Urology Journal

Abstract not available

Purpose: In recent years, many new immunosuppressive drugs have been discovered and developed for clinical use in transplantation. This review focuses on new drugs and novel strategies that have been shown to have immunosuppressive activity in patients.

Materials and Methods: The literature was reviewed.

Results: The introduction of cyclosporine in the early 1980s improved renal allograft survival by approximately 15 percent at one year post transplant. However, cyclosporine failed to enhance long term graft survival. In addition, transplant recipients are at risk of significant side effects due to immunosuppression, including infection, cardiovascular disease, hypertension and malignancy. The limitations constitute the rational for the continued development of new immunosuppressive agents.

Conclusion: The therapeutic armamentarium for transplant immunosuppression continues to broaden and become more complex, as does the variety of potential drug combinations or protocols. Further studies in a large number of individuals are required to clarify the role of new immunosuppressive agents and novel strategies in transplant recipients.

Purpose: We reported the outcome and complications of laparoscopic aberrant vessels transposition without performing pyeloplasty in patients with ureteropelvic stenosis.

Materials and Methods: A total of 10 patients with ureteropelvic stenosis accompanying with aberrant vessels underwent laparoscopic transposition of vessels between June 2001 and March 2003. 4 of the cases were male and 6 were female, and 4 out of 10 had right side and 6 had left side involvement. The mean age was 31.9 (14 - 59). Reaction of aberrant vessels was performed by cutting the vain and fixing the artery to the lipid layer around the kidney and renal pelvis.

Results: The procedure was successful in all the cases without any perioperative complications. The operative time was 2.20 hours (1.45 - 2.50) including cystoscopy, DJ placement, and transposition. Mean hospital stay was 2.9 (2-5) days, and patients were followed up an average of 9.1 (3-22) months. Except one case of rehospitalization due to pain, no complication occurred. The rate of clinical and radiological improvement was 100% and IVP showed a decrease in the degree of hydronephrosis as well as the resolution of obstruction observed in renogram.

Conclusion: With regard to our findings, it seems, at least in a proportion of patients with UPJ stenosis accompanied with crossing vessels, that mechanical compression is the mere cause of obstruction and primary stenosis does not coexist. As a result, treatment is achieved by transposition of the crossing vessels without entering the renal unit.

Purpose: To determine the feasibility, safety, and efficacy of diagnostic and therapeutic ureteroscopy in renal allograft ureters.

Materials and methods: We reviewed 1560 consecutive renal allografts have been preformed between June 1989 and February 2002.Twenty-eight patients (1.8%) had indication for endoscopic procedure on allograft ureter. Six patients had obstructive ureteral calculi with a history of failed ESWL, 3 had suspected ureteral stricture, 9 had upward migrated ureteral stents and 10 had ureteral stricture at ureteroneocystostomy site. Ureters were anastomosed to bladder using Leadbetter- Politano and Lich-GreGoire methods in 6 and 22 cases, respectively. Ureteroscopies were performed with semi rigid 9.8F wolf ureteroscope.

Results: Identifying and introducing the ureteral orifice was successful in 19 (68%) cases. If we exclude 10 patients with ureteral stricture, ureteroscopy was successful in 13 out of 18 (72%). Four ureteral calculi (67%) were removed with ureteroscope.Seven out of nine migrated stents (78%) were retrieved. Four patients with ureteral stricture at ureteroneocystostomy site (40%) had successful ureteral dilatation and double J ureteral catheters were also inserted. Diagnostic ureteroscopy was successful in all cases. Two complications including one urinary leakage and one symptomatic urinary tract infection occurred that were managed conservatively.

Purpose: The accurate diagnosis of submucosal ureteral stones in order to choose a proper and less complicative method of treatment is of significant importance. The use of KUB to detect submucosal ureteral stones has been studied in this research.

Materials and Methods: This prospective study has been carried out on 33 patients (23 males and 10 females) with lower ureteral stone (17 cases in the right ureter and 16 in the left) located under iscial spine as was indicated in their KUB. The distance from the lower end of stone to the midline of sacrum was measured per millimeter using KUB. All patients underwent ureteroscopy, and accordingly those with submucosal ureteral stones were distinguished. The correlation between the distance of the lower end of stone from the middle line of sacrum and the existence of submucosal ureteral stone was analyzed.

Results: Nineteen out of 33 studied patients had submucosal ureteral stones. The average distance between the peak of stone and the middle line of sacrum in patients with submucosal ureteral stone was 9.7 mm with an accuracy of 1.4 mm, a confidence interval 95% and standard deviation of 3.1 mm. Accordingly, if the distance of stone from the middle line of sacrum is lower than 13.7 mm, in 90% of cases the stone will be submucosal.

Conclusion: In patients with lower ureteral stone, the KUB of whom indicates a stone under iscial spine, if the distance of the peak of stone from the midline of sacrum was lower than 15 mm, the stone could most likely be submucousal, a point, which should be considered during treatment. In such cases the intravesical approach should be considered intraoperatively and preparation for submucosal ureteral incision must be provided. This method would be useful in stone removal, if the classic ureteroscopy was not successful.

Purpose: To evaluate the effect of intravenous thyrotropin releasing hormone (TRH) on the urethral closure pressure (UCP).

Materials and Methods: Twenty-two female patients with either bladder outlet obstruction (BOO) or detrusor under activity were included in this study. They divided into two study and control groups randomly. Twelve patients in study group received 200 microgr of TRH intravenously and patients in control group received intravenous normal saline as placebo. Standard urethral pressure profilometry was performed before injection and after injection at 5, 10, 20 and 30 minutes. Functional profile length (FPL), maximum urethral closure pressure (MUCP), and urethral closure pressure at the proximal quarter of the FPL (1/4 FLP) and at the distal quarter of FPL (3/4 FLP) were measured in both groups.

Results: The mean age of the study and control groups were 41.61 ± 21.7 years and 43.59 ± 19 years respectively .The study and control groups included 5 BOO and 6 detrusor under activity and 4 BOO and 5 detrusor under activity respectively. The mean peak flow rate was 5.69 ± 8.4 ml/s in the study group and 6.31 ± 81 ml/s in control group. There wasn't significant difference between two groups. Mean maximum urethral closure pressure demonstrated no significant difference in two groups before and after TRH injection, but a marked reduction in 3/4 UCP and 3/4 FPL in patients after TRH injection was seen.

Conclusion: TRH injection significantly reduces the distal urethral pressure.

Purpose: Our aim was to provide a simple, non-invasive, low cost, and practical method to be used by nurses and technicians in a low hazardous, safe, and painlessness anesthesia.

Materials and Methods: In a prospective blind clinical trial 40 children between 4 and 6 months who were candidated for subumbilical elective surgeries were recruited. They were randomly divided into two groups. Bupivacain 0.25% was prescribed in the control group according to Armitage formula (0.5- 1 ml/kg); while, supp. Acetaminophen was administered in the subject group by a dosage of 30-40 mg/kg.

Results: There was no statistically significant difference in the pain score of the two groups within 2 hours postoperatively, but higher pain score was reported in subject group during the third and forth hours.

Conclusion: Caudal anesthesia with bupivacaine has better painless period postoperatively.

Purpose: We compared two surgical methods of augmentation cystoplasty (AC), before and after renal transplantation, and the outcomes of both methods with transplant patients with normal bladder function.

Materials and Methods: 1520 kidney transplantations were performed at Shahid Labbafinejad Center between March 1988 and February 2002 of which 36 cases was accompanied with AC. In 20 patients (group A) AC was performed before transplantation. This group consisted of 14 males and 6 females with a mean age of 26.1 (13-39) at the time of transplantation. Sixteen patients consisting of 11 males and 5 females (mean age 27.3, 12-44) underwent AC after transplantation. Eventually 40 transplant patients with normal bladder function were assigned in the control group including 18 males and 22 females with a mean age of 31.2 (11-55) (group C).

Results: Normal graft function was achieved in 16, 13, and 33 patients of groups A, B, and C respectively over the mean follow-up of 70, 59, and 76 months (p<0.7). Mean serum creatinine during the follow-up was 1.48 ± 0.4, 1.7 ± 1, and 1.4 ± 0.55 for groups A, B, and C respectively. 9, 12, and 17 patients (26, 64, and 34 cases) with UTI requiring hospital admission were observed in the 3 groups respectively. The incident of UTI and the resultant hospitalization in group B was more than the one in group C (P < 0.03), but it did not differ significantly from group A to group C.

Conclusion: AC is a safe and effective method to improve the lower urinary system function and with the exception of increased risk of UTI following AC after transplantation (group B), there is no considerable difference in the complication rates between AC before and after renal transplantation. As a result, we can perform AC before or after kidney transplantation in patients with dysfunctional lower urinary tract system up to their specific conditions.

Bladder cavernous hemangioma (BCH) is a rare cause of hematuria. It may appear in every part of the urinary tract and presents mostly in childhood. Bladder hemangioma (BH) is suspected by cystoscopy and radiologic findings and confirmed by pathologic examinations. The treatment of BH differs from partial cystectomy and endoscopic removal or LASER therapy. Since BCH is a rare case and because of its big size and specific cystoscopic findings, we report a treated case of it in this article.