Urology Journal

Introduction: The aim of this study was to evaluate the treatment of upper ureteral calculi with extracorporeal shock wave lithotripsy (SWL) in the supine and prone positions.

Materials and Methods: A total of 68 patients with upper ureteral calculi underwent SWL. In 35 patients, the procedure was performed in the supine position (group 1), while in the 33 remainders, it was performed in the prone position (group 2). The stone-free rate, the number of SWL sessions required, and the number of shocks per treatment session were compared between the 2 groups.

Results: The mean calculus size was 12.4 ± 3.1 mm and 12.2 ± 2.9 mm in groups 1 and 2, respectively. The stone-free rate was 81.8% in group 1 and 82.9% in group 2 (P = .91). The number of sessions for achieving the stone-free status was similar in the patients of the 2 groups (1.9 ± 0.8 in group 1 versus 1.9 ± 0.8 in group 2; P = .79). The mean number of shock waves per treatment session was not significantly different between the 2 groups. No major complications were seen and none of the patients required hospitalization, placement of a ureteral catheter, or a double-J stent.

Conclusion: Our study showed that in the prone position, treatment of the upper ureteral calculi by SWL is as safe and effective as the supine position.

Introduction: Cystinuria is an autosomal recessive disorder which clinically presents as cystine calculi. In this study, we reviewed cystine calculi cases in the west of Iran to determine their common presentations and response to different therapeutic modalities.

Materials and Methods: Between 1999 and 2005, we had 22 pediatric patients (11 boys and 11 girls) with cystine calculi. The demographic characteristics and clinical data of the patients as well as the treatment results were reviewed.

Results: The mean age of the patients was 34.20 ± 42.99 months (range, 4 to 156 months). They were followed for a mean duration of 23 months (range, 3 to 70 months).  Thirteen patients (59.1%) had bilateral and 9 (41%) had unilateral kidney calculi. The sizes of the calculi were between 2 mm and 20 mm. Nine patients (41%) had renal atrophic changes and 1 (4.5%) had obstructive acute renal failure. Hydration and urinary alkalinization were administrated to all of the patients which yielded an excellent result in 54.5% and a  poor response in 27.2%. Captopril started for 5 patients was effective only in 1. D-penicillamine had no favorable response. Extracorporeal shockwave lithotripsy was successful in 5 attempts and failed in 4. Surgical interventions were performed for 13 patients (59.1%) and 6 (27.2%) required more than 1 surgical operation.

Conclusion: We recommend metabolic workup of childhood urolithiasis and appropriate medical management of its underlying disease. We also recommend minimally invasive urologic techniques including shockwave lithotripsy only when there are clear indications for nonmedical procedures.

Introduction: The aim of this prospective study is to determine the relationship between the pathologic characteristics of the transitional cell carcinoma (TCC) of the bladder and prostatic involvement.

Materials and Methods: Sixty men with bladder TCC underwent standard radical cystoprostatectomy and were enrolled in this study. Vascular and perineural invasion, maximum diameter of the tumor, presence of carcinoma in situ, distance between the tumor and the bladder neck, and grade and local stage of the tumor were recorded and their relation with prostatic involvement was studied. In addition, hydronephrosis and age of the patients were included in the analysis.

Results: The mean age of the patients was 63.9 ± 11.1 years. Of 60 men included in this study, 15 patients were found to have prostatic involvement with TCC (25%). Univariate statistical analyses showed that vascular invasion and the distance between the tumor and the bladder neck were significantly related to the prostatic involvement (P = .007; P < .001). But, in the logistic regression, only the distance between the tumor and the bladder neck was significantly related to the prostatic involvement (P = .001).

Conclusion: This study suggests that the probability of prostatic involvement in patients with bladder TCC tumors near the bladder neck is high. Prostate-sparing or capsule-sparing cystectomy should be avoided in such patients.

Introduction: Survivin is an inhibitor of apoptosis that is expressed in undifferentiated tissues like tumors. Detection of survivin in urine has been proposed as a diagnostic marker for bladder cancer. We evaluated the urine samples of patients with bladder cancer for survivin and compared them with healthy controls.

Materials and Methods: The urine specimens of 20 patients with transitional cell carcinoma (TCC) of the bladder (group 1) and 18 controls without cancer (group 2) were collected before cystoscopy and assessed for survivin by reverse transcriptase polymerase chain reaction.

Results: All patients except 1 in group 1 were men. Urine specimens were positive for survivin in 18 (90%) and 9 (50%) patients of groups 1 and 2, respectively (P = .007). Sixteen patients with TCC had urine cytology, of which 6 (37.5%) were positive. Urine survivin was positive in all 10 patients with negative cytology. Nine patients in this group had low-grade tumors.

Conclusion: Urine survivin seems to have a higher sensitivity than urine cytology, especially in low-grade bladder cancer. The quantitative measurement of survivin in urine by advanced techniques may provide a better diagnostic and prognostic tool. However, the clinical use of survivin and its association with different stages and grades of TCC still requires more studies.

Introduction: The aim of this study was to evaluate the accuracy of Technetium Tc 99m dimercaptosuccinic acid (99mTc-DMSA) renal scintigraphy in the diagnosis of urinary tract infection (UTI) in children with suspected infection but with a negative urine culture.

Materials and Methods: The records of all children with suspected or definite diagnosis of UTI presented during a 2-year period were reviewed in this study. Abnormal findings on renal scintigraphy, voiding cystourethrography (VCUG), and ultrasonography were evaluated and compared between the patients with the definite diagnosis of UTI and those with suspected UTI and negative urine cultures.

Results: Of 210 patients, 86 had a definite diagnosis of UTI (group 1) and 124 had suspected UTI without a positive culture (group 2). Abnormal findings on DMSA scans were seen in 76 patients (88.4%) in group 1 and 84 (67.7%) in group 2. Vesicoureteral reflux was detected by VCUG in 50% and 32.3% of the patients in groups 1 and 2, respectively. In group 2, vesicoureteral reflux was seen in 40.5% of the patients with abnormal DMSA scan. Ultrasonography findings were abnormal in 51.3% and 39.8% of the patients with abnormal DMSA scan findings in groups 1 and 2, respectively.

Introduction: Our aim was to compare the nuclear DNA integrity of the spermatozoa from infertile men with abnormal semen parameters with that from normospermic fertile men, and to evaluate the relationship between the sperm DNA integrity and semen parameters.

Materials and Methods: Thirty ejaculate samples with abnormal semen analysis and 30 ejaculates with normal semen parameters were randomly collected from infertile and fertile men, respectively. The acridine orange test was used to assess the integrity of sperm DNA.

Results: The number of ejaculates with a DNA Fragmentation Index (DFI) above 30% were 16 (53.3%) and 22 (73.3%) in fertile and infertile subjects, respectively (P = .10). The mean DFI was 37.7 ± 19.6% and 46.1 ± 16.7% in the fertile and infertile subjects, respectively (P = .24). The DFI of the fertile men with normal sperm morphology (12 patients) ranged from 1% to 80%. In the samples with oligoasthenospermia, mean DFI was 52.7 ± 17.9%. There were 2 samples with severe teratospermia (normal morphology less than 4%) and DFIs of 70% and 87%. There were no significant correlations between the DNA integrity and the 3 parameters of semen quality in our 60 subjects. 

Conclusion: Our results failed to show any significant difference in the DNA integrity of the spermatozoa between infertile and fertile men. Also, no correlation was noticed between the DNA abnormality and the semen parameters in the studied samples.

Introduction: We reviewed the long-term outcome of substitution urethroplasty with skin flaps for anterior urethral strictures, comparing 1-stage with 2-stage repairs.

Materials and Methods: A total of 45 patients with urethral strictures, 2.5 cm or longer, had undergone skin flap urethroplasty. A 1-stage surgical operation had been done in 10 patients (Orandi and bilateral pedicle island of penile skin) and a 2-stage surgical repair had been performed in 35 using the Johanson technique. They were followed up by retrograde urethrography for 1 to 10 years.

Results: The mean age of the patients was 46.3 ± 17.1 years. Etiology of the stricture was instrumentation in 33.3% of the patients, urethritis in 28.9%, trauma in 13.3%, and unknown in 24.5%. At the first postoperative year, the success rate was 75.6%. This rate was 71.4% and 90% for the 1-stage and 2-stage operations, respectively (P = .23). There were 1 (10%) and 10 (28.6%) cases of recurrent structure and 1 (10%) and 3 (8.6%) cases of fistula in the patients with the 1-stage and 2-stage operations within the first year, respectively. During the 5 postoperative years, 70% of the patients with the 1-stage repair, 57.1% with the 2-stage repair, and 60% in total had no complications.

Conclusion: Based on the previous studies and our experience, we recommend skin flap urethroplasty. However, some measures such as proper tailoring of the flap and the extension of the incision onto the intact segments should be considered for achieving a better outcome.

Introduction: Fournier gangrene is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia, the perineum, or the abdominal wall that is associated with high morbidity and mortality. In this series, we describe 12 patients with Fournier gangrene who had presented to our medical center.

Materials and Methods: Twelve men had been diagnosed with Fournier gangrene in Shohada-e- Tajrish hospital between March 2002 and September 2005. Their medical records were reviewed and the Fournier Gangrene Severity Index scores before and after the treatment were determined.

Results: Fifty percent of the patients were diabetic and their mean age was 58.2 ± 17.8 years. The mean delay between the onset of the disease and the admission was 4.9 days and the mortality rate was 16.6%. The median Fournier Gangrene Severity Index scores before the admission and at the time of discharge were 4.5 (range, 0 to 11) and 0 (range, 0 to 9), respectively (P = .005). One of the patients who died had the scores of 11 and 9, respectively. Split-thickness skin graft was performed for 5 patients (41.7%).

Conclusion: In Fournier gangrene, a rapid diagnosis and emergent surgical intervention is crucial. The Fournier Gangrene Severity Index seems to be an excellent tool for outcome prediction.

Introduction: We report the incidence, distribution, etiology, and outcome of the urogenital trauma in 8 major cities of Iran according to the database of national trauma project.

Materials and Methods: Between 2000 and 2004, we prospectively collected the data of all the traumatic patients hospitalized for more than 24 hours in 8 cities (Tehran, Mashad, Ahwaz, Shiraz, Tabriz, Qom, Kermanshah, and Babol). We analysed the data taken from 17 753 trauma admissions. Patients with sustained urogenital traumas were identified and studied.

Results: A total of 175 patients (0.98%) had injuries to the urogenital system. Male to female ratio was 4. The patients’ mean age was 25 ± 16 years (range, 2 to 80 years). Of 175 patients, 159 (90.9%) had blunt trauma and 16 (9.1%) had penetrating trauma. Road traffic accident was the most common cause of trauma (65.1%). The most common injured organs were the kidney in 61.1% and the bladder in 13.7%. One hundred and forty-two patients (81.1%) had associated intra-abdominal injuries and 129 (73.7%) had other accompanying injuries. Sixty (34.2%) patients required surgical intervention. Nine patients (5.2%) died due to the severity of the injuries. All patients who died had severe injuries (Injury Severity Score >12).

Conclusion: In Iran, blunt traumas including road traffic accidents are the main cause of urogenital traumas. The majority of the patients with urogenital trauma have multiple injuries and require a multidisciplinary approach.

 

Introduction: The aim of this study was to report our 23-year experience in the diagnosis and treatment of retrocaval ureter.

Materials and Methods: Data from 13 patients with retrocaval ureter were reviewed. Intravenous urography and retrograde pyelography had been used for confirming the diagnosis. All of the patients had been symptomatic and undergone surgery. A control intravenous urography had been performed 6 months postoperatively.

Results: The mean age of the patients was 23 years (range, 12 to 37 years). Twelve patients (92.3%) were men. The clinical manifestations were pyelonephritis in 7 (53.8%), right flank pain in 4 (30.8%), gross hematuria in 1 (7.7%), and ureteral calculus in 1 (7.7%). All of the patients had type 1 right-sided retrocaval ureter. Associated anomalies were seen in none of the patients. The control intravenous urography showed improvement of renal function.

Conclusion: In our patients, the most common cause of referral was pyelonephritis. In symptomatic cases, operation is needed and can improve renal function.

Introduction: Nocturnal enuresis is a very common finding in children to the extent that many families and caregivers, alike, may dismiss it as a developmental stage rather than a disease. Persistence of nocturnal enuresis into adulthood, however, has received little discussion and is surrounded by fallacies.

Materials and Methods: All existing literature cited in PubMed between 1970 and 2005 were reviewed using the search entries “nocturnal enuresis AND adultâ€.

Result: Of the 220 papers reviewed, enuresis persisting into adulthood was covered in only 87. Those aspects pertinent to this subset of patients were placed in focus.

Conclusion: In contrast to the numerous researches on childhood enuresis, persistent adulthood enuresis is an underdiscussed subject, distinct in a few aspects of its etiology and management described herein.