. The objects included copper wire, carrot, lead pencil, intrauterine device, surgical gauze, pieces of Foley catheter, and teflon beak of resectoscope sheath. The most common presenting symptoms were urinary frequency and dysuria. Endoscopic retrieval was possible in 8 (50.0%) patients, and the remaining underwent open cystostomy. Conclusion: Intravesical foreign bodies should be included in the differential diagnosis of patients with chronic lower urinary tract problems. Radiological evaluation is necessary to determine the exact size, number, and nature of them. The most suitable method for removal of intravesical foreign bodies depends on the nature of the foreign body, age of the patient, and available expertise and equipment. Most intravesical foreign bodies can be retrieved with minimally invasive techniques.

A 45-year-old man was diagnosed with retroperitoneal ganglioneuroma. The tumor was a large encapsulated mass of firm consistency with a homogeneous, solid, grayish white-cut surface, having a focally edematous appearance (Figures, Top).

Introduction: Circumcision is one of the most common surgical operations throughout the world, and meatal stenosis is one its late complications. We evaluated the topical use of a lubricant jelly after circumcision in boys in order to reduce the risk of meatal stenosis. Materials and Methods: A randomized control trial was performed, in which 2 groups of boys younger the 2 years old underwent circumcision according to the sleeve method. The parents in the study group were instructed to use petroleum jelly on the circumcision site after each diaper change for 6 months. In the control group, no topical medication was used. The children were followed up regularly and evaluated for meatal stenosis, bleeding, infection, and recovery time. Results: A total of 197 boys in each group completed the study. None of the children in the study group but 13 (6.6%) in the control group developed meatal stenosis (P<.001). Infection of the circumcision site was seen in 3 (1.5%) and 23 (11.7%) children of the lubricant and control groups, respectively (P<.001), and bleeding was seen in 6 (3.0%) and 37 (18.8%), respectively (P<.001). The mean time of recovery in the lubricant group was 3.8±1.2 days, while it was 6.9±4.2 days in the control group (P=.03).Conclusion: Based on the findings of this study, it seems logical to use a lubricant jelly for reducing postcircumcision meatal stenosis and other complications.

Introduction: Studies have shown different types of RAS mutations in human bladder tumors with a wide range of mutation frequencies in different patient populations. This study aimed to assess the frequency of specific-point mutations in the RAS gene family of a group of Iranian patients with bladder cancer. Methods: We examined the tumor specimens of 35 consecutive patients with transitional cell carcinoma. The DNA samples were evaluated for the occurrence of HRAS, KRAS, and NRAS activation using a polymerase chain reaction-restriction fragment length polymorphism technique. Results: None of the patients had mutations in the RAS gene family "hot spots" including codons 12, 13, and 61. Conclusion: We failed to find RAS mutations in our bladder tumor samples. These observations may reflect the involvement of different etiological factors in the induction of bladder tumor of which RAS mutation might not be present in all populations.

Introduction: The aim of this study was to determine the diagnostic value of urine nuclear matrix protein 22 (NMP22) level in detection of transitional cell carcinoma (TCC) of the bladder. Materials and Methods: A total of 76 patients with newly-diagnosed or recurrent TCC and 75 controls without urinary tract disorders participated in this study. A urine sample was obtained for measurement of the NMP22 level using the enzyme-linked immunoabsorbent assay. The resulted values were evaluated in comparison with the results of pathologic examination. Results: A total of 76 patients with TCC of the bladder and 75 volunteers without TCC were enrolled in the study. The mean level of urine NMP22 had an increasing trend associated with tumor grade (P=.01) and tumor stage (P<.001). In participant without TCC, the mean urinary NMP22 level was 5.48±6.34 U/mL, while this value was 25.01±35.33 U/mL in patients with TCC of the bladder (P<.001). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of urine NMP22 for detection of TCC were 75.5%, 86.7%, 85.1%, 77.4%, and 80.8%, respectively. The sensitivity of NMP22 in detecting stage Ta tumors appeared to be low (31.3%), but for grade 1 tumors, the sensitivity was 66.7%.Conclusion: Measurement of urine NMP22 is a noninvasive, highly sensitive, and specific method for detecting TCC of the bladder and estimating its grade and stage. Further studies can be helpful to determine whether it can be used in clinical practice.

Introduction: We aimed to assess the effects of different types of diabetes mellitus (DM) on patients receiving living donor kidney allograft. Materials and Methods: A total of 111 kidney transplant patients with DM and 111 randomly selected kidney transplant recipients without DM were enrolled in the study. The characteristics of the kidney allograft recipients and the allograft and patient outcomes were assessed and compared between 4 groups of kidney recipients without DM and patients with type 1 DM, type 2 DM, and post transplant DM. Results: Of the 111 patients with DM, 36 (32.4%), 20 (18.0%), and 55 (49.6%) had been diagnosed with type 1 DM, type 2 DM, and post transplant DM, respectively. Diabetic patients had significantly higher rates of rejection episodes (P=.049) and suffered more frequently from delayed graft function (P=.03) compared to the kidney recipients in the control group. Patient and allograft survival rates were significantly lower in the patients with DM (regardless of their DM type) compared to the nondiabetic patients (P=.03 and P=.04, respectively). Prominently, type 1 DM had significantly adverse effects on patient and allograft survival. Patients with post transplant DM had a relatively better patient survival compared to those with type 1 DM and type 2 DM. Conclusion: We found that kidney recipients with DM, especially preexisting DM, had worse patient and graft survival rates compared to the nondiabetics. These findings suggest that kidney transplant patients presenting with any type of DM should be more closely followed.

Introduction: We conducted this study to determine the effects of saffron (Crocus sativus) on the results of semen analysis in men with idiopathic infertility. Materials and Methods: In this clinical trial, 52 nonsmoker infertile men whose problem could not be solved surgically were enrolled. They were treated by saffron for 3 months. Saffron, 50 mg, was solved in drinking milk and administered 3 times a week during the study course. Semen analysis was done before and after the treatment and the results were compared. Results: The mean percentage of sperm with normal morphology was 26.50±6.44% before the treatment which increased to 33.90±10.45%, thereafter (P<.001). The mean percentage of sperm with Class A motility was 5.32±4.57% before and 11.77±6.07% after the treatment (P<.001). Class B and C motilities were initially 10.09±4.20% and 19.79±9.11% which increased to 17.92±6.50% (P<.001) and 25.35±10.22% (P<.001), respectively. No significant increase was detected in sperm count; the mean sperm count was 43.45±31.29x106/mL at baseline and 44.92±28.36x106/mL after the treatment period (P=.30).Conclusion: Saffron, as an antioxidant, is positively effective on sperm morphology and motility in infertile men, while it does not increase sperm count. We believe further studies on larger sample sizes are needed to elucidate the potential role and mechanism of action of saffron and its ingredient in the treatment of male infertility.

Introduction: Our aim was to evaluate the relationship between lower urinary tract symptoms (LUTS), age, and sexual dysfunction in the Iranian men aged 50 to 80 years. Materials and Methods: A total of 357 men aged 50 to 80 years presenting at the urological clinic were enrolled in this study. The International Prostatic Symptom Score (IPSS) and the International Index of Erectile Function (IIEF) questionnaires were used to assess the LUTS and sexual function, respectively. The questionnaires were completed by face-to-face interview. Logistic regression model was used for multivariate analysis of the risk factors of sexual dysfunction and its domains assessed by the IIEF. Results: Of the patients, 332 (93%) were sexually active with a median sexual attempts of 4.6 times per month. Frequency of sexual attempts was inversely related to LUTS severity (P<.001). Advanced age was positively associated with LUTS severity (r=0.534, P<.001). Sexual dysfunction, defined as IIEF score of 20 and less, was present in 68.2% of the patients. All IIEF domain scores and the overall score were correlated with age (P<.001) and the IPSS (P<.001). In a multivariate analysis, age, diabetes mellitus, and the IPSS were strong independent predictors of the overall IIEF score. Conclusion: Sexual activity as an important component of the quality of life continues in the majority of men over 50 years. However, their sexual function can be severely affected by LUTS and its severity.

Introduction: Our aim was to evaluate clean intermittent catheterization (CIC) results in combination with triamcinolone ointment for lubrication of the catheter after internal urethrotomy. Materials and Methods: Seventy patients who underwent internal urethrotomy were assigned into 2 groups and performed CIC with either triamcinolone 1% ointment or a water-based gel (control) for lubrication of the catheter. They continued CIC regimen up to 6 month and were followed up for 12 months. Retrograde urethrography and urethrocystoscopy were done 6 and 12 months postoperatively. In case of obstructive symptoms or any difficulty in passing the urethral catheter, internal urethrotomy would be performed, if needed, and the same follow-up protocol would be started again. The recurrence rates after the first and second urethrotomy attempts were compared between the two groups. Results: Thirty patients in the triamcinolone group and 34 in the control group completed the study. There were no significant differences in the baseline characteristics of the patients or the etiology of the stricture between the two groups. There was a 30.0% recurrence rate in the patients of the triamcinolone group versus 44.1% in those of the control group after the first internal urethrotomy (P=.24). Following the second internal urethrotomy, the urethra was stabilized in 88.9% of the patients in the triamcinolone group and 60.0% those in the control group (P=.15). Conclusion: Administration of triamcinolone ointment in patients on CIC regimen after internal urethrotomy only slightly decreased the stricture recurrence rate, and its possible effects should be more investigated.

INTRODUCTION: Pelvic irradiation is known to cause several complications involving urinary bladder such as radiation cystitis, ulceration, and incontinence. Spontaneous intraperitoneal rupture of the urinary bladder is a rare complication following pelvic irradiation. To the best of our knowledge, there is only one report of radiation-induced bladder rupture following irradiation for prostate cancer which was managed surgically.

Recent investigations of the underlying pathophysiology of renal cell carcinoma (RCC) has resulted in the identification of involved molecular pathways, including the inactivation of the von Hippel-Lindau gene in most sporadic cases of RCC.(1) They are characterized by one specific histological type. In contrast, kidney tumors in patients with Birt-Hogg-Dube syndrome (BHD) consist of a variety of histological types.(2) We report a patient with multiple renal cell tumors in one kidney with a history of spontaneous pneumothorax, but without skin lesions which are typical signs of BHD syndrome.

INTRODUCTION: True hermaphroditism is a rare form of ambiguous genitalia characterized by simultaneous presence of both normal male and female gonadal tissues in a same patient. Although uncommon, true hermaphroditism has been reported in more than 400 individuals, to date. We report a hermaphrodite patient presenting with a pelvic abscess.

INTRODUCTION: "Forgotten" indwelling stents can result in complications such as encrustation, pyelonephritis, recurrent obstruction, and stent migration and breakage. We report a case of forgotten stent with encrustation of the proximal and distal ends, spontaneous disappearance of the middle segment, and an associated hourglass pelvic stenosis resulting in hydronephrosis.

INTRODUCTION: Vesicocutaneous fistula (VCF) is a known complication of longstanding suprapubic cystostomy tract. We report the first case of neglected urethral stricture with rectourethral fistula following pelvic trauma presenting as "watering-can abdomen" due to multiple vesicocutaneous fistulas following suprapubic cystostomy.

Studying the Avicenna’s Canon of Medicine, provides noteworthy information on the subjects related to urology. Some examples of these amazing items have been confirmed by the modern urology: explaining the 2-stage function of the bladder (filling and emptying stages); indirect pointing to a scientific law, named later as the Laplace’s law, which is applicable to bladder physiology and explains intravesical pressure stability; describing the bladder layers and strength of the urothelial layer, which was later proved to be due to the tight junctions; describing the intramural ureter and its antireflux mechanism; scientific classifying the urethral and bladder diseases; and describing meticulously the semiology and epidemiology of bladder calculi. Avicenna has also pointed to inversion therapy in the treatment of urinary calculi, grating sign in bladder calculi, manipulation methods for treatment of bladder calculi, and finally, the Crede maneuver. His methodology is completely scientific, based on experiments and truly a basis of the modern medicine. This article is a review of Avicenna’s views in medicine and their comparison with the modern urology.