Urology Journal

PURPOSE: To determine the role of glutathione S-transferases (GSTs; GSTM1, GSTT1, and GSTP1) gene polymorphisms in susceptibility to male factor infertility. MATERIALS AND METHODS: We report a pooled analysis of 11 studies on the association of GSTM1, GSTT1, and GSTP1 polymorphisms and male factor infertility, including 1323 cases and 1054 controls. RESULTS: An overall significant association was determined between the GSTM1 null genotype [odds ratio (OR), 2.74; 95% confidence interval (CI), 1.72 to 3.84; P = .003], GSTT1 null genotype (OR, 1.54; 95% CI, 1.43 to 3.47; P = .02), and male factor infertility. The GSTP1 Ile/Val genotype had overall protective effect against development of infertility (OR, 0.48; 95% CI, 0.27 to 0.77), while there was significant heterogeneity between studies. In sensitivity analysis, two studies were excluded; the association and direction between GSTM1 and GSTT1 null genotypes and GSTP1 Ile/Val genotype and male infertility remained unchanged. There was no significant interaction between smoking status and studied genotypes on male infertility risk (P = .26). CONCLUSION: These results demonstrated that amongst populations studied to date, GSTM1 and GSTT1 null genotypes are associated with strong and modest increase in the risk of male infertility, respectively. On the contrary, GSTP1 Ile/Val genotype has protective effect.

PURPOSE: To evaluate factors affecting the success rate of stone fragmentation and stone-free rate after extracorporeal shockwave lithotripsy (SWL) in treatment of upper urinary tract stones. MATERIALS AND METHODS: A total of 121 patients with upper urinary tract calculi underwent SWL treatment. RESULTS: Success rate of stone fragmentation after SWL was 73.6% (89/121). In 89 patients who had success of breaking stones, 71 patients were followed up for the assessment of stone-free status, of whom 51 (71.8%) patients were stone-free at 3-month follow-up. Among four prognostic factors, including body mass index (BMI), stone size, stone position, and hydronephrosis, BMI and stone position had a significant impact on the success rate of stone fragmentation (P = .04 and U1: P = .0108, respectively). Among five prognostic factors of BMI, stone size, stone position, hydronephrosis, and times of SWL treatments, stone size was the only factor with significant impact on the stone-free rate (middle: P = .0229). CONCLUSION: Our study suggests that stone fragmentation and stone-free rate after SWL treatment for upper urinary tract stones can be predicted.

PURPOSE: To compare arterial blood gas analysis of patients who underwent percutaneous nephrolithotomy (PCNL) in flank position under ultrasonography guidance with PCNL in prone and supine positions under fluoroscopic guidance. MATERIALS AND METHODS: In a clinical trial, a total of 90 patients with no upper urinary tract abnormalities were candidate for the PCNL. They were assigned into three groups using pseudorandomization method (30 patients in each group). Patients in group 1 underwent ultrasonography-guided PCNL in flank position. Patients in groups 2 and 3 underwent fluoroscopic-guided PCNL in prone and supine positions, respectively. Arterial blood gas was taken just before and 20 minutes after repositioning. RESULTS: The patients’ mean age was 40.8 ± 6.9, 39.4 ± 10.6, and 37.2 ± 11.1 years in flank, prone, and supine positions, respectively (P = .69). The mean body mass index was 27.8 ± 3.4, 26.7 ± 4.7, and 28.1 ± 5.1 kg/m2 in flank, prone, and supine positions, respectively (P = .21). Arterial oxygen pressure (PaO2) increased significantly in flank (111.7 ± 43.8 to 132.8 ± 58.1 mmHg; P = .01) and prone (118.6 ± 50.2 to 134.6 ± 58.5 mmHg; P < .001) positions and decreased nonsignificantly in supine group (121.7 ± 64.5 to 119.7 ± 60.9 mmHg; P = .23). With surgical positioning, there were no significant changes demonstrated in PaCO2 and serum concentration of HCO3 in the flank, prone, and supine groups. CONCLUSION: We could suggest that flank and prone positions could improve patients’ oxygenation during PCNL procedure.

PURPOSE: To retrospectively analyze the efficacy of extracorporeal shockwave lithotripsy (SWL) for managing ureteral stones in patients who were treated during a 12-year period at a single center in Turkey. MATERIALS AND METHODS: The study involved 3300 patients who had single ureteral stone and underwent SWL between January 1999 and March 2011. Medical records from 2836 (85%) patients were available for evaluation. Only patients with radiopaque stones of 5- to 15-mm diameter were included. All procedures were carried out by an experienced urologist (ACK). Patients with proximal ureteral calculi were treated in supine position. Those with mid or distal ureteral stones were treated in modified prone position. Persistence of radiologic image of the stone after three SWL sessions or no spontaneous passage of stone fragments after one month of follow-up was defined as treatment failure. Treatment success was defined as radiologically confirmed fragmentation and spontaneous passage of the stone. RESULTS: The success rates for the subgroups with stones located in the proximal, mid, and distal ureter were 85.1%, 83.9%, and 88.4%, respectively (P = .257). The success rates for individuals with smaller stones (≤ 10 mm) in the proximal, mid, and distal ureter were 90%, 85.8%, and 90.4%, respectively (P = .07). The corresponding rates for individuals with larger stones (> 10 mm) were 75.3%, 81.3%, and 81.6%, respectively (P = .09). CONCLUSION: Our retrospective evaluation of this large patient series reveals that SWL is effective for treating stones in the proximal, mid, and distal ureter.

PURPOSE: To evaluate the surgical experience and outcomes of retroperitoneoscopic renal pedicle lymphatic disconnection (RRPLD) and to define a learning curve for this minimally invasive technique to treat patients with intractable chyluria. MATERIALS AND METHODS: We collected the clinical records of 40 consecutive patients who were selected for RRPLD of 42 renoureteral units between 2007 and 2010 for chyluria by a single surgeon with no experience for this procedure. Patients’ demographics and peri-operative parameters were recorded and compared. Operation time, blood loss, and other peri-operative parameters were analyzed to document the learning curve for the procedure. RESULTS: All the 40 patients, 14 women and 26 men, underwent RRPLD successfully, and no open conversions were needed. The median operation time was 77.5 minutes [interquartile ranges (IQR): 69.0 to 89.0] and the median blood loss was 46.5 mL (IQR: 35.0 to 67.0). A total of five complications occurred (11.9%). We divided the patient cohort to the first 20 (group 1) and the last 20 (group 2) patients since operation time reached a plateau after about 20 cases. There were significant differences in the operation time (P = .000) and the blood loss (P = .006) between the two groups. The two phases did not differ in terms of demographic data, peri-operative complications, gastrointestinal recovery time, extubation time, or hospitalization duration. CONCLUSION: Retroperitoneoscopic renal pedicle lymphatic disconnection is a well standardized and reproducible procedure. This study of the learning curve of a single surgeon suggests that competence at performing RRPLD is reached after approximately 20 cases.

PURPOSE: To investigate the relationship between serum level of YKL-40 and Gleason score, grade and stage of the disease, and for the first time, with tumor burden in patients with prostate cancer (PCa). MATERIALS AND METHODS: Serum levels of YKL-40 and prostate-specific antigen were measured in 34 men (mean age: 66 years) with newly diagnosed and untreated PCa, in 34 men (mean age: 65 years) with biopsy proven benign prostatic hyperplasia, and in 29 healthy young men (mean age: 24 years). RESULTS: Serum YKL-40 concentration in men with PCa and benign prostatic hyperplasia, and in controls were 165.67 ± 107.84 ng/mL, 137.38 ± 82.04 ng/mL, and 69.69 ± 18.46 ng/mL, respectively. Serum level of YKL-40 was correlated with tumor burden in 30.4% of the patients with PCa (P = .04). A cut-off serum YKL-40 value of 92.696 ng/mL produced 70.6% sensitivity and 93.1% specificity. Elevated serum level of YKL-40 was strongly associated only with metastatic stage of the PCa. No association was observed between elevated level of YKL-40 and Gleason score groups or Gleason grade. CONCLUSION: Our results suggest that elevated serum level of YKL-40 may be a useful indicator of tumor burden and metastatic stage of PCa. Further studies are warranted to better elucidate the meaning of YKL-40 in tumor burden and invasiveness.   

PURPOSE: To investigate and compare the expression of OCT4B1 between tumor and non-tumor bladder tissues. MATERIALS AND METHODS: We investigated the expression of OCT4B1 in 30 tumor and non-tumor surgical specimens of the bladder, using the TaqMan real-time polymerase chain reaction approach and by carefully designing primers and probes specific for the amplification of the variant. RESULTS: Most tumor and non-tumor samples of the bladder showed OCT4B1 expression, but its expression level was significantly higher in the tumors (P < .002). Moreover, the up-regulation of OCT4B1 was more significant in high-grade tumors compared to the low-grade ones (P < .05). We have also employed the RNA interference strategy to evaluate the functional role of OCT4B1 in a bladder cancer cell line, 5637. Suppression of OCT4B1 caused some changes in cell cycle distribution, and significantly elevated the rate of apoptosis in the cells. CONCLUSION: Our findings suggest that OCT4B1 plays a potential role in tumor initiation and/or progression of the bladder cancer. Additionally, OCT4B1 can be regarded as a new tumor marker for detection, classification, and treatment of the bladder cancer. However, more experimental studies are needed to replicate our findings.

PURPOSE: To analyze the role of negative versus positive immunoexpression of E-cadherin in recurrence rate of low-grade bladder tumors. MATERIALS AND METHODS: A total of 180 patients with unifocal, superficial, low-grade, papillary transitional cell carcinoma of the bladder were included in this study. The E-cadherin expression was evaluated using E-cadherin antibody. The patients were followed up for 36 months. Thereafter, recurrence rate of the tumor was compared between E-cadherin positive and negative groups. RESULTS: Of 180 low-grade carcinomas, E-cadherin immunoexpression was negative in 101 (56%) and positive in 79 (44%) patients. The recurrence rate in negative and positive groups was 65.6% and 37.9%, respectively. Negative in comparison with positive E-cadherin expression was associated with more disease recurrence (P = .045). CONCLUSION:  There is an association between decreased E-Cadherin immunoexpression and tumor recurrence in low-grade and non-muscle invasive transitional cell carcinoma of the bladder.

PURPOSE: To estimate the bladder weight by automated ultrasound method (BladderScan BVM 9500) in adult females without lower urinary tract symptoms and to assess both the intra-observer and interobserver reproducibility of this method. MATERIALS AND METHODS: Healthy volunteers were recruited in King Khalid University Hospital from hospital staff and patients attending the gynecological clinic over a period of six months. All women were screened for any lower urinary tract symptoms using a validated short version of Urinary Distress Inventory questionnaire. BladderScan BVM 9500 device (Diagnostic Ultrasound, Bothell, WA) was used to measure bladder wall thickness, bladder volume, and calculated bladder weight. RESULTS: Eighty-five women were included in the study. The mean age was 37.5 years (± 11.1). Mean bladder wall thickness (BWT) was 1.68 mm (95% confidence interval: 1.61 to 1.75) and the mean ultrasound-estimated bladder weight (UEBW) was 32.25 g (95% confidence interval: 31.7 to 32.8). The UEBW intra-observer (ICC: 0.81) and interobserver (ICC: 0.8) reproducibility were excellent while intra-observer (ICC: 0.55) and interobserver (ICC: 0.6) reproducibility for BWT were moderate. No correlation was found between UEBW and age, height, body weight, or bladder volume. CONCLUSION: The estimated bladder weight by automated ultrasound device in asymptomatic adult females yields reproducible measurements and can be used as a reference for future understanding of the changes in bladder weight related to different types of urinary incontinence or voiding disorders.

PURPOSE: To investigate the prevalence of inguinoscrotal pathologies among a stable population in adolescent age and the association between varicocele and some somatometric features. MATERIALS AND METHODS: A computerized database of 12581 candidates for junior officer studentship in a military college examined from 2002 to 2009 was assessed, and prevalence of inguinoscrotal pathologies as well as relationship of varicocele with weight, height, and body mass index (BMI) were evaluated in a relatively stable group regarding the body status. RESULTS: Of the applicants, 1424 (11.32%) were affected by at least one inguinoscrotal pathology. Including patients surgically treated, the most common disease was varicocele (5.96%), 98% of which were left-sided, followed by inguinal hernia (3.85%), predominantly located on the right side (55.5%), and undescended testis (0.76%). Younger applicants were more prone to have lower BMI (P = .0001) and varicocele than the older group (P = .036). The presence of varicocele was significantly associated with height (P = .0001) and inversely correlated with BMI (P = .0001), but not with weight (P = .08). Logistic regression analysis showed that lower age and greater height were significant predictors for the occurrence of varicocele in this relatively homogenous population regarding the somatometric features. CONCLUSION: Varicocele, being the most common inguinoscrotal pathology in adolescent age, was found to be highly correlated with age, height, and BMI.

PURPOSE: To assess whether bowel preparation prior to kidney-ureter-bladder (KUB) radiography and intravenous urography (IVU) are of value in improving visualization of the urinary system. MATERIALS AND METHODS: A total of 186 patients participated in this study. Thirty-nine patients with chronic constipation based on Rome III criteria and 147 patients with normal bowel habits were included. All the patients were randomly divided into two groups. Patients in group 1 received castor oil before imaging and had to eat or drink nothing after midnight. Patients in group 2 were allowed to eat and drink before the examination and received no bowel preparation. Kidney-ureter-bladder radiographies were obtained in all the patients and IVUs were indicated in 77 patients. To assess the image quality, radiographic images were divided into 5 anatomical regions and each region was scored from 0 to 3 based on obscurity of the images by the bowel gas or fecal residue. RESULTS: Mean total score for visualization of the urinary system on plain and contrast images did not differ significantly between the two groups (P = .253). However, patients with chronic constipation who received bowel preparation revealed a significantly better visualization score on plain images (P = .001). CONCLUSION: Bowel preparation prior to KUB and IVU does not improve the quality of the images in patients with normal bowel habits. However, a significantly better visualization of KUB was noted among patients with chronic constipation who had received bowel preparation.