ISSN: 1735-1308

Vol. 16 No. 2 (2019)

Best Reviewer



 Purpose: To conduct a comprehensive meta-analysis of existing evidence to quantify and compare the safety and efficacy of PCNL (percutaneous nephrolithotomy), RIRS (retrograde intrarenal surgery) and ESWL (extracorporal shockwave liithotrispy) for lower pole renal stones 10-20mm.

Materials and Methods: We conducted a systematic literature search in the EMBASE, MEDLINE, Cochrane da­tabases and Google Scholar to identify relevant studies published in English up to May 2018. Literature reviewed included meta-analyses, and randomized and nonrandomized studies. The subject in the management of PCNL, RIRS and ESWL of studies which included patients with lower pole renal stones 10-20mm. The odd ratio (OR) and mean difference(MD) with its 95% confidence interval (CI) using fixed-or-random-model were calculated to estimate the safety and efficacy of PCNL, RIRS and ESWL for lower pole renal stones 10-20mm. Two reviewers independently assessed the quality of all included studies, and the RevMan 5.3 software was used to analyze the included studies.

Results: Three randomized controlled trials and five retrospective case control studies were included, involving a total of 1615 patients in our meta-analysis. Our results suggest that, for lower pole renal stones 10-20mm, PCNL has a great advantage to RIRS(OR=1.95, 95% CI: 1.22-3.12, P = .005, I2 = 39%) and ESWL(OR=0.22, 95% CI: 0.15-0.34, P < .00001, I2 = 0%) in stone-free rate. Comparing PCNL(MD=-24.97, 95% CI: -40.90--9.04, P = .002; I2 = 76%) (MD=-2.43, 95% CI:-4.70--0.17, P = .04, I2 = 99%) and RIRS(MD= -15.39, 95% CI: -25.54--5.25, P = .003, I2 = 99%) (MD=-0.95, 95% CI: -1.29--0.61, P < .00001, I2 = 96%), ESWL owns some advantages in shorter operative time and hospital stay. Both of PCNL (OR=70.21,95%CI:25.01-197.11, P < .00001) (OR=4.01,95%­CI:2.04-7.89, P < .0001) and RIRS (OR=32.31,95%CI:18.39-56.76, P < .00001, I2=0%) (OR=3.06, 95%CI:1.94- 4.84, P < .00001, I2=19%) have some strong points in lower retreatment rate and auxiliary procedure rate com­paring ESWL, but no statistical significant difference is found between them(OR=0.46,95% CI:0.15-1.42, P =.18, I2=0%)(OR=0.75,95% CI:0.35-1.59,P =.45). About complication rate, there's no statistical significant difference found in PCNL(OR=1.42, 95%CI:0.91-2.21,P=.12, I2=0%), RIRS (OR=0.74,95%CI:0.51-1.07,P = .11, I2=30%) and ESWL(OR=0.41,95% CI:0.16-1.09, P = .07,I2=70%).

Conclusion: Both of PCNL and RIRS offer a longer operative time, the lower retreatment rate and auxiliary proce­dure rate while PCNL has the longest hospital stay and the highest SFR. However, ESWL is confirmed to have the lowest SFR, the higher retreatment rate and auxiliary procedure rate, but a shorter operative time and the shortest hospital stay. The overall complication rates among the three therapies are comparable.

Comparison of Supracostal and Infracostal Access For Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

zhaohui He, Fucai Tang, Zechao Lu, Ye He, Genggeng Wei, Fangling Zhong, Guohua Zeng, Weizhou Wu, Lemin Yan, Zhibiao Li

Urology Journal, Vol. 16 No. 2 (2019), 5 May 2019 , Page 107-114

 Purpose: In this meta-analysis, we aimed to compared efficacy and safety of supracostal and infracostal access for percutaneous nephrolithotomy (PCNL).

Materials and Methods: We included eligible studies from PubMed, EMBASE, Cochrane Library, Web of Sci­ence and China National Knowledge Infrastructure. Literature searching, quality assessment and data extraction were performed by two independent reviewers. Data were analyzed by RevMan software. Binary and continuous variables were calculated as odds ratios (OR) and mean difference (MD).

Results: Two prospective comparative studies and seven retrospective observational studies were included in the meta-analysis, which contained 1,024 cases of supracostal access and 1,249 cases of infracostal access for PCNL. The supracostal access resulted in a significant reduced mean hemoglobin (95% CI: 0.26-3.46, MD = 1.86 g/L, P = .02) and a higher incidence of hydrothorax (95% CI: 4.77-22.95: OR = 10.47, P < .00001) compared to infracostal access. However, there no difference between supracostal and infracostal access regarding additional procedures (95% CI: 0.70-1.69, OR = 1.09, P = .71), stone-free rate (95% CI: 0.80-1.72, OR = 1.18, P = .41), length of hospital stay (95% CI: -0.03-0.37, MD = 0.17 day, P = .10), and occurrence of fever (95% CI: 0.95-2.03, OR = 1.39, P = .09) and blood transfusion (95% CI: 0.45-1.70, OR = 0.88, P = .70). No publication bias was identified in the study.

Conclusion: Supracostal access was effective, but not as safe as infracostal access PCNL due to a higher risk of reduced hemoglobin and hydrothorax. Therefore, infracostal access should be the preferred safe and effective approach recommended for PCNL. When a supracostal puncture is performed, essential precautions to avoid he­moglobin loss and hydrothorax should be used.

Ascorbic Acid Supplements and Kidney Stones Incidence Among Men and Women: A systematic review and meta-analysis

Kehua Jiang, Kun Tang, Haoran Liu, Hua Xu, Zhangqun Ye, Zhiqiang Chen

Urology Journal, Vol. 16 No. 2 (2019), 5 May 2019 , Page 115-120


 Purpose: The relationship of ascorbic acid (AA) supplements and risk of kidney stones among men and women is controversial. This systematic evaluation was performed to obtain comprehensive evidence about the relationship of AA supplements and risk of kidney stones among men and women.

Material and Methods: A systematic search of Pubmed, the Cochrane Library, Web of Science, Embase was performed to identify studies that exhibited the relationship of AA supplements and risk of kidney stones among men and women and were published up to Mar 2017. Outcomes of interest included kidney stones incidence and risk factors.

Results: Four studies estimating the association between AA supplements and risk of kidney stones were included for meta-analysis. The kidney stones incidence was significantly higher in men than women with AA supplements (OR= 1.62; 95% CI: 1.09 to 2.42; P = 0.02). AA supplements (250-499mg/d, 1000-1499mg/d) was remarkably correlated with the risk of renal stones among men (OR= 1.14, 95% CI: 1.00 to 1.28, P = 0.04; OR= 1.12, 95% CI: 1.11 to 1.13, P < 0.00001; respectively). However, AA supplements (500-999 mg/d, >1500 mg/d) did not correlate with the risk of renal stones among men (OR= 1.20, 95% CI: 0.99 to 1.46, P = 0.06; OR= 1.28, 95% CI: 1.00 to 1.63, P = 0.05; respectively). In addition, AA supplements (250-499mg/d, 500-999mg/d, 1000-1499mg/d, >1500mg/d) did not remarkably correlate with the risk of renal stones among women (OR= 1.00, 95% CI: 0.82 to 1.22, P = 0.98; OR= 1.08, 95% CI: 0.99 to 1.18, P = 0.09; OR= 0.99, 95% CI: 0.90 to 1.08, P = 0.77; OR= 0.99, 95% CI: 0.99 to 1.09, P = 0.88; respectively).

Conclusion: AA supplements was remarkably correlated with higher risk for kidney stones incidence in men, but not in women. Further multicenter, prospective and long-term follow-up RCTs are required to verify these findings.



The Effect of Percutaneous Nephrostomy Implementation on The Outcome of Ureteroscopic Stone Treatment

Fuat Kizilay, Adnan Simsir, Baris Altay, Oktay Nazli, Ibrahim Cureklibatir, Bulent Semerci

Urology Journal, Vol. 16 No. 2 (2019), 5 May 2019 , Page 121-127

 Purpose: We aimed to investigate the effect of percutaneous nephrostomy (PCN) implementation on the second ureteroscopy (URS) outcomes after a failed URS.

Materials and Methods: The data of four hundred forty-eight patients with an unsuccessful URS history were evaluated. Patients were divided into two groups; patients who underwent PCN before second URS (Group A) and patients who did not (Group B). We compared the stone access rate in the second URS between the two groups according to patient and stone characteristics and operative data. Then, group A was subdivided into two groups according to stone access as; access succeeded (Group A1) and access failed (Group A2). We also compared stone access rates between these two groups in terms of gender, age, body mass index, stone size, side, location, grade of hydronephrosis and PCN duration. All data were available immediately after surgery and obtained from patient files and the outcome assessment was performed during the study period.

Results: Stone access rate was higher in group A than group B (143/196 vs 41/252, P = .0018). Mean nephrostomy duration and mean hydronephrosis grade were significantly higher and mean stone size was significantly lower in group A1 than group A2 (18.74 vs 9.62 days, P < .001; grade 3.25 vs 1.21, P = .038; and 7.286 vs 12.631 mm P < .001, respectively).

Conclusion: PCN is a favourable intervention after a failed URS and increases the success rate of the second op­eration with ease of implementation and minimal morbidity.



 Purpose: This study aimed to document the surgical and oncologic results of nephron sparing of non-ischemic laparoscopic partial nephrectomy without the step of hilus controlling and even without dissecting to expose the main renal vascularity and directly focusing on mass removal.

Materials & Methods: The records of the patients who underwent our modified laparoscopic partial nephrectomy technique were evaluated retrospectively. The patients’ medical records, including tumor complexity calculated via R.E.N.A.L nephrometry scores, operation time, estimated blood loss, blood transfusions, hospital stay, pre- and postoperative serum creatinine levels, complications via the Clavien classification system, pathological status of surgical margin, and follow-up times, were documented.

Result: The data of 55 patients with 58 renal units were evaluated. Almost all tumors were in the low complex group (91%), with a mean size of 31.74 ± 7.38 mm (range: 12-46 mm). Mean operation time, estimated blood loss, and transfusion rates were 138.62 ± 38.45 minutes (range: 90-240 min), 242.24 ± 107.12 mL (range: 100-500 mL), and 19%, respectively. The hemoglobin level decreased by a mean of 2.05 ± 0.87 g/dL. Whereas the perioperative complications were Clavien grades I, II, and III (74%, 23%, and 3%, respectively), mean hospital stay and fol­low-up time were 4.05 ± 1.97 and 19.67 ± 13.57 (ranges: 2-10 days and 1-44 months), respectively.

Conclusion: Present un-controlled results pointed that tumor-focusing nephron-sparing non-ischemic partial lap­aroscopic nephrectomy may be preferable for small-sized, low-complex renal masses.


Osteopontin And Angiogenic Factors As New Biomarkers Of Prostate Cancer

Tomasz Wisniewski, Agnieszka Zyromska, Roman Makarewicz, Ewa Zekanowska

Urology Journal, Vol. 16 No. 2 (2019), 5 May 2019 , Page 134-140

Purpose: The novel biomarkers that would identify patients at risk for relapse and metastatic spread are needed. The aim of this study was the evaluation of serum levels of osteopontin (OPN) and tumor endogenous angiogenic factors such as vascular–endothelial growth factor (VEGF), vascular-endothelial growth factor receptor 2 (VEGF R2), endostatin, angiostatin and thrombospondin 1, in prostate cancer (PC) patients.

Material and Methods: Blood concentrations of the analyzed parameters were determined in 40 prostate cancer patients eligible for radiotherapy as well as in the control group consisted of 25 volunteers. Commercial ELISA kits were used for the analysis.

Results: Significantly higher levels of OPN (101.49 ng/mL vs 59.88 ng/mL; P<.001), endostatin (252.60 ng/mL vs. 223.55 ng/mL; P=.043), angiostatin (47 ng/mL vs. 13 ng/mL; P=.047), VEGF (262.1 pg/mL vs. 138.0 pg/mL; P=.056) and VEGF R2 (11188.81 pg/mL vs. 9377.50 pg/mL; P=.047) were detected in PC patients compared with the control group. In PC patients we showed a positive correlation between OPN level and TNM clinical stage(R=0.36; P=.02) and negative correlation between OPN level and hemoglobin concentration (R=-0.33; P=.04).

Conclusion: The study showed higher levels of the angiogenic factors in PC patients compared with the control group and identified OPN as an indicator of the PC clinical stage as well as a decreased hemoglobin level.

Association study of Retinoic Acid Related Orphan Receptor A (RORA) gene and risk of prostate disorders

Mohammad Taheri, Rezvan Noroozi, Alireza Dehghan, Golnaz Atri Roozbahani, Mehrnoosh Musavi, Mir Davood Omrani, Soudeh Ghafouri-Fard

Urology Journal, Vol. 16 No. 2 (2019), 5 May 2019 , Page 141-144

Purpose: Prostate cancer (PCa) and benign prostate hyperplasia (BPH) are two prevalent disorders among men with considerable mortality and morbidity. Several association studies have been conducted in different populations to find genetic loci linked with these disorders. Retinoic acid-receptor-related orphan receptor alpha (RORA) codes for a transcription factor which regulates expression of several cancer-related genes. Besides, RORA has been shown to be down-regulated in PCa tissues and cell lines.

Materials and Methods: In the present study we evaluated genotype and allele frequencies of rs11639084 and rs4774388 variants within RORA gene in PCa and BPH patients compared with healthy subjects.

Results: The rs11639084 and rs4774388 alleles were not different between PCa and normal groups 95% CI: 0.52-1.24, OR = 1.04, P = .34; 95% CI: 0.48-1.33, OR = .79, P = .39 respectively. Moreover, we did not detect any significant difference in allele, genotype or haplotype frequencies of these SNPs between the other study groups.

Conclusion: The mentioned RORA variants are possibly not involved in the pathogenesis of PCa and BPH. Future studies are needed to assess the associations between other variant within this gene and PCa risk to suggest a putative mechanism for involvement of RORA in PCa.

Long-term Changes in Renal Function, Blood Electrolyte Levels, and Nutritional Indices after Radical Cystectomy and Ileal Conduit in Patients with Bladder Cancer

Makito Miyake, Takuya Owari, Mitsuru Tomizawa, Masaru Matsui, Naoko Nishibayashi, Kota Iida, Kenta Onishi, Shunta Hori, Yosuke Morizawa, Daisuke Gotoh, Yoshitaka Itami, Yasushi Nakai, Takeshi Inoue, Satoshi Anai, Kazumasa Torimoto, Katsuya Aoki, Nobumichi Tanaka, Kiyohide Fujimoto

Urology Journal, Vol. 16 No. 2 (2019), 5 May 2019 , Page 145-151

Purpose: To assess the long-term changes in renal function, blood electrolyte levels, and nutritional indices after radical cystectomy and ileal conduit in patients with bladder cancer.

Patients and Methods: In 129 patients who underwent radical cystectomy and ileal conduit, we evaluated clinicopathologic features, complications, and the change in the estimated glomerular filtration rate (eGFR) from baseline to 1, 2, 3, 4, 5, and 10 years postoperatively. Two nutritional indices, the geriatric nutritional risk index (GNRI) and prognostic nutrition index (PNI), were calculated with laboratory tests. The Student t-test, Mann-Whitney U test, paired t-test, or Wilcoxon’s signed-rank test was used, as appropriate.

Results: In the ileal conduit group, a parastromal hernia was observed in 10% of patients, whereas 13% had an ureteroenteric anastomotic stricture, which was associated with greater decline in the eGFR postoperatively. The first 5 year-decline in the eGFR was 1.74 mL/min/1.73 m2/year. The levels of only potassium showed a significant increase at 1 year postoperatively (mean: 4.34 mEq/L) and remained high compared with the baseline (4.14). Evaluation of the nutritional indices demonstrated that the GNRI, not PNI, showed a significant, transient increase from 1 to 4 years (range: 108?110) postoperatively compared with the baseline (105).

Conclusion: The first 5 year-decline was much higher than that among Japanese individuals who participated in an annual health examination program. Further research should be performed to identify an appropriate strategy for selecting the suitable type of urinary diversion and postoperative nutritional interventions to improve the clinical outcome of patients with bladder cancer.

Second Transurethral Resection of Bladder Tumor: Is it Necessary in All T1 and/or High-Grade Tumors?

Mohsen Ayati, Erfan Amini, Reza Shahrokhi Damavand, Mohammad Reza Nowroozi, Mohammad Soleimani, Ehsan Ranjbar, Ali Nowroozi

Urology Journal, Vol. 16 No. 2 (2019), 5 May 2019 , Page 152-156

Purpose: To evaluate the role of second transurethral resection of bladder tumor (TURBT) in patients with T1 and/or high-grade bladder tumor regarding tumor size, multiplicity, and presence or absence of muscle in specimens of initial resection.

Materials and Methods: A total of 107 patients with either primary T1 or high-grade urothelial bladder cancer underwent second TURBT within 6 weeks after initial surgery and prior to starting intravesical immunotherapy. We assessed the incidence of residual disease and upstaging in second TURBT.

Results: Upstaging was noted in 11 (10.3%) patients and residual tumor was evident in 29 (27%) patients. Disease upstaging had a statistically significant association with tumor size, multifocality, and absence of muscle at initial resection in univariate analysis. Presence of residual tumor in second resection also showed significant association with tumor size and absence of muscle at initial resection but not multifocality. Multivariate logistic regression analysis revealed that absence of muscle at initial resection independently predicts disease upstaging during second TURBT (OR = 8.123, 95% CI: 1.478-44.632). Furthermore, both tumor size (OR = 13.573, 95% CI: 3.104-59.359) and absence of muscle (OR = 21.214, 95% CI: 6.062-74.244) were independent predictors of residual disease in second TURBT.

Conclusion: We showed that second TURBT in a subset of patients with single, small T1 and/or high-grade tumor who underwent complete initial resection might be of limited value.

Aim. The complaints of lower urinary tract symptoms (LUTS) in cases with Prostate carcinoma (Pca) depend on coexisting benign prostate hyperplasia (BPH) or aging bladder. We aimed to investigate and compare the effect of goserelin acetate with leuprolide acetate on total prostate volume (TPV), post voiding residue (PVR), International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax) reduction on cases of advanced Pca.

Methods. Patients with advanced Pca were treated with goserelin acetate (10.8 mg/3 months) or leuprolide acetate (22.5 mg/3 months) for 6 months. Changes in Prostate specific antigen (PSA), testesterone level, TPV, IPSS, PVR, and Qmax were assessed every 3 months.

Results. Fifty-one patients analyzed in this study. Mean percent decrease in PSA and testesterone from baseline to 6th month was not significantly difference between two groups (respectively; p = 0.9, p = 0.15) but TPV was reduced by -20.2 % ± 4.8 and -15.6 % ± 1.04,  the median total IPSS score was decreased by -34.77 % ± 8.8 and -19.77 % ± 6.1, median Qmax increased by 45.34 % ± 10.16 and 23.21 % ± 6.93, median PVR decreased by -31.54 % ± 8.4 and -19.23 % ± 5.5, respectively for two groups (all parameters (p < 0.05))

Conclusion. In this study, we observed that the improvement of voiding parameters goserelin acetate was beter than leuprolide acetate. Especially it was detected the superiority of goserelin acetate group on the reduction of TPV, PVR and IPSS. Oncological outcomes were not different in both groups.

purpose: to evaluate the feasibility of cytoreductive radical prostatectomy (RP), lymphadenectomy, and bilateral orchiectomy in patients with advanced prostate cancer (PCa) with oligo- and poly-metastases. Furthermore, the functional and oncological outcomes of these patients in comparison with the control group that underwent treatment only with systemic therapy (ST group) is investigated in a well-selected, prospective cohort study.   

Material and methods: A total of 26 patients were enrolled in CRP (cytoreductive radical prostatectomy) group and 23 patients in ST group. The patients have been followed (9 to 43 months(median:19.5)) with PSA (prostate specific antigen), whole body bone scan and other necessary imaging and laboratory tests. Functional and oncological outcomes were compared between two groups.

Results: Biochemical relapse was occurred in 9 patients (34.6%) in CRP group and in 17 patients (73.9%) in ST group (p=0.01). Whole-body bone scans showed reduced metastasis volume occurred more in CRP group (p=0.003). There was no voiding dysfunction in 22 patients in CRP group post-operatively (84.6%), while in ST group trans-urethral resection of prostate or permanent Foley catheter was needed in 8 patients (34.7%) and bilateral percutaneous nephrostomy was done in one. six patients in CRP group (23%) and eight patients in ST group (34.7%) were expired because of prostate cancer and there was no difference between cancer specific survival between two groups (p=0.975).

Conclusion: Although surgery doesn’t improve cancer specific survival in patients with skeletal metastatic prostate cancer in the short term, but offers better local control, improves biochemical relapse-free survival, might prevent excessive interventions, reduce bone pain and metastasis.

Purpose: To report on an ascending radical retropubic prostatectomy (RRP) technique and determine whether this technique has better perioperative, oncological and functional outcomes than the standard RRP technique applied in our clinic

Material and Methods:

The perioperative and functional outcomes of the 246 patients that underwent standard RRP (N = 150) or modified RRP (N = 96) were evaluated, retrospectively. In the modified RRP technique the dorsal vasculare complex (DVC) was controlled at first. Thereafter, the bladder neck was incised at the prostate-vesical junction. After seminal vesicles and vasa were exposed, posterior dissection was continued until to the apex. Finally, the urethra was divided. To assess the differences between the two groups the independent sample T-test and chi-square test were used.


The mean volume of  estimated blood loss (EBL) was significantly longer in the standard RRP group than in the modified RRP group (610 vs. 210 ml, respectively; P= .001). The mean operative time (OT) was significantly less in the modified RRP group (177 vs. 134 min, respectively; P = .003), as were the transfusion rate TR (P = .041). With regard to the rate of postoperative complications, a statistically significant difference was observed between the two groups (P = .014). Continence rates after 3 and 12 months postoperatively were 98.95% and 98.95 % in the modified RRP group, and 97.33% and 98.66% in the standard RRP group, respectively ( P = .83).


We observed that the EBL, TR and OT were significantly lower when we applied the modified RRP technique to patients. This modified technique might be applicable for institutions as an alternative procedure for the standard RRP technique.


A comparison between dextranomer/ hyaluronic acid and polyacrylate polyalcohol copolymer as bulking agents for treating primary vesicoureteral reflux

Farshid Alizadeh, Iman Omidi, Saeid Haghdani, Mohammad Hatef Khorrami, Mohammad Hossein Izadpanahi, Mehrdad Mohammadi Sichani

Urology Journal, Vol. 16 No. 2 (2019), 5 May 2019 , Page 174-179

Purpose: In recent years, endoscopic subureteral injection has gained popularity as a therapeutic alternative to open surgery because of its high success rates and low morbidity. We compared the success and complication rates of Polyacrylate polyalcohol copolymer (PPC) and Dextranomer/Hyaluronic acid (Dx/HA) in the endoscopic treatment of VUR.

Materials & Methods: We retrospectively reviewed the patients who underwent endoscopic correction of their VUR by subureteric injection of PPC or Dx/HA from Jan 2010 to April 2016. The injection technique was STING (subureteric), distal HIT (intraureteric), and double HIT according the hydrodistention (HD) grade. The success rate, injection technique, injection volume, VUR grade, and obstruction rate were evaluated and compared between two groups.

Results: 107 renal refluxing units (RRU) with a mean age 55.23±36.58 months and 64 RRU with a mean age 52.13±31.66 months were treated in Dx/HA and PPC groups, respectively. The PPC group showed a more successful outcome in comparison to the Dx/HA group (92.2% versus 75.7% of the RRU with P value<0.001) at 3 months follow up. The injection technique was not significantly different between two groups. In PPC group the success rate was decreased significantly with increasing reflux grade but this reduction was not statistically significant in Dx/HA group. The injected volume was significantly more in PPC group; in addition, there was statistically significant correlation between injected volume of the bulking agent and obstruction rate. However, the obstruction rate did not establish significant difference between the two groups (P value=0.83), however it was earlier in Vantris (4 months versus 22 months).

Conclusions: Our investigation approved PPC as a more effective material, regardless of other confounding variables such as reflux grade, learning cure, and technique of injection, in endoscopic treatment of VUR. In addition, the other remarkable point is this effectiveness is not accompanied by more post-operation obstruction.

The Differences Between Preterm and Term Birth Affecting Initiation and Completion of Toilet Training Among Children: A Retrospective Case-Control Study

Dilek Yildiz, Derya Suluhan, Berna Eren Fidanci, Merve Mert, Turan Tunc, Bulent Altunkaynak

Urology Journal, Vol. 16 No. 2 (2019), 5 May 2019 , Page 180-185

Purpose: This study seeks to investigate the possibility the existence of a difference in terms of start and end dates of toilet training between term and preterm children as well as the possible determining factors.

Materials and Methods: This study was conducted as a 5-year retrospective case (children born preterm-(32 to <37 weeks) – and control (children born at term (>37 weeks + 1 day)) study. The data were collected with a form consisted of questions about demographic data (12 questions) and toilet traning features (10 questions) through face-to-face interviews with the mothers. A chi-square test and logistic regression analysis were conducted to examine the data. Odds ratio was used as a measure of the relation between levels of the dependent variable. p< .01 and p< .05 values were assumed to be statistically significant.

Results: The study examined a total of 133 children including 59 preterm children and 74 children born at term including 60 (45.1%) boys and 73 (54.9%) girls. The possibility of starting toilet training at or before 24 months was found to be 6.4 times greater in full-term children than preterm children (OR=6.493). The logistic regression analysis, which aimed at identifying any variables that might affect end date of toilet training, found that despite the tendency to consider preterm   birth as a factor prolonging the duration of toilet training, the difference was not found to be statistically significant (p= .07).

Conclusion: This study compared full-term and preterm children in terms of start and end dates of toilet training and found that preterm children start toilet training later than full-term children. Based on the results of the study, it is possible to say that preterm birth, gender and birth order affect start date of toilet training. However there is no difference between term and preterm babies on the end date of toilet training.


Purpose: There was no appropriate instrument for assessing the self-management of Iranian kidney transplant recipients. This study was done to translate the Self-Management Scale for Kidney Transplant Recipients into Persian and evaluate its psychometric properties.

Material and Methods: This cross-sectional methodological study was done from October 2016 to March 2017. The psychometric properties of the scale were evaluated in the following four steps: forward-backward translation, face and content validity assessments, construct validity assessment via exploratory factor analysis, and reliability assessment via internal consistency and test-retest techniques.

Results: The means of item impact score, content validity ratio, and simplicity, clarity, and relevance content validity indices were 3.94, 0.73, 0.96, 0.93, and 0.98, respectively. Exploratory factor analysis revealed a four-factor structure for the scale which explained 70.75% of the total self-management variance. The four factors of the scale were “self-monitoring”, “self-care behaviors”, “early detecting and coping with abnormalities”, and “drug management”. The Cronbach’s alpha and the test-retest intraclass correlation coefficient of the scale were 0.73 and 0.90, respectively.

Conclusion: The Persian Self-Management Scale for Kidney Transplant Recipients has acceptable validity and reliability. It can be used in educational and clinical environments and also in research studies for measuring kidney transplant recipients’ self-management.


Salvage autologous fascial sling after failed anti-incontinence surgeries: Long term follow up

Farzaneh Sharifiaghdas, Nastaran Mahmoudnejad, Mehdi Honarkar Ramezani, Hamidreza Shemshaki, Fatemeh Ameri

Urology Journal, Vol. 16 No. 2 (2019), 5 May 2019 , Page 193-197

OBJECTIVE: To evaluate long term outcomes of autologous pubovaginal fascial sling (AFPVS) as a salvage procedure following different types of failed anti-incontinence surgeries.

MATERIALS AND METHODS: We retrospectively reviewed medical records of patients who had undergone salvage AFPVS after any kind of anti-incontinence surgery from 2005-2015 at our medical center. Patients were contacted by telephone. Revised Urinary Incontinence Scale (RUIS) was used to determine the success rate.

RESULTS: A total of 40 patients out of 51 were successfully contacted. Mean patient age was 50.8± 9.8 years (range30-75) and mean follow up was 62.6±32.4 months (range12-120). Of 40 patients, 14(35%) had pure SUI and 26(65%) complained of mixed urinary incontinence. A total of 15(37.5%) patients had a failed Burch colposuspention, 5(12.5%) TVT, 8(20%) TOT, 3 (7.5%) AFPVS and five (12.5%) patients had history of failed mini-sling procedure. Four (10%) patients had undergone more than one anti incontinence surgeries. Overall success rate was 65% in our study. New onset urge urinary incontinence was detected in 25% of patient which was negatively associated with satisfaction and recommendation.  There was no statistically significant correlation between mixed urinary incontinence, type or number of previous failed surgeries with success however presence of pure SUI had a strong

COCLUSION: Autologous pubovaginal fascial sling might be considered as a safe and efficacious salvage surgical option following failed midurethral slings, Burch colposuspention and even AFPVS itself. It will provide reasonable long term results with no major complications.  


The Effects of Nocturnal Blood Pressure Paterns and Autonomic Alterations on Erectile Functions in Patients with Hypertension

Ercan Yuvanc, Mehmet Tolga Dogru, Vedat Simsek, Hüseyin Kandemir, Devrim Tuglu

Urology Journal, Vol. 16 No. 2 (2019), 5 May 2019 , Page 198-204

Purpose: Hypertension (HT) is known to be of the main risk factors for erectile dysfunction (ED). But non-dipping (<%10 drop in the night) of HT is not investigated truly. The aim of this study was to test the hypothesis that the non-dipper hypertensive patients are more prone to develop erectile dysfunction.

Materials and Methods: This was a cross-sectional clinical study. 70 HT patients diagnosed by Ambulatory blood pressure monitoring (ABPM) were classified into 3 groups (No ED, mild to moderate and severe) according to their International Index of Erectile Function (IIEF) scores. All three groups were compared for their dipping status by ABPM, heart rate variability (HRV) by holter monitoring.

Results: In our study non-dipper hypertensives had statistically more erectile dysfunction (P=0.004). Also severe ED patients with non-dipping pattern had decreased dipping blood pressure levels then those of ED(-) patients with non-dipping HT (P= .003)(Daytime Systolic/Nighttime Diastolic Blood Pressure= 0.8 ± 0.07 / 3.90 ± 1.5, respectively). LF/HF daytime/ nighttime in holter reflecting sympathetic overactivity (P< .001).

Conclusion: Autonomic dysfunction especially sympathetic overactivity is associated with both non dipping pattern of HT and erectile dysfunction as a common pathologic pathway, besides there might be an association between ED and non dipping HT.

The Effects of Oral 5-alpha Reductase Inhibitors on Penile Intracavernosal Pressures and Penile Morphology in Rat Model

Sahin Kilic, Engin Kolukcu, Fikret Erdemir, Ismail Benli, Akgul Arici

Urology Journal, Vol. 16 No. 2 (2019), 5 May 2019 , Page 205-211

Purpose: Benign prostatic hyperplasia (BPH), and erectile dysfunction (ED) are urological diseases which affect more than 50 % of men older than 50 years of age. It has been reported that 5-alpha-reductase inhibitors (5-ARIs) used in clinical studies for the treatment of BPH caused ED in 0.8-15.8% of the patients. The aim of this study is evaluation of the effects of oral finasteride and dutasteride on penile intracavernosal pressures and penile morphology in a rat model.

Materials and Methods: Thirty Wistar Albino strain male rats were randomized into control (n = 10), finasteride (n = 10), and dutasteride (n = 10) groups. After 8 weeks of treatment erectile responses were evaluated in all rats measuring intracavernosal pressure (ICP) changes during erectile responses to cavernosal nerve electrical stimulation. Serum hormone levels were studied and all rats underwent prostatectomy and penectomy. All tissue samples were examined histomorphologically and a semiquantitative scoring system was used for cavernosal tissue collagen density grading. One-way analysis of variance was used for statistical analysis and P < .05 was accepted as the level of statistical significance. For two group comparisons Tukey HSD test was used as post hoc test of one way analysis of variance.

Results: Approximately 50% decrease was seen in mean ICPs in the finasteride and dutasteride groups compared to the control group for all voltages (2.5 V, 5 V. 7.5 V). Mean ICPs for 7.5 V were 62.17 ± 30.89mmHg in control group, 35.27 ± 31.94 in the finasteride, and 36.01 ± 19.20mmHg in the dutasteride group. But regarding ICPs there was no statistically significant difference between the groups (P > .05). The serum testosterone (T) concentrations were higher in treatment groups (P < .001). Serum dihydrotestosterone (DHT), luteinizing hormone (LH) and follicle stimulating hormone (FSH) concentrations were not significantly different between the groups. As a result of histomorphological studies, a statistically significant increase in cavernosal tissue collagen density, and marked atrophic changes in prostatic epithelial tissues were observed in the treatment groups.

Conclusion: Although 5-ARIs cause marked atrophic changes in prostatic epithelial tissues, and prominent collagen deposition in penile cavernosal tissues, no significant effect on penile ICPs was seen in this study. The failure to show a statistically significant difference was attributed to higher standard deviations of ICP values. If sample size and duration of the treatment are increased, statistically significant results in ICPs may be reached. The penile morphology evaluation results point to a negative effect of 5-ARIs on erectile function.

 Purpose: To investigate the relationship between the histopathological findings of testis tissue samples and sperm retrieval success of micro-TESE in non-obstructive azoospermia (NOA) patients.

Method: Histopathological examination results of the testis tissue samples of 795 NOA patients who underwent micro-TESE operation in our clinic between 2003 and 2014 were included. Histopathological findings were grouped as hypospermatogenesis, incomplete spermatocytic arrest, complete spermatocytic arrest, Sertoli cell only syndrome (SCOS), and fibrosis/atrophy. Chi-square analysis was used to compare the histopathological findings with the sperm retrieval rates of micro-TESE.

Result: Sperm was found in 341 (42,9%) patients following micro-TESE compared to 454(57,1%) patients where sperm were not detected (P < 0.001). Sperm retrieval rates of micro TESE were significantly higher in hyposper­matogenesis and incomplete maturation arrest groups (93.2% (P < 0.001) and 72.5% (P < 0.001), respectively). Complete maturation arrest, SCOS and fibrosis/atrophy were determined at significantly higher rates in patients (220.2%) with no sperm found compared to patients with sperm (P < 0.001).

Conclusion: The findings of this study are consistent with those of previous studies in the literature. Testicular histopathological findings can provide additional data when informing NOA patients about the expected success of further micro-TESE operations.

Neutrophil-Lymphocyte Ratio Could Be a Marker for Erectile Dysfunction

Ali Aslan, Yasemin Kaya, Abdullah Cirakoglu, Erdal Benli, Esra Yancar Demir, Mustafa Kerem Çalg?n

Urology Journal, Vol. 16 No. 2 (2019), 5 May 2019 , Page 216-220

Purpose: The literature reveals lots of information about the relationship between inflammatory markers and many diseases. In this study, we aimed to determine the relationship between erectile dysfunction and the neutrophil-lymphocyte ratio (NLR), which is a simple and nonspecific inflammatory marker.
Materials and Methods: Ninety patients with erectile dysfunction (ED) and ninety-four healthy subjects were included in this study from our internal medicine and urology clinics. As diagnosis criteria, we used the first 5 questions of International Index for Erectile Function. The duration of erectile dysfunction was asked and recorded. Height, weight and waist circumference of patients were measured. We performed total blood count, sedimentation, C-reactive protein, and blood chemistry.
Results: There were statistically significant differences between the control [1,038 (0,507-1,92)] and ED [59,5 (52,0-68,0)] groups in terms of NLR (P < .001). According to the multivariate logistic regression analysis, Duration of ED (Cut off: 7,5 month) predicted ED with 78,8% sensitivity and 63,1% specificity (AUC: < ,001, 95% CI 1,030 (1,010-1,050), P = .003). Moreover, NLR (Cut off: 1,574) predicted ED with 81,8% sensitivity and 67,0% specificity (AUC: < 0,001, 95% CI 1,994 (1,139-3,490), P = .016) according to the multivariate logistic regression analysis.
Conclusion: It was found that the neutrophil-lymphocyte ratio was higher in patient group than the control group. Also, the neutrophil-lymphocyte ratio (NLR) predicted ED and it might be helpful in diagnosing erectile dysfunction.


In this article we present two-year-old male patient who had history of Fournier gangrene of scrotum. Extensive perineal and scrotal debridement with suprapubic cystostomy tube insertion had been done for him in the emergency setting One year later his parents brought him back for scrotal reconstruction. A novel technique by using rotational perineal flap was used.The cosmetic result of1 months and 3 months follow up is presented in the article.