UROLOGY JOURNAL
Year:2016 | Volume:13 | Issue:6|Papers Count:11

Purpose: The prognostic value of circulating tumor cells (CTC) detected in castration-resistant prostate cancer (CRPC) is currently under debate. The aim of our meta-analysis was to evaluate the prognostic effect of CTC and to elucidate whether the detection of CTC in the peripheral blood (PB) of patients diagnosed with CRPC can be used as an independent prognostic factor for survival. Materials and Methods: The Pubmed, Science Citation Index, Cochrane Database, Embase Cell Research database and the references in relevant studies were systematically searched. Hazard ratios (HRs) for overall survival (OS) with 95% confidence intervals (CIs), subgroup analysis, sensitivity analysis, meta-regression analysis was pooled and publication bias were conducted. Results: Ten eligible studies enrolling 1206 patients were identified for final analysis. To decrease the heterogeneity of this meta-analysis we excluded two studies after sensitivity analysis. Remained eight studies were enrolled in the pooled analysis and the result revealed that CTC positivity (presence of 5 or more CTCs per 7. 5mL PB) was significantly associated with a poor OS (HR = 2. 76, 95%CI: 2. 28-3. 34, P <. 0001). Conclusion: Our study demonstrated that CTC positivity indicates poor prognosis in patients with CRPC. CTC counts can be used as an independent prognostic factor of survival rate in patients with CRPC.

Purpose: To evaluate the clinical curative effect and safety of transurethral (bipolar) plasmakinetic resection of the prostate (PKRP) combined with thulium laser in the treatment of large prostates (> 80mL). Materials and Methods: From January 2014 to December 2015, 61 patients with benign prostate hyperplasia (BPH) were treated with PKRP combined with thulium laser (n = 25) or PKRP only (n = 36). We retrospectively analyzed the perioperative status of patients status during 3-month follow-up. Results: There was no significant difference between the two groups before treatment (P >. 05). PKRP combined with thulium laser was significantly superior to PKRP in terms of surgical duration, intraoperative blood loss, postoperative bladder washing time, postoperative complications and time of hospital stay (P <. 05). There were no significant improvements at international prostatic symptom score (IPSS), quality of life (QOL), maximum flow rate (Qmax), and post-void residual (PVR) urine between two groups after 3 months (P >. 05). Conclusion: PKRP combined with thulium laser is superior than PKRP only for better surgical duration, less bleeding, higher efficiency and much quicker recovery. It may be a better choice for the treatment of BPH with large prostate (> 80mL).

Purpose: Natural history and modality of treatment for asymptomatic renal calculi less than or equal to 5 millimetres in size is still unknown. Many options are available ranging from medical expulsive therapy to minimally invasive surgery. Till date no study has focussed on this very common but asymptomatic issue. Hence, this study is undertaken to evaluate efficacy of medical expulsive therapy in renal calculi less than or equal to 5mm in size. Materials and Methods: A prospective, parallel group, randomized study was carried out from 1st June 2014 to 31st May 2015, with total of 100 patients, 50 patients in each group. Patients with renal stones less than or equal to 5mm were included in the study. Group A Patients were administered medical expulsive therapy which included tamsulosin 0. 4 mg daily at night time, furosemide 20mg, spironolactone 50mg in a single morning dose, and syrup potassium magnesium citrate 20Meq per dose three times a day for 12 weeks while group B patients were given placebo. The primary outcome variable was number of patients achieving clearance of stone during 12-week treatment period in both groups. Results: No statistically significant differences in age, gender, stone size, and calyceal stone location was found between the two treatment arms. A spontaneous stone expulsion rate of 50% (at 6 weeks) and 86 %( at 12 weeks) was noted in group A versus 28% (at 6 weeks) and 38 % (at 12 weeks) in group B. Less number of pain episodes and less analgesic medication was required in group A as compared to group B. Conclusion: Medical Expulsive therapy for 12 weeks significantly improves stone free rates in renal calyceal calculi less than or equal to 5mm.

Purpose: To investigate the influence of stone opacity in plain radiography on stone free rate and complications of percutaneous nephrolithotomy (PCNL). Materials and Methods: A number of 101 patients who underwent PCNL between July-September 2015 were prospectively included. Stone opacity was judged on preoperative plain Kidney-Ureter-Bladder X-ray. Stone free rate was evaluated two weeks after the operation by ultrasonography and KUB. Results: There were 61 patients with opaque stones and 40 patients with non-opaque stones. The age, body mass index, preoperative creatinine, history of stone surgery, and stone size was not statistically different between patients with opaque and non-opaque stones. Neither operation duration nor access numbers were statistically significant between opaque and non-opaque stones. The frequency of stone free patients in opaque stones and nonopaque stones were 55/61 (90%) and 30/40 (75%) respectively (P =. 04) The magnitude of hemoglobin drop in opaque stones and non-opaque stones were 1. 9 ± 1. 2 mg/dL versus 2. 9 ± 1. 7 mg/dL (P =. 005). Conclusion: The stone free rate is lower and the magnitude of bleeding is higher in PCNL of non-opaque stones when compared to opaque stones if rigid instruments are used for nephroscopy.

Purpose: Partial nephrectomy is the gold standard treatment for small kidney masses. Data on the comparison of laparoscopic (LPN) versus open partial nephrectomy (OPN) are based on retrospective studies. Thus, we planned to compare these two techniques in a prospective trial. Materials and Methods: The study population consisted of patients over 18 years old with single renal mass of ≤ 4 cm. Patients were divided into two groups considering their preference. Study arms were matched according to age, gender, tumor size and location and renal nephrometry score. Mean operation time, warm ischemia time, hospital stay, peri-operative complications and changes in glomerular filtration rate (GFR) after 1 month were recorded and compared in two groups. Patients’ satisfaction score, visual analogue scale and narcotics use to control post-operative pain were also studied. Results: 34 and 31 patients underwent LPN and OPN, respectively. There was no significant difference between OPN and LPN regarding hospital stay (4. 1 versus 4. 6 days; P =. 37), mean hemoglobin drop (2. 17 and 1. 96 g/dL; P =. 62), changes in GFR and positive margin (1 versus 3 p=. 40). LPN was accompanied with longer mean surgery time (180 min versus 127 minutes; P <. 001) and higher rate of urologic complications (P =. 04); nevertheless, patient satisfaction rate was higher (P =. 02) and dose of narcotics necessary for controlling post-operative pain was lower (P =. 04) in LPN. Conclusion: This clinical trial shows that LPN has some benefits over OPN, including decreased post-operative pain and higher patient satisfaction. However, extra caution should be considered in the issue of tumor margin and urinary leakage in LPN.

Purpose: To assess the success and complication rates of glanular hypospadias or dorsal hood deformity surgery, using a modified Firlit’ s technique without glanuloplasty. Materials and Methods: Between May 2013 and December 2015, 41 patients with glanular hypospadias or dorsal hood deformity without hypospadias and mild ventral chordee underwent surgery. Thirty-eight who completed the 1 week and 6-month follow-up were retrospectively evaluated. Exclusion criteria were complete absence of corpus spongiosum resulting in very thin distal urethra, moderate to severe ventral chordee or deep urethral plate that seemed to be better served by tubularization techniques. Modified Firlit’ s technique (a submeatal inverted V incision in addition to the classic technique) was applied to all patients. Results: The mean age was 20. 4± 13 months (range: 6-52 months). The only complication was a narrow-band ventral skin necrosis in 1 patient (2. 6%) that was replaced by new skin growth without need for further intervention. No other complications including unresolved chordee, urethrocutaneous fistula, meatal stenosis, hematoma, infection or post-operative bleeding was observed. Defining the satisfactory result as the glanular position of the meatus and the absence of residual chordee, all patients had satisfactory outcome. Conclusion: Modified Firlit’ s technique is a simple method with excellent cosmetic results and low complication rate that avoids unnecessary glans dissections. When prepucioplasty is not desired, this technique can be considered as a viable option.

Purpose: This study aims to determine extracorporeal shock wave lithotripsy (ESWL)-induced renal tubular damage and the affecting factors by measuring urinary beta2microglobulin (β 2M) excretion. Materials and Methods: This is a cross-sectional study conducted on 91 patients with renal stones who underwent ESWL during 2012. Urinary beta2microglobulin was measured immediately before and after the procedure for each patient and analyzed based on different variables to evaluate factors affecting ESWL-induced renal tubular injury. Results: Mean ± SD urinary beta2-microglobulin values, before and after ESWL were 0. 08 ± 0. 07 and 0. 22 ± 0. 71 mg/dL respectively, the average difference between which was equal to 0. 14 ± 0. 07 mg/dL. These figures exhibited a 166. 66% rise in the urinary β 2M concentration after ESWL which was statistically significant (P <. 001). Multivariate analysis showed that hypertension (P =. 05) and the history of ESWL (P =. 02) were predictive factors of higher post-ESWL urinary beta2-microglobulin excretion. Conclusion: Urinary excretion of beta2-microglobulin increased significantly immediately after ESWL. These changes could indicate that ESWL is a contributing factor to renal tubular damage. It also seems that in patients with hypertension and a previous history of ESWL the likelihood of this injury is higher than others.

Purpose: Adrenal gland injury (AGI) caused by trauma may cause bleeding and life-threatening problems in children. The objective of this study was to analyze the prevalence of AGI in final diagnoses of trauma. Materials and Methods: The records of 458 patients with abdominal trauma (out of a total 8, 200 pediatric patients with trauma of any sort), who were referred to our clinic between January 2009 and July 2014, were reviewed retrospectively. The numbers of patients with AGI and their ages, gender, trauma patterns, affected organs, pediatric trauma scores (PTSs), and injury severity scores (ISSs) were recorded, as well as the associated ultrasound (US) and tomographic scan data, treatments, and complications. Computed tomography (CT) scans obtained after trauma were subjected to both primary and secondary evaluation. Results: In total, 28 patients with AGI were detected; their average age was 8. 54 ± 4. 09 (3– 17) years. Twenty (71%) patients were male and 8 (29%) were female. Nineteen (68%) patients had fallen from heights; the most commonly injured organs were the kidneys, spleen, and lungs. Injuries were right-sided in 26 (92. 9%) patients. The mean ISS was 13. 2 (range 5– 50) and the mean PTS 8. 6 (range 0– 11). Seven patients had ISS > 16 and nine had PTS < 8. AGI was diagnosed by CT in 14 (50%) patients and in 3 (9%) by US at primary evaluation. Upon secondary scan inspection focusing on the possibility of adrenal gland injury, such injury was ultimately detected in 28 patients. All patients underwent conservative follow-up, and one died. Conclusion: We recommend calculation of the PTS, as well as other trauma scores, when pediatric patients suffering multiple or blunt abdominal trauma(s) present to the emergency. In addition, we believe that in children with trauma involving the liver, spleen or kidneys, careful evaluation using a CT scan would increase the diagnosis of AGI and reveal a realistic rate of AGI in trauma cases.

Purpose: To compare monotherapy with tadalafil or tamsulosin and their combination therapy in men with benign prostatic hyperplasia and erectile dysfunction by comparing IPSS score, prostate volume and Qmax and some other outcomes. Materials and Methods: This randomized, single-blind, paralleled group clinical trial was done in 2013 on patients who had referred to our hospital in Tehran. All patients with lower urinary tract symptoms, benign prostatic hyperplasia and any grade of erectile dysfunction were recruited. They were randomly divided into three groups (61 participants in each group): Group A received 20 mg/daily tadalafil; Group B received 0. 4 mg/daily tamsulosin; Group C receieved a combination of 0. 4 mg/daily tamsulosin and 20 mg/daily tadalafil. Primary outcomes were prostate volume, prostate specific antigen, post-void residual volume, IPSS score, LUTS severity, Qmax, IIEF and erectile dysfunction severity and secondary outcome was complications. Results: The mean ± SD of ultrasonographic prostate volume was 61. 4 ± 15. 1 mL and prostate specific antigen level was 2. 4 ± 1. 9 ng/dl. Post-void residual level was significantly different before and after the treatment, except for group A. Also, this group had no meaningful difference compared to the other groups in this regard (P > 0. 05). There were significant differences between pre-and post-treatment international prostate symptom scores in each group (P < 0. 05). Conclusion: Combination of tamsulosin and tadalafil can improve international prostate symptom scores, international index of erectile function questionnaire scores and Qmax in patients with lower urinary tract symptoms and benign prostatic hyperplasia to more degrees than their separate use. This combination is recommended because of its synergistic effects, well toleration and safety.

A 55-year-old male patient reported a mechanical failure 4 months after inflatable AMS® 700 CX penile prosthesis (IPP) implantation. Patient underwent surgical exploration and the cylinders and pump were removed and replaced with a new IPP but the reservoir was left in situ. One month later he complained a second time for mechanical failure again, and a 3-4 cm foreign body was observed inside the reservoir during abdominal ultrasound (Figure 1) and was confirmed after a scond surgical procedure (Figures 2 and 3)...

A 65-year-old male was admitted to the hospital for percutaneous nephrolithotripsy because of a stone in the pelvis of the right kidney. During the retrograde pyelography a very discreet pyeloiterstitial backflow, and a massive backflow to the main renal vein was seen (Figure 1). About one minute after first injection of the contrast medium, pyelovenous backflow was no more observed, while pyelosinus backflow was clearly present (Figure 2). Repeated injection of small amount of contrast medium resulted in almost immediate pyelovenous backflow, and persistent pyelosinus backflow (Figure 3)...