ISSN: 1735-1308

Vol. 16 No. 3 (2019)

REVIEW


Purpose: Tamsulosin, a medical expulsive therapy (MET), was always recommended for patients with distal ure­teral calculi less than 10 mm. The aim of the systematic review was to assess the efficacy and safety of tamsulosin in MET compared with placebo.

Materials and Methods: A comprehensive search was conducted in the databases PubMed, EMBASE and Web of Science for relevant articles, covering all the literatures published until April 2018. All placebo controlled trails were identified in which patients were randomized to receive either tamsulosin or placebo for distal ureteral calculi.

Results: A total of seven placebo controlled studies including 4135 patients met the inclusion criteria and were involved in the review. We found that tamsulosin was associated with a significantly higher expulsion rate (ESR) [odds ratio (OR) = 1.10, 95% confidence interval (CI) = 1.00-1.21] than placebo in patients with distal ureteral stones less than 7 mm. The ESR ranged from 67.0%-90.7%. But the significant difference was better seen in pa­tients with distal ureteral stones less than 10 mm (OR = 1.11, 95% CI = 1.01-1.21). Even though tamsulosin has a higher incidence of retrograde ejaculation than placebo, no significant difference was observed in the incidence of other adverse events.

Conclusion: The results of the current meta-analysis indicated that tamsulosin was superior to placebo in its effi­cacy for distal ureteral stones though retrograde ejaculation was worse with tamsulosin use. It should be a safe and effective medical expulsive therapy choice for distal ureteral stones when stone sizes are less than 10 mm.

ORIGINAL PAPER (ENDOUROLOGY AND STONE DISEASE)


Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy Methods For Management of Big- Sized Kidney Stones(? 4 cm): Single Center Retrospective Study

Ahmet Nihat Karakoyunlu, Mehmet Caglar Cakici, Sercan Sari, Emre Hepsen, Hakki Ugur Ozok, Azmi Levent Sagnak, Hikmet Topaloglu, Aykut Bugra Senturk, Hamit Ersoy

Urology Journal, Vol. 16 No. 3 (2019), 17 June 2019 , Page 232-235
https://doi.org/10.22037/uj.v0i0.4072

 

Purpose: Management of ? 4 cm sized kidney stone is a rarely seen problem in urology. Few studies are present about this issue. Percutaneous nephrolithotomy(PNL), Retrograde Intrarenal Surgery(RIRS) and open surgery are the methods used in stone management. In our study we aimed to compare RIRS and PNL in the management of ? 4 cm sized kidney stones.

Materials and methods: Among patients who had undergone RIRS and PNL in D?skap? Y?ld?r?m Beyaz?t Train­ing and Research Hospital, 94 patients who had ? 4 cm sized kidney stones were included our study. The demo­graphic, intraoperative and postoperative data of these patients and complications were evaluated retrospectively.

Results: 94 patients (67 PNL, 27 RIRS) were in the study. Stone laterality, urinary anomaly and gender were sim­ilar in two groups.(Group PNL(P) and Group RIRS(R)) Stone number were 2.55 ± 1.44 and 2.78 ± 1.42 in Group P and R, respectively. Stone size were 47.06 ± 7.02 and 46.41 ± 6.00 mm. in Group P and R, respectively. The differences between two groups were not statistically significant.(P > .05) In Group P scopy time, hospital stay and stone free rate were higher and operation time was lower than Group R. And the difference was statistically significant(P < .05).

Conclusions: As a result, PNL is an effective method and operation time is lower than RIRS. Also a second oper­ation for JJ stent taking is lower in PNL . RIRS is a safe method. RIRS has less complications and hospitalization time. They are feasible in treatment of ? 4 cm sized kidney stones.

 

Purpose: We aimed to evaluate whether these parameters could be guiding for us in selection between retrograde intrarenal surgery (RIRS) and mini-percutaneous nephrolithotomy (PNL) procedures in kidney stones that are smaller than 2 cm.

Materials and Methods: The patients who had kidney stones smaller than two cm and were planned to undergo surgery were randomly distributed into 2 groups prospectively. RIRS was performed in the RIRS group using a 7.5-F fiberoptic flexible ureterorenoscope while mini-PNL group was dilated up to 16.5F and mini-PNL was per­formed with 12F nephroscopy. Preoperative characteristics, operative and postoperative results were compared in two groups. Thereafter, intra and intergroup comparisons were made to determine the effects of Hounsfield unit (HU) value indicating the stone density being higher or lower than 677 and stone location on stone-free rates.

Results: The study involved 60 patients including 30 in each group. The groups’ preoperative values were similar. The hospitalization time and the total duration of scopy were longer in mini-PNL when the postoperative values were compared (P < .0001). In terms of stone densities, HU values that were lower than 677 in the mini-PNL group affected the stone-free rate and reduced it from 100% (> 677HU) to 55.6% (< 677HU), whereas the change was significant (P = .005). Lower calyx stones affected the RIRS results negatively, whereas multiple calyceal stones affected the mini-PNL group negatively.

Conclusion: Both methods had a similar success rate, but lower pole stones, multiple calyceal stones and stone density parameters affected the stone-free rates significantly, and these may be effective in treatment selection.

Evaluation and Comparison of Metabolic Disorders between Patients with Unilateral and Bilateral Staghorn Renal Stones

Mehrdad Mohammadi Sichani, Amir Jafarpisheh, Alireza Ghoreifi

Urology Journal, Vol. 16 No. 3 (2019), 17 June 2019 , Page 242-245
https://doi.org/10.22037/uj.v0i0.4316

Purpose: Metabolic disorders are common in patients with staghorn renal stones. Aim of this study was to evaluate and compare the metabolic disorders in patients with unilateral and bilateral staghorn stones.

Materials and Methods: In this cross sectional study, 78 patients who underwent percutaneous nephrolithotomy (PCNL) for staghorn renal stones were included. The urine volume, the level of calcium, oxalate, uric acid, phos­phate, sodium, citrate, creatinine, and cystine from 24 hour urine collection as well as the serum levels of calcium, phosphorus, magnesium, creatinine, blood urea nitrogen (BUN), parathyroid hormone (PTH) and uric acid were recorded and compared among the two groups with unilateral and bilateral renal stones.

Results: 56 patients (71.8%) had unilateral and 22 (28.2%) had bilateral renal stones. At least one abnormal meta­bolic factor was found in 32 (57.1%) and 15 (68.2%) patients with unilateral and bilateral renal stones, respectively (P = .044). Cystine urine levels and serum levels of BUN were higher in cases with bilateral compared to unilateral renal stones (36.4% vs. 12.5%, P = .025 and 27.3% vs. 1.8%, P = .002, respectively).

Conclusion: Metabolic factors are strongly correlated with the formation of staghorn renal stones specially bilat­eral ones. In our study among different metabolic factors, cystine urine levels and serum levels of BUN were sig­nificantly higher in patients with bilateral renal stones. Proper metabolic assessments are recommended in patients with staghorn urolithiasis.

Comparison of Two Different Anesthesia Methods in Patients Undergoing Percutaneous Nephrolithotomy

Mehmet Solakhan, Ersan Bulut, Mehmet Sakip Erturhan

Urology Journal, Vol. 16 No. 3 (2019), 17 June 2019 , Page 246-250
https://doi.org/10.22037/uj.v0i0.4291

Purpose: The study aims to compare the effectiveness, safety and costs of two different anesthesia methods in percutaneous nephrolithotomy (PCNL) operations.

Material and Method: In our study, data was retrospectively examined of 1657 patients who underwent PCNL due to renal calculi between 2009 and 2017. Patients were separated into two groups according to the type of anesthesia; as those who underwent PCNL by general anesthesia (GA) (n = 572) and those under spinal anesthe­sia(SA) (n = 1085). Standard PCNL technique was used in both groups. Gender, age, operation duration, period of hospitalization, stone-free ratio, post-operative narcotic analgesic need and complications were compared between these two groups.

Results: A total of 1657 patients consisting of 1064 (64.2%) male patients and 593 (35.8%) female patients were included in the study. The average age of the all patients was 33.2 ± 12.4 (range 16-74) years. The two groups were similar in terms of mean age, gender, stone size, stone location and body mass index. Mean operation time was sig­nificantly shorter in the SA group than in the GA group (81.8 ± 33.9 minute vs. 118.2 ± -42.9 minute respectively, P < .001). Mean period of hospitalization was remarkable shorter in the SA group than in the GA group (30.0 ± 9.9 hours vs. 38.4 ± 11.2 hours respectively, P < .001). Post-operative narcotic analgesic need rate was significantly higher in the GA group than in the SA group (33.4% vs. 10.9%, respectively, P < .001). Anesthesia cost was found significantly lower in the SA group than in the GA group (USD 21.3±2.8 vs. USD 83.6 ± 9.5, respectively, P < .001). Significant difference was not observed between both groups in terms of stone-free ratio, amount of bleed­ing, fluoroscopy time, pre-operative and post-operative complications.

Conclusion: Compared to those performed with GA, PCNL performed with SA is a safe, effective and low-cost method.

Ureteroscope-aided Reinsertion of Dislodged Pigtail Nephrostomy Tube Through Collapsed Tract

Shun-Kai Chang, Bo-Jung Chen, Yeong-Chin Jou, Min-Chun Li, Pei-Yi Chen

Urology Journal, Vol. 16 No. 3 (2019), 17 June 2019 , Page 251-254
https://doi.org/10.22037/uj.v0i0.4258

Purpose: To introduce an alternative method for the reinsertion of pigtail catheter for collapsed nephrostomy tract.

Materials and Methods: Between January 2013 and October 2016, a total of ten patients with collapsed nephros­tomy tract underwent ureteroscope-aided reinsertion of the pigtail catheter after the failure of manual reinsertion by guidewire. Under local anesthesia, the ureteroscope was inserted through a percutaneous nephrostomy (PCN) opening. The access path was obtained by careful tracing for prior placement of pigtail catheter. The clinical features of these ten patients, including operation time, success rate and complications, were evaluated by retro­spective chart review. The Clavien classification was applied to define the grade of complications after one-month follow-up.

Results: Among the ten cases of difficult PCN revision, eight underwent the procedure within 24 hours of the dislodgement. The remaining two patients underwent the procedure within 2 days and 8 days. The period of pigtail tube dwelling ranged from 2 weeks to 10.5 months. The procedure was successful in nine cases and the operation time ranged from 10 to 30 minutes. No fluoroscope was used in any patient. All of the nine patients had a good drainage function after tube reinsertion. Complications occurred only in one patient who had postoperative fever classified as Clavien grade 2.

Conclusion: Reinserting the dislodged pigtail nephrostomy tube with the aid of an ureteroscope is an alternative method that may decrease the necessity of new tract creation.

ORIGINAL PAPER(UROLOGICAL ONCOLOGY)


The Effect of Phosphodiesterase 5 Inhibitor on Biochemical Recurrence Following Radical Prostatectomy in Patients with Prostate Cancer

Jae-Wook Chung, Jin Woo Kim, Yun-Sok Ha, Seock Hwan Choi, Jun Nyung Lee, Bum Soo Kim, Hyun Tae Kim, Eun Sang Yoo, Tae Gyun Kwon, Tae-Hwan Kim

Urology Journal, Vol. 16 No. 3 (2019), 17 June 2019 , Page 255-259
https://doi.org/10.22037/uj.v16i3.4263

Purpose: Recently, controversy exists regarding the oncologic outcomes associated with the use of phosphodi­esterase 5 inhibitor (PDE5i). Therefore, we attempted to verify the effect of PDE5i on biochemical recurrence (BCR) following radical prostatectomy (RP) in patients with prostate cancer (PCa).

Materials and Methods: From January 2011 to May 2016, 351 patients who had undergone bilateral neurovas­cular bundle saving and who were confirmed as having pT2N0M0 disease were included in the present study. We divided these patients into three groups: no PDE5i use, PDE5i use on demand , and PDE5i use for rehabilitation. We retrospectively analyzed the effect of PDE5i on BCR of PCa. Mean follow-up period was 34.4 months and mesurement of outcome was whether the patients developed BCR during regular follow-up.

Results: 25 (7.1%) patients showed BCR and univariate analysis found no significant differences in BCR between the three groups (5 (6.9%) in no PDE5i use, 8 (9.5%) in PDE5i use on demand, 12 (6.2%) in PDE5i use for rehabili­tation). Multivariable analyses showed that treatment type was not a significant factor for BCR between the groups with no PDE5i use and PDE5i use (HR = 1.34 [0.49–3.70]; P = .573) and between the groups with on demand and rehabilitation use (HR = 1.37 [0.35–5.37]; P = .646). Kaplan-Meier survival curves show that there were no significant differences in PSA recurrence-free survival in three groups (P > .05).

Conclusion: Use of PDE5is was not associated with any adverse effects on BCR after RP in patients with PCa.

Impact and Predictive Value of Prostate Weight on the Outcomes of Nerve Sparing Laparoscopic Radical Prostatectomy in Patients with Low Risk Prostate Cancer

Dong-Gen Jiang, Chu-Tian Xiao, Yun-Hua Mao, Jian-Guang Qiu, Jie Si-tu, Min-Hua Lu, Xin Gao

Urology Journal, Vol. 16 No. 3 (2019), 17 June 2019 , Page 260-266
https://doi.org/10.22037/uj.v0i0.4327

Purpose: To investigate the impact of prostate weight on outcomes of nerve sparing laparoscopic radical prosta­tectomy (LRP) and assess its predictive value on postoperative continence and potency recovery.

Materials and Methods: We conducted a retrospective study on the clinical data of 165 patients with low risk prostate cancer (PCa) who underwent nerve sparing LRP. All the patients included had normal preoperative uri­nary and sexual function. The association of prostate weight with perioperative data was assessed using Spearman correlation coefficient. Univariate and multivariate Cox regression analyses were employed to identify prognostic predictors for continence and potency recovery.

Results: Increased prostate weight was significantly associated with older age, higher prostate-specific antigen (PSA), lower biopsy and pathological T stage and Gleason score, longer operative time, and higher estimated blood loss (P < .05). The continence rates at the 3rd, 6th, and 12th month after surgery were 63.6% (105/165), 87.9% (145/165), and 95.8% (158/165); and the potency rates were 44.8% (74/165), 62.4% (103/165) and 77.6% (128/165), respectively. Furthermore, multivariate Cox analysis showed that patient age (HR = 0.52, 95% CI: 0.35- 0.76) and prostate weight (HR = 0.54, 95% CI: 0.34-0.86) were independent predictors for continence recovery, while only patient age (HR = 0.66, 95% CI: 0.45-0.96) could independently predict potency recovery.

Conclusion: Larger prostate size was correlated with older age, higher PSA, lower tumor stage and grade, longer operative time, and more intraoperative blood loss in low risk PCa patients. Increased prostate weight may inde­pendently predict poor continence recovery after nerve sparing LRP.

The Association of miR-let 7b and miR-548 with PTEN in Prostate Cancer

Mojtaba Saffari, Sayyed Mohammad Hossein Ghaderian, Mir Davood Omrani, Mandana Afsharpad, Kimia Shankaie, Niusha Samadaian

Urology Journal, Vol. 16 No. 3 (2019), 17 June 2019 , Page 267-273
https://doi.org/10.22037/uj.v0i0.4564

Purpose: This study aims to investigate the expression level of mir-let7b-3p and mir-548, which are involved in PTEN expression in tissue samples of prostate cancer patients versus benign prostate hyperplasia (BPH) and normal adjacent tissue.

Materials and Methods: Prostate cancer tissues were obtained from patients after receiving informed consent. Total RNA extraction and cDNA synthesis were performed for determining gene expression.

Results: Ten patients were determined to have high Gleason scores (> 7), 36 and seven samples had intermediate Gleason scores (7?) and BPH, respectively, and 40 samples were derived from normal adjacent tissue. Downreg­ulation of mir-let7b and upregulation of mir-548 expression significantly correlated with high-risk Gleason scores.

Conclusion: The present study showed that miR-let7b and/or mir-548 can be considered as potential targets in prostate cancer therapy.

Effect of Treatment Modality on Long Term Renal Functions in Patients With Muscle Invasive Bladder Cancer

nurullah hamidi, Evren Suer, Mete Ozkidik, Mehmet Ilker Gokce, Erdem Ozturk, Cihat Ozcan, Kadir Turkolmez, Yasar Beduk, Sumer Baltaci

Urology Journal, Vol. 16 No. 3 (2019), 17 June 2019 , Page 274-278
https://doi.org/10.22037/uj.v0i0.4251

Purpose: To compare of changes in glomerular filtration rate (GFR) in patients who underwent radical cystectomy (RC) and multimodal treatment (MMT).

Materials and Methods: We identified 472 consecutive patients who underwent RC or treated with MMT for muscle invasive bladder cancer (MIBC) at our institution, between January 1995 and December 2010. After ex­cluding the patients who died within 5 years or without 5 years of follow-up, 175 and 59 patients who were treated with RC and MMT, respectively were included to the study. GFR was measured before treatment and every 6 months after treatment till the end of 60th month.

Results: The mean age and mean baseline GFR were 66.5±5.7 years and 85.1±18.2 mL/min/1.73m2, respectively for all patients. We detected statistically significant higher decrease rates for GFRs in MMT group compared to RC group at every follow up period till 42nd month. Renal function decreasing was found to be more prominent during first year of follow-up (79.1 to 65.9 mL/min/1.73m2) in MMT group. However, GFR decreased more reg­ularly in RC group (~4 mL/min/1.73m2 per year). MMT, lower baseline GFR, Diabetes Mellitus, hypertension, and ureteroenteric anastomotic stricture development were associated with low GFR under 60 and 45 mL/min at the end of five years.

Conclusion: Decreased renal function is noted in many MIBC patients after RC or MMT in the long-term fol­low-up. Renal function deterioration is more prominent within the first year after MMT.

ORIGINAL PAPER (PEDIATRIC UROLOGY)


Introduction: The cytokine profile and the ultrastructural changes of refluxing ureterovesical junctions(UVJs) of children treated with failed dextranomer/hyaluronic-acid (Dx/HA) injections were investigated using immunohis­tochemical methods and transmission electron microscopy(TEM).

Patients and Methods: Eighteen children who had undergone injection for reflux were included the study. The smooth muscle arrangement of the ureteral wall, transforming growth factor-? (TGF-?1),vascular-endotheli­al-growth factor (VEGF) and CD34 were evaluated immunohistochemically, and the results were compared with 10 age-matched autopsy specimens as controls. The ultrastructural evaluation and morphological description was made semi-quantitatively and compared with published data.

Result: Four of the patients (22%) were male, and 14 (78%) were female. The mean age of the patients was 105.4 ± 44.5(48-184) months. There was no correlation between the vesicoureteral reflux (VUR) grade and age (P = 0.85). The mean VEGF and CD34 scores were 16.2 ± 9.6 (0-90) cells per HPF and 10.2 ± 3.5 (4-16) vessels per HPF in ureters with reflux; these values were 60.6±16.4 (32-84) cells per HPF and 17.8 ± 4.1 (12-24) vessels per HPF in the control group. The amount of VEGF and CD34 were significantly decreased in patients compared with the control group (P < 0.001, P < 0.001).The TGF-?1 levels were significantly higher in patients with VUR compared with the control group (34.2 ± 19.9 vs 5.0±1.9; P=0.001).The amount of VEGF, CD34, and TGF-?1 were not correlated with the grade of reflux (P = 0.26, P = 0.94, and P = 0.42, respectively). Ultrastructural changes in the muscle cells were observed in all the VUR specimens (Grade II-IV).

Conclusion: Refluxing ureters exhibited immune-histopathological abnormalities and ultrastructural changes of the muscle cells in all VUR specimens in the ureterovesical junctions of children treated with failed Dx/HA injec­tions for reflux.

ORIGINAL PAPER (FEMALE UROLOGY)


Hypersensitive or Detrusor Overactivity: Which is Associated with Filling Symptoms in Female Bladder Outlet Obstructed Patients?

Junlong Zhang, Mingxin Cao, Yu Chen, Weijie Liang, Yueyou Liang

Urology Journal, Vol. 16 No. 3 (2019), 17 June 2019 , Page 285-288
https://doi.org/10.22037/uj.v0i0.4362

Purpose: To investigate and compare detrusor overactivity (DO) and bladder filling sensation characteristics in female bladder outlet obstruction (FBOO) patients with or without overactive bladder (OAB) symptoms.

Materials and Methods: One hundred fifty-seven FBOO patients with urodynamic testing were recruited. Pa­tients who showed urinary urgency ( ? 6 episodes/3 d), with or without urinary frequency ( ?8 voids/24 h), and urge incontinence ( ? 3 episodes/3 d) were considered to have OAB. The detrusor overactivity (DO) and bladder filling sensation measures including first sensation (FSF), first desire to void (FDV) and strong desire to void (SDV) during filling cystometry were recorded. The associations between urodynamic variables and OAB symp­toms were analysed.

Result: FBOO patients had a high incidence (79%) of OAB. FBOO patients with OAB symptoms had significantly younger age, higher incidence of DO (19.4% versus 6.1%) (P = .051) and lower bladder volumes of FSF (180.32 ± 83.48 versus 226.18 ± 100.90 mL), FDV (269.00 ± 109.78 versus 330.45 ± 123.95 mL) and SDV (345.56 ± 135.43 versus 422.33 ± 148.40 mL) (P < .05) compared to patients without OAB. In multivariate analyses, both DO (OR = 4.83, 95% CI: 1.02-22.85, P = .047) and lower bladder volumes at FDV(OR = 2.47, 95% CI: 1.03-5.95, P = .044) and SDV (OR = 3.07, 95% CI: 1.25-7.55, P < .014) were still independently associated with OAB, after adjustment for age and other confounding factors.

Conclusion: FBOO patients had a high incidence of OAB. Not only DO but also bladder hypersensitivity were independently associated with OAB symptoms in FBOO patients.

ORIGINAL PAPER (ANDROLOGY)


The Effect of Heroin Addiction on Human Sperm Parameters, Histone-to-Protamine Transition, and Serum Sexual Hormones Levels

Zohreh Nazmara, Mohammad Najafi, Samira Rezaei-Mojaz, Mansoureh Movahedin, Zahara Zandiyeh, Peymaneh Shirinbayan, Mohsen Roshanpajouh, Hamid Reza Asgari, Leila Hosseini Jafari Lavasani, Morteza Koruji

Urology Journal, Vol. 16 No. 3 (2019), 17 June 2019 , Page 289-294
https://doi.org/10.22037/uj.v0i0.4321

Purpose: To investigate the effects of heroin on sperm parameters, histone-to-protamine transition ratios in mature sperm, and serum reproductive hormone levels in active heroin users.

Materials and Methods: Semen and blood samples were collected from 25 men who used only heroin for at least 12 months and the same number healthy men who did not use any drugs and did not suffer from infertility problems. Computer-based analysis, Aniline blue staining, and hormonal assessment were performed to provide valuable new information on the relationship between addiction and semen profile and serum reproductive hor­mone levels.

Results: Our finding showed that semen pH (7.8 vs. 7.75), sperm motility (42.93 ± 3.89% vs. 68.9 ± 2.68%), and viability (73.27 ± 3.85% vs. 86.48 ± 1.05%), and sperm histone replacement abnormalities (32.33 ± 10.89% vs. 5.56 ± 0.85%) were significant differences in addicted group vs. non-exposed ones (P ? .05). In addition, serum sex hormone levels were not significantly differed between groups. There was a correlation between the amount of daily heroin consumption and LH level. We also observed that duration of drug dependence is correlated with sperm abnormalities.

Conclusion: We concluded that heroin consumption affect sperm maturities such as histone-to-protamine ratio and impair semen profile in general and particularly sperm morphology and motility. Heroin may be considered as one of the idiopathic male infertility reason.

Effects of Psychological Status on The Oxidation Parameters of Semen and Blood in Azoospermic Men

kemal gumus, Mehmet Gulum, Ercan Yeni, Halil Ciftci, Yigit Akin, Emre Huri, Hakim Celik, Ozcan Erel

Urology Journal, Vol. 16 No. 3 (2019), 17 June 2019 , Page 295-299
https://doi.org/10.22037/uj.v0i0.4540

Purpose: In limited number of studies performed concerning the psychological moods of female, and male with the diagnosis of infertility, data related to increased incidence of depression, and anxiety have been reported. The objective of this study is to determine whether azoospermia has any psychological effects on men, and investigate the potential effects of psychological mood on seminal, and plasma oxidative parametres.

Materials and Methods: Twenty-seven patients whose two consecutive semen analyses were reported as pellet –negative azoospermia constituted the azoospermic group, and 30 healthy individuals who applied to the infertility polyclinic with normal seminal parametres comprised the normozoospermic group.

Results: BECK Anxiety scores were significantly higher in the azoospermic group (P = 0.009). When compared with the normozoospermic group, higher levels of oxidative parametres, but lower levels of the antioxidative parametre were detected in the azoospermic group (P < 0.05). In the azoospermic group, a positive correlation was detected between BECK Anxiety and total oxidant status. Anxiety may increase oxidative parametres in both plasma, and seminal fluid (r = 473, p = 0.026).

Conclusion: Anxiety may increase oxidative parametres in both plasma, and seminal fluid. Oxidative milieu may impair sperm quality, and affect the success rates of assisted reproductive treatments. The determination of oxida­tive potential in infertile men, thiol, and prolidase may be used as biomarkers.

Evaluation of Oxidative Stress in Testis and Sperm of Rat Following Induced Varicocele

Neem Erfani Majd, Niloofar Sadeghi, Marziyeh Tavalaee, Mohammad Reza Tabandeh, Mohammad Hossein Nasr- Esfahani

Urology Journal, Vol. 16 No. 3 (2019), 17 June 2019 , Page 300-306
https://doi.org/10.22037/uj.v0i0.4740

Purpose: Oxidative stress (OS) plays a central role in the pathophysiology of varicocele (VC), however, com­prehensive studies concomitantly assessing semen parameter along with chromatin status, oxidative stress, and enzymatic antioxidants in both testis and sperm are limited. Therefore, this study aims to assess these parameters in varicocelized rats.

Materials and Methods: For this study, 30 Wistar rats were randomly divided into three groups: Control group (I); sham-operated group (II) and left varicocele group (III). Left varicocele was induced and two months after surgery, we evaluated sperm parameters, persistent histone, DNA integrity and lipid peroxidation in sperm and also oxidant/antioxidant markers in testis.

Results: The results showed that sperm concentration, motility, and normal morphology significantly decreased in varicocele group compared to other groups (P < 0.001). Also, we observed a significant increase in persistent histone and DNA damage of sperm cells in varicocele rats (P < 0.05). In addition, oxidant assessment analysis showed that ROS level was higher in testis tissue and sperm cells from the left varicocele rats compared to the control group (P < 0.05).

Conclusion: This results show that varicocele has a negative effect on spermatogenesis and increased oxidative stress and reduce in antioxidant capacity hand in hand lead to the production of sperm with damaged chromatin which reduces the fertility potential and may jeopardize the future health of the progeny.

CASE REPORT


We encountered 2 patients (a 33-year-old woman and a 66-year-old man) with an aldosterone-producing adenoma (APA) and a left accessory spleen. The patients’ primary symptoms were hypertension and hypokalemia, and both had elevated serum aldosterone levels. Preoperative computed tomography a left suprarenal retroperitoneal mass and laparoscopic left adrenalectomy was performed in both cases. The postoperative microscopic examination revealed splenic tissue. Both patients experienced relief of their hypertension and hypokalemia, with an uneventful recovery.

A Case Report of Synchronous Prostate Cancer and Rectal Gastrointestinal Stromal Tumor and its Management

Ryuta Watanabe, Akira Ozawa, Tokuhiro Iseda, Hiroaki Hatano

Urology Journal, Vol. 16 No. 3 (2019), 17 June 2019 , Page 322-325
https://doi.org/10.22037/uj.v0i0.3834

A 72-year-old Japanese man presented to the hospital with complaints of gross hematuria. Contrast enhanced com­puted tomography revealed a broad-based, approximately 3-cm bladder tumor near the right ureteral orifice and a 5-cm mass located between the prostate and rectum. The patient underwent transurethral resection of the bladder tumor and a transrectal biopsy of the lesion. Histological examination of the specimens suggested that the patient had a muscle invasive adenocarcinoma from transurethral resection and a rectal gastrointestinal stromal tumor in TRUS biopsy. Patient underwent total pelvic exenteration and ileal and colonic stomas to divert urine and faeces. Final pathology report of the resected specimen revealed a rectal gastrointestinal stromal tumor and prostatic ad­enocarcinoma, which had invaded the urinary bladder and seminal vesicles. Synchronous gastrointestinal stromal tumor in rectum and prostate cancer treated with total pelvic exenteration has not been reported before in literature.

UNCLASSIFIED


Comparison of Alpha-Blockers and Antimuscarinics in Improving Ureteral Stent-Related Symptoms: A Meta-Analysis

Yiyang Gao, Hengrui Liang, Luhao Liu, Alberto Gurioli, Wenqi Wu

Urology Journal, Vol. 16 No. 3 (2019), 17 June 2019 , Page 307-311
https://doi.org/10.22037/uj.v0i0.4142

Purpose: A meta-analysiswas conducted to compare alpha-blocker (AB) and antimuscarinic (AM) monotherapies in releasing US-related symptoms.

Methods: A comprehensive literature search was performed on online databases PubMed, Web of Science, Med­line, and Cochrane library. Ureteric Symptom Score Questionnaire (USSQ), International Prostate Symptom Score (IPSS), quality of life (QoL) and visual analogue pain scale (VAPS) were pooled and compared.

Results: Nine full-text articles met the inclusion criteria and have been included. The studies were conducted in 9 different centers between 2009 and 2016. All articles were RCT studies and a total of 654 patients were recorded totally, among which 323 were given alpha-blockers while others were given antimuscarinics. Although patients using alpha-blockers presented lower USSQ scores, no statistically significant difference was recorded in urinary symptom(SMD 0.5, 95 % CI -0.2 to 1.20, P = 0.159), pain(SMD 0.33, 95 % CI -0.26 to 0.92, P = 0.280),general health, work performance(SMD-0.34, 95 % CI -0.08 to 0.76, P = 0.115) and sexual performance (all p > 0.05) (SMD 0.12, 95 % CI -0.10 to 0.34, P = 0.280). Meanwhile IPSS (SMD -0.10, 95 % CI -0.32 to 0.11, P = 0.358), QoL(SMD-0.03, 95 % CI -0.23 to 0.18, P = 0.802) and VAPS(SMD 0.08, 95 % CI -0.15 to 0.31, P = 0.447) were similar between the two groups (all P > 0.05).

Conclusion: The analysis suggests that AB showed a similar effect with AM. It is necessary to conduct a larger and more detailed cohort study and find the population that potentially might benefit most by AM.

Purpose: Catheter-associated urinary tract infection (CAUTI) occurs frequently in critical illness with signifi­cant morbidity, mortality, and additional hospital costs. The epidemiology of symptomatic ward-acquired CAUTI (within 48 hours of intensive care unit [ICU] admission) has not been carefully examined. The objective of our study was to identify the patient characteristics and microbiology of symptomatic CAUTI in critical illness.

Materials and Methods: A 4-year retrospective observational study (2013-2016) was conducted at a single adult ICU with 30 beds in a tertiary hospital in Northeast China. The enrolled patients were over 18 years of age and had been diagnosed as having symptomatic CAUTIs in the ICU from January 2013 to December 2016. The infor­mation of clinicopathological characteristics (such as age, sex, underlying diseases, hospital admission diagnosis, ICU admission source, severity of illness, duration of urinary catheterization, use of antibiotics, duration of ICU stay, and ICU mortality) was recorded in an electronic database by senior clinicians who were blinded to the study purpose and design. Microbiological data were retrieved from the computerized hospital database.

Results: Between January 2013 and December 2016, 4115 patients were admitted to the ICU. Ninety-eight symp­tomatic CAUTI cases were enrolled in this study, including 29 patients who had ward-acquired CAUTI and 69 pa­tients who had ICU-acquired CAUTI. Patients with ward-acquired symptomatic CAUTI had significantly shorter overall ICU length of stay and shorter urinary catheterization time, and the overall ICU mortality was significantly higher in patients who had ICU-acquired symptomatic CAUTI. More third-generation cephalosporins and carbap­enems were used prior to CAUTI in the patients with ICU-acquired symptomatic CAUTI. Escherichia coli and Acinetobacter baumannii were the most common bacteria causing ward-acquired and ICU-acquired CAUTI, re­spectively. There were a higher number of cases of non-Candida albicans infections in patients with ICU-acquired symptomatic CAUTI than in patients with ward-acquired symptomatic CAUTI.

Conclusion: Clinical characteristics, microbiological characteristics, and prognosis were different between ward-acquired and ICU-acquired symptomatic CAUTI. Patients with ICU-acquired symptomatic CAUTI had higher overall ICU mortality.