Urology Journal

Purpose: Urolithiasis during pregnancy poses risks for mother and the fetus with specific challenges in diagnosis and management. We report our experience with urgent percutaneous nephrolithotomy (PCNL) in seven pregnant patients with symptomatic renal stone in early pregnancy.
Materials and methods: Seven pregnant patients with symptomatic renal stones were reviewed. The technique comprised PCNL with complete access under guide of ultrasonography in prone position under general anesthesia
using pneumatic lithoclast for stone fragmentation.
Results: There was no significant residual fragment of stone in the operated kidneys. The patients discharged without complications and delivered their babies healthy.
Conclusion: PCNL should not be considered as the first therapeutic method in the first trimester of pregnancy, unless in urgent situations such as symptomatic renal pelvic stone with moderate to severe hydronephrosis in patients who do not tolerate or are complicated by nephrostomy or internal stent. However, this procedure could be technically demanding and should be done in centers with enough experience and equipment in percutaneous
nephrolithotomy.

Purpose: Ultrasound-guided PCNL in Galdakao-modified supine Valdivia (GMSV) position has taken into consideration during the last decade; however, guidewire slippage during tract dilatation is still a big concern in this approach. Here we presented our results of combination of this modification with ureteroscopic guidewire retrieval to ensure a safe and confident renal access.
Materials and Methods: From June 2015 to March 2016, 30 consecutive patients with renal stone of ? 2.5 cm were enrolled. After general anesthesia, all patients were positioned in GMSV position. Semi-rigid ureteroscopy up to the renal pelvis was performed by an assistant urologist. Ultrasound (US)-guided renal access and passage of guidewire was performed by another urologist after which the first urologist grasped and retrieved the guidewire from the renal pelvis to the ureter and then out of urethra. Stone manipulation was performed as standard PCNL.
All patients were evaluated regarding age, stone burden, anthropometrics measurements, major and minor surgical complications, and stone free rate.
Result: Guidewire retrieval was successful in 26 patients (86.7%) and tract dilatation was achieved in all (100%) of this group. In other 4 patients (13.3%) retrograde endoscopic guide wire retrieval failed; in one patient, (3.33%) ureteroscope did not reach the renal pelvis because of tall stature; One patient (3.33%) had narrow calyceal infundibulum which prevented the guidwire passage along the stone to reach to the renal pelvis, and for two patients (6.67%) ureteroscope did not pass the ureteropelvic junction because of narrow ureteropelvic angle.
Conclusion: Guidewire retrieval seems to improve the results of US-guided GMSV position PCNL by eliminating the possibility of guidewire slippage during tract dilatation.

Purpose: To present our experience with synchronous or metachronous laparoscopic pyelolithotomy and ureterolithotomy for patients with bilateral urolithiasis.
Materials and Methods: The data of all patients who underwent laparoscopic pyelolithotomy (± ureterolithotomy) for bilateral renal and/or ureteral stones from November 2009 to July 2014 were included. Laparoscopic operations were performed through a transperitoneal approach.
Results: 10 patients underwent laparoscopic operations for renal stones (19 kidney stones) and ureteral stones (1 ureteral stone). 4 patients underwent synchronous operations and 6 patients underwent metachronous operations. The mean ± SD of operation duration were 212 ± 51 minutes for synchronous operations and 166 ± 41 minutes for metachronous operations. Residual stone was observed 5 patients. No patient developed urinary leakage.
Conclusion: Laparoscopic pyelolithotomy and/or ureterolithotomy for bilateral stones is a feasible option in centers with experience in laparoscopy.

Purpose: Bladder carcinoma is one of the most common malignancies in worldwide. Among several risk factors, Human Papilloma Virus (HPV) have been presumed to play a causative role in the etiology of bladder cell carcinoma. The aim of this study was to evaluate the involvement of HPV infection in biopsy specimens of patients with transitional cell carcinoma at the west of Iran.
Materials and methods: In this study, 97 biopsy specimens including 67 patients with transitional cell carcinoma (TCC) of bladder and 30 cases of control group with the mean age of 63 years were studied using immunohistochemistry to identify HPV.
Results: 22.4% of patients with TCC of bladder and 3.3% of control group were positive for HPV with a meaningful relation (P=.019). The prevalence of HPV was 4.3 fold higher in men than women. Most TCC patients were
belonged to grades II and III.
Conclusion: Considering the higher incidence of HPV positivity in patients with TCC of bladder compared to control group, it seems to be a meaningful association between HPV infection and TCC of bladder, at least in the west of Iran.

Purpose: Sexual functions in the males with obstructive sleep apnea syndrome (OSAS) have been well investigated in the literature; however sexual functions in the premenopausal women with OSAS have been studied to a lesser extent.
Materials and methods: The study included 22 premenopausal women diagnosed as OSAS by the polysomnographic (PSG) evaluation. The control group included 13 premenopausal women suspected of sleep-related
respiratory disorder, but whose PSG tests were determined to be normal. Both groups were administered Epworth Sleep Scale (ESS), Beck Depression Scale (BDS), and Female Sexual Function Index (FSFI) questionnaire forms. Relations between disease parameters, and the total FSFI score, and scores of the six FSFI parameter were analyzed.
Results: The total FSFI score in the cases with OSAS, was determined to be significantly lower than that of the control subjects (P = .031). Scores of the desire, arousal, and orgasm were determined to be significantly lower in
the patient group, compared to control group (P = .034; P = .048; P = .039). The total FSFI scores, and scores of the desire, arousal, lubrication, orgasm, satisfaction and pain subscales in the cases did not correlate significantly with the apnea-hypopnea index (AHI), Non-Rapid Eye Movement 1 (NREM1)%, NREM2%, NREM3%, REM%, the time spent with saturation O2< 90%, minimum oxygen saturation (%), ESS scores, and BDS scores (all P > .05).
Conclusion: Women with OSAS experience sexual dysfunction when compared with normal population. Clinical evaluation has to include also the evaluation of sexual life in women.

Purpose: Expression assessment of the inflammasome genes in the acute and the chronic phases of Spinal cord injury (SCI) on adult rat testis and examination of associations between inflammasome complex expression and sperm parameters.
Materials and methods: In this study, 25 adult male rats were randomly divided into 5 groups. SCI surgery was performed at T10-T11 level of rats’ spinal cord in four groups (SCI1, SCI3, SCI7, and SCI56). They were sacrificed after 1day, 3days, 7days and 56 days post SCI, respectively. One group remained intact as control (Co).
CASA analysis of sperm parameters and qRT-PCR (ASC and Caspase-1) were made in all cases.
Results: Our data showed a severe reduction in sperm count and motility, especially on day 3 and 7. ASC gene expression had a non-significant increase on day 1 and 56 after surgery compared to control group. Caspase-1 expression increased significantly on day 3 post injury versus the control group (P = .009). Moreover, Caspase-1 overexpression, had significant correlations with sperm count (r = -0.555, P = .01) and sperm progressive motility (r = -0.524, P = .02).
Conclusion: Inflammasome complex expression increase following SCI induction. This overexpression correlates to low sperm parameters in SCI rats.

Purpose: Intravesical BCG instillations improve recurrence free survival in patients with non-muscle-invasive bladder cancer (NMIBC).
Methods: This is a national survey study, covering 223 urological centres, aimed at reliable identification of BCG availability and implemented treatment patterns.
Results: Response rate was 93.7%. BCG was used in 56.5% of urological departments. Another 22.7% referred patients to other hospitals for instillations, while 20.8% did not recommend BCG at all. The most common indications for BCG instillations were as follows: T1 tumours (88.5%), carcinoma in situ (83.6%) and high grade tumours (73.8%). Maintenance therapy was routinely abandoned in 16.4% of centres or was scheduled for <1 year, 1 year, 3 years and 1-3 years in 6.6%, 19.7%, 21.3% and 31.2% of centres, respectively. Continuation of BCG
despite treatment failure in carcinoma in situ cases was considered in 21.3% of departments.
Conclusion: Our findings indicate that BCG is underused, while patterns of maintenance and follow-up are suboptimal.

A sixty-three-year-old Caucasian male was referred to emergency service 10 hours after self-infliction of a mercury glass thermometer into the urethra. The patient presented without abdominal or voiding symptoms. Radiological
imaging confirmed the presence of a thermometer in the peritoneal cavity, without signs of contrast leakage from the bladder. The patient underwent suture of the perforation site with a subsequent successful removal of the foreign body using laparoscopic approach. Recovery was uneventful.
To the best of our knowledge, we are not aware of any previous report of laparoscopic removal of a mercury glass thermometer from the peritoneal cavity. Laparoscopic removal of fragile items, such as a thermometer, is obviously feasible but associated with substantial risks.

Ureteral metastasis of renal cell carcinoma (RCC) is rare and usually confined to the ipsilateral ureter. In literature, about 50 cases have been reported so far. Of these, only 14 metastasized metachronously to the contralateral ureter.
A seventy-one-year-old man was hospitalized with recurrent painless severe haematuria. Seven years previously, he had undergone radical nephrectomy of the right kidney due to a clearcell renal cell carcinoma (cRCC), Fuhrman grad 2. Intravenous urography and a retrograde ureterogram revealed a filling defect (25 mm) in the left distal ureter, which we expected to be an urothelial carcinoma. Biopsy was not possible, due to ureteral stricture. Diagnostic workup revealed no other sites of metastasis. To preserve kidney function and quality of life we refrained
from performing nephroureterectomy and opted for an autotransplantation of the solitary left kidney with ureteral reimplantation in the bladder. We resected the ureter and histopathologicial examination showed a metastasis of cRCC, Fuhrman grade 2.
Postoperatively, the patient developed an acute postrenal failure, hence a nephrostomy and a bladder catherization were performed. After this, the patient improved significantly and the drains could be removed. Currently the patient is free of complaints. The residual and contralateral ureter is a potential metastatic site after RCC. Autotransplantation is an option for
surgical treatment.

Purpose: We aimed to investigate the exact localization of neural pathway and the frequency of nerve fibers, which are located in the pelvic facial layers in the prostate and periprostatic regions.
Materials and Methods: We used four fresh frozen cadavers in this trial. Anatomical layers of anterior rectus fascia and abdominal rectus muscle were dissected to reach the retropubic area. Prostate, visceral and parietal pelvic fascia, levator ani muscle and puboprostatic ligaments were identified. Nine tissue samples, each 1x1 cm in size, were obtained from each cadaver and grouped separately. The locations of these samples are as follows. Group G I from 12 o’clock (apical region), G II from right prostatic apex, G III from 2 o’clock, G IV from right far pelvic lateral, G V from 5 o’clock, G VI from 7 o’clock, GVII from left far pelvic lateral, G VIII from 10 o’clock and G IX from left prostatic apex. Nerve distribution, frequency and diameters of these 9 groups were compared to each other.
Results: 36 specimens were obtained from 4 cadavers. Mean number of nerve fibers was 14.1. The number of nerve fibers in each location were not statistically different from each other (P = .9). Mean nerve diameter was 89.1 µm. Mean diameter of nerves was statistically different between groups II, III IV and VI and VIII (P = .001). No difference was seen amongst others.
Conclusion: The distributions of nerve fibers at prostate and peri-prostatic region were homogeneous while the nerve diameters varied amongst the different regions.