Urology Journal

Purpose: To compare the clinical efficacy between locally applied diclofenac diethylamine gel,
EMLA cream and systemically given diclofenac sodium for the pain relief during extracorporeal
shock wave lithotripsy (SWL) using Dornier Delta Compact Lithotripter.
Material and Methods: One hundred five patients with renal stones were randomly divided in to
3 groups. Group A was given intramuscular diclofenac sodium (1 mg/kg), 45 minutes before the
procedure. In group B, 10 gm of eutectic mixture of local anesthetic (EMLA) cream and in group
C, 15 gm of diclofenac diethylamine gel was applied locally 45 minutes before the procedure.
Ten-score linear and visual analogue scale (VAS) was used to assess the severity of pain during
the procedure. Analysis of variance (ANOVA) test was used to compare various parameters and
analyzed statistically.
Results: All the three groups were not statistically different with respect to age, weight, stone
size, number of shock wave delivered and maximum voltage used (P > .05). The mean pain score
in group A was 4.48, in group B was 3.60 and in group C was 3.95, which were not significantly
different (P = 1.34). Complication like skin lesion was found only in injection diclofenac sodium
group whereas cold sensation at the local site was typically found in diclofenac diethylamine gel
group.
Conclusion: Although not statistically significant, the mean pain score in locally applied analgesic
agents (EMLA and diclofenac diethylamine gel) is lower as compared to intramuscularly given diclofenac
sodium. Among these two locally acting drugs, diclofenac diethylamine gel is an equally
effective alternative to EMLA.

Purpose: To evaluate effect of ethanolic extract of Pedalium murex Linn. fruits on experimental
model of calcium oxalate nephrolithiasis.
Materials and Methods: Thirty-six male Wistar albino rats were randomly divided in 6 groups.
Normal controls received distilled water for 28 days. Other five groups received ethylene glycol
(1% v/v) in distilled water for 28 days. Pedalium murex ethanolic extract was given 200 mg/kg
and 400 mg/kg orally in distilled water for 28 days in prophylactic groups (III and IV) and from
15th to 28th days in treatment groups (V and VI). The urea, creatinine, random blood sugar, aspartate
aminotransferase, alanine aminotransferase, alkaline phosphatase, bilirubin and calcium were
measured on 28th day. 24 hr urinary oxalate and volume were measured on day 0 and 28. On day
28, kidneys were removed, weighed and subjected to histopathological examination. Calcium oxalate
crystallization was evaluated by renal histopathology and in-vitro method of mineralization.
All parameters were analyzed by Kruskal-Wallis or one-way ANOVA with post-hoc test.
Results: Pedalium murex showed significant improvement in renal function and kidney weight in
prophylactic groups as compared to ethylene glycol controls. It did not show any effect on urinary
oxalate, urine volume and any other serological parameters. Calcium oxalate crystallization was
significantly reduced in all the Pedalium murex treated groups (P < .05). Calcium oxalate and phosphate
mineralization were also inhibited by 33% and 57%.
Conclusion: Ethanolic extract of Pedalium murex fruits possess significant activity for prevention
of renal calculi.

Purpose: High mobility group box (HMGB) proteins are nuclear nonhistone chromosomal
proteins that bend DNA, bind preferentially to distorted DNA structures, and promote the assembly
of site-specific DNA binding proteins. Recent reports indicate that HMGB1 functions
as a proinflammatory cytokine. Here, we studied expressions of HMGB1 and HMGB2 in human
renal cancer.
Material and Methods: Immunohistological expressions of HMGB1 and HMGB2 were assessed
in 39 surgically resected human renal cancer specimens.
Results: HMGB1 was expressed in the nucleus in 37 out of 39 (94.9%) renal clear cell cancers,
while its expression in the cytosol was noted in 19 cases (48.7%). Cytosolic HMGB1 is
expressed more frequently in cancers beyond the pT1b classification than in those at the pT1a
classification. Higher tumor grades (≥ G2) were also significantly linked with the cytosolic
expression of HMGB1. HMGB2 was expressed in the nucleus in 35 of 39 (89.7%) renal clear
cell cancers, while its expression in the cytosol was observed in only 7 case (17.9%). Linkage
between cytosolic expression of HMGB2 and T classifications was weakly observed, while that
between nuclear expression and T classifications was not.
Conclusion: HMGB1 expressed in the cytoplasm may be an effective marker indicating higher
T classifications and tumor grades.

Purpose: To evaluate the epidemiological, clinical and pathological parameters that may predict
the presence of positive surgical margins and extraprostatic disease in patients with low risk [prostate
specific antigen (PSA) < 10, and Gleason score ≤ 6, stage T1c)] prostate cancer.
Materials and Methods: We retrospectively analyzed the medical records of patients who had
undergone radical prostatectomy from January 2005 until January 2011. The analysis comprised
patients’ age, preoperative serum prostate specific antigen (PSA) level, prostate volume, PSA density,
biopsy Gleason score, the presence of bilateral disease according to the results of biopsy cores
analysis, the percentage of cancer in biopsy material and the presence of high grade prostatic intraepithelial
neoplasia.
Results: A total of 117 patients were included in the study. Positive surgical margins were found in
37 (31.6%) patients and 23 (19.7%) had advanced disease. The results of the multivariate analysis
showed that bilateral disease was the single significant predictor for advanced disease prediction
(P = .04). Same results was obtained by the univariate analysis of the variables for prediction of
positive surgical margins, where bilateral disease after biopsy cores analysis was the only factor to
be statistical significant (P = .018).
Conclusion: Bilateral prostate cancer in prostate biopsy is significantly associated with positive
surgical margins and advanced disease in patients that are operated for prostate cancer of low risk.
This observation may assist the selection of patients in whom a bilateral nerve sparing radical prostatectomy
is planned to be performed.

Purpose: To determine the long-term outcomes of pneumoperitoneum on the testes in an experimental
laparoscopy model.
Materials and Methods: Twenty-four rats were divided into three groups: Group A, the control
group; Group B, exposed to a 10 mmHg intra-abdominal pressure (IAP); and Group C, exposed
to a 20 mmHg IAP with CO2 pneumoperitoneum for 60 minutes. After 6 weeks, the testes were
removed, and testicular injury score and Johnson score were examined histologically. Germ cell
apoptosis was also detected using flow cytometry.
Results: A significant difference was determined between all groups in terms of testicular injury
scores, Johnson scores, and germ cell apoptosis percentages. For the testicular injury score, there
were significant differences between the groups for the right testis (group A versus B, P = .009;
group A versus C, P < .0001; and group B versus C, P = .001) and for the left testis (group A versus
B, P = .001; group A versus C, P < .0001; and group B versus C, P = .002). Significant differences
were determined in the Johnson scores for the right testis between all groups (group A versus B, P
= .001; group A versus C, P < .0001; and group B versus C, P = .008, respectively). Percentage of
apoptotic testis cells were significantly differed between all groups (P = .001 for each).
Conclusion: This study shows that increased IAP during pneumoperitoneum causes histopathology
and apoptotically-evident damage to the testes in the long-term, depending on the magnitude
of IAP increase, which may cause sub/infertility. Considering the experimental nature of this study,
further clinical studies are needed for a more decisive conclusion.

Purpose: To compare the erectile effect of propofol and halothane on unwanted intraoperative
penile erection (UIOPE) during pediatric hypospadiasis repair.
Materials and Methods: One hundred and seventeen boys who were in the age range of
6 months to 6 years and referred for hypospadiasis repair to our referral teaching hospital
were included in this randomized clinical trial. Patients were randomly assigned to one
of the two study groups before anesthesia induction. Anesthesia was maintained with a
continuous intravenous infusion of propofol and inhalational halothane in the propofol (P)
and halothane (H) groups, respectively. Data regarding the patients’ age, weight, pre- and
intra-operative chordee, UIOPE, anesthesia time, surgery time, hematoma formation, and
wound infection were collected. The Chi-Square and Fisher’s exact tests were used for
comparison.
Results: No statistically significant differences were noted regarding age, weight, and preand
intra-operative chordee between the two groups. The incidence of UIOPE (10.34%
versus 57.63%; P = .000), anesthesia time (174.15 ± 15.02 versus 181.26 ± 15.19; P =
.012), and surgery time (162.34 ± 12.99 versus 167.69 ± 13.90; P = .034) were significantly
lower in group P compared with group H.
Conclusion: The use of propofol during hypospadiasis surgical repair is more safe and
effective than halothane in preventing UIOPE and reducing surgery and anesthesia time.

Purpose: Varicocele, most treatable pathologic condition in male infertility, exerts unfavorable
effects on testicular ultrastructure via various mechanisms. In this study we aimed to demonstrate
adverse effects of varicocele on both testes.
Materials and Methods: Twenty one adult male Albino rats were divided into 3 groups. Sham
operation was performed for group 1 (control group), and this group of rats were sacrificed 4 weeks
later. Experimental varicocele model was performed for group 2 (varicocele group) and these animals
were sacrificed 4 weeks after the operation. In group 3 the rats were varicocelectomized 4
weeks later. This group of rats were sacrificed at 4 weeks postoperatively. The level of testicular
damage was examined, and serum testosterone and intratesticular testosterone levels were measured.
Results: Mean (±SD) damage scores of the right testes of the sham, varicocele, and varicocelectomy
groups were 0, 1.64 ± 1.3, and 1.21 ± 0.3, respectively. There was no statistically significant
differences between damage scores of groups 2, and 3 (P = .320), relevant scores of both groups
were determined to be significantly higher than group 1 (P = .009, and P = .001). Mean (±) damage
scores of the left testes of the three groups were detected to be 0.43 ± 1.13, 2.29 ± 1.15, and 1.78 ±
0.39, respectively. The difference between varicocele, and varicocelectomy groups was not statically
significant (P = .112).
Conclusion: Unilateral varicocele has deleterious effects on both testes. There was no statistically
significant difference as for histopathologic recovery following varicocelectomy.

Purpose: To investigate a potential alteration in the expression levels of transforming
growth factor β (TGF-β) and miR-21 in bladder cancer tissues.
Material and Methods: Using real-time polymerase chain reaction (PCR) method, we
examined a potential correlated expression of miR-21 and TGF-β variants in 30 bladder
tumors and their marginal/non-tumor biopsy specimens obtained from the same patients.
Results: Our data revealed a significant down-regulation of TGF-β variants (P = .03) along
with a non-significant alteration in the expression of miR-21 in tumor vs. non-tumor samples.
However, in contrast to low-grade tumors, the expression of miR-21 was upregulated
in high-grade ones, and the expression level can efficiently discriminate low-grade tumors
from high-grade ones (P = .03).
Conclusion: In accordance to the observed similarity between TGF-β variants and miR-21
gene expression alterations in bladder tumors, treating 5637 bladder cancer cell line with
TGF-β recombinant protein caused a significant upregulation of miR-21. The later finding
further confirmed a correlated expression of TGF-β and miR-21 in bladder tumors.

Purpose: We aimed to compare the effectiveness of intranasal desmopressin and doxazosin treatments
in patients with nocturia and benign prostatic hyperplasia (BPH).
Material and Methods: Thirty one men with BPH and three or more episodes of nocturia were
randomized to receive 2 mg doxazosin at night for two weeks increasing to 4 mg for a further two
weeks versus 20 μg intranasal desmopressin at night. For all patients, number of nocturia, urinary
flow rate, residual urine volume and quality of life score were checked. Outcomes were measured at
two months. The comparison of before and after treatment changes between the groups were done
by student’s t-test.
Results: In doxazosin group, mean number of nocturia were 3.2 ± 0.4 (3-4 times) times per night and
1.2 ± 0.8 (0-3 times) times per night before and after treatment, respectively. In desmopressin group,
mean number of nocturia were 3.4 ± 0.5 (3-4 times) and 1.5 ± 0.6 (1-3 times) times per night before
and after treatment, respectively. In doxazosin group, mean residual urine volumes were 44.3 ± 35.9
ml (range 0-120 ml) and 23.1 ± 18.8 ml (range 0-50 ml) before and after treatment, respectively. In
desmopressin group, mean residual urine volumes were 36.6 ± 32.4 ml (range 0-120 ml) and 14.0 ±
26.9 ml (range 0-90 ml) before and after treatment, respectively. Improvements in number of nocturia,
residual urine volume, quality of life scores and peak urinary flow rates weren’t statistically
significant between two groups, whereas change in international prostate symptom score (IPSS) score
was more significant in doxazosin group.
Conclusion: Intranasal desmopressin, is an effective symptomatic treatment of men with BPH complaining
of nocturia, as well as doxazosin treatment.

pelvic lipomatosis is a benign proliferation of adipose tissue predominantly in the
pelvic retroperitoneum. Involvement of the bladder and ureter may cause bilateral
hydroureteronephrosis and low capacity bladder.(1) We present the case report of a
patient with pelvic lipomatosis causing bilateral hydroureteronephrosis with low capacity
bladder managed by laparoscopy assisted ‘U’ configuration bilateral ileal ureter.

Purpose: To discuss the pharmacotherapeutic aspects of Mirabegron which is a first-inclass
novel β3 receptor agonist drug recently approved by the food and drug administration
(FDA) for the treatment of overactive bladder (OAB).
Materials and Methods: We conducted a computerized search of the MEDLINE/PUBMED
databases with the word Mirabegron, β3 receptor agonist and overactive bladder.
Results: Effect of Mirabegron on β3 adrenergic receptor purportedly releases nitric oxide
(NO) by an increase in intracellular Ca2+ through accumulation of cyclic adenosine
monophosphate (cAMP). Along with NO which relaxes the detrusor muscle, it also
releases an urothelial-derived inhibiting factor (UDIF) that inhibits contractions. It increases
the bladder capacity by causing bladder relaxation during the storage phase.
Conclusion: Mirabegron appears to be a promising treatment in OAB patients by shifting
its management from reducing detrusor over-activity to inducing relaxation. Also it
lacks the troublesome side effects associated with the standard antimuscarinic management.

Purpose: To evaluate the efficacy of autologous single-donor fibrin glue after tubeless percutaneous
nephrolithotomy (PCNL).
Materials and Methods: Forty-three patients were planned for tubeless PCNL in a prospective
cohort study and randomized in two groups with or without using fibrin glue. Randomization
method was based on the computer-generated random numbers.
Results: Transfusion, urinary leakage, or major complications were found in neither of the
groups. There was no difference between two groups in stone free rate (P = .53), and changes
in hemoglobin (P = .61) and serum creatinine (P = .63) level.
Conclusion: Although autologous fibrin glue did not play any significant role in improving
results or decreasing complications after tubeless PCNL in our study, its use was safe and did
not increase complications.