ISSN: 1735-1308

Vol. 16 No. 06 (2019)

Best Reviewer


ORIGINAL PAPER (ENDOUROLOGY AND STONE DISEASE)


The Effects of Aqueous Extract of Eryngium Campestre on Ethylene Glycol-Induced Calcium Oxalate Kidney Stone in Rats

Hamidreza Safari, Sajjad Esmaeili, Mohammad Sadegh Naghizadeh, Mehran Falahpour, Mohammad Malekaneh, Gholamreza Anani Sarab

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 519-524
https://doi.org/10.22037/uj.v0i0.4287

Purpose: This study aimed to evaluate the anti-inflammatory effect of E. campestre using the aqueous extracts, obtained from the aerial parts, on Ethylene Glycol (EG)-induced calcium oxalate kidney stone in rats.

Materials and Methods: 64 male Wistar rats were randomly divided into 8 groups. Group I was considered as negative control and received normal saline for 30 days, group II as kidney stone control received EG for 30 days, groups III to VI as prophylactic treatment received EG plus 100, 200 or 400 mg/kg extracts for 30 days and groups VI to VIII received EG as therapy from day one and 100, 200 or 400 mg/kg extract from the 15th day. On the 30thday from the start of induction, rats were euthanized. Blood was collected and the kidneys were immediately excised. Slides from each one’s kidneys were prepared and stained with Hematoxylin & Eosin method. Also levels of interleukin-1 beta (IL-1?) and interleukin-6 (IL-6) were determined in rat’s serum by competitive ELISA kit.

Results: E. campestre reduced IL-1? and IL-6 levels, showing a significant reduction for both cytokines in all prophylactic groups, especially at the dose of 400 mg/kg (P-value < .001). Moreover, IL-1? (p = .011) reduced significantly in the therapy groups in 400 mg/kg dose. Crystal count reduction was seen in all prophylactic and therapy groups in comparison with group II.

Conclusion: These results suggest that the E. campestre extract has potent suppressive effect on pro-inflammatory cytokine production in rat. Also, E. campestre decreases crystal deposition in the kidney of the hyperoxaluric rat.

Effect of Irrigation Solution Temperature on Complication of Percutaneous Nephrolithotomy: A Randomized Clinical Trial

Seyed Reza Hosseini, Mohammad Ghasem Mohseni, Seyed Mohammad Kazem Aghamir, Hamed Rezaei

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 525-529
https://doi.org/10.22037/uj.v0i0.4399

Purpose: Many factors affecthypothermia and shivering during percutaneous nephrolithotomy and in recovery.
Hence this study was carried out to determine the effect of irrigation solution temperature on complications of
percutaneous nephrolithotomy.

Materials and Methods: In this randomized clinical trial, 60 patients undergoing PCNL in Sina University Hospital
were enrolled. The patients were randomly assigned in three groups according to simple random manner. The
groups included three groups of room temperature fluid (24 degree), warm solution (37 degree), and cold fluid (20
degree) during nephroscopy.

Results: Although the initial core temperature was alike across the groups (P > .05); the hypothermia rate occured
in all 20 patients in the cold fluid group (P = .012). There was significant difference between the groups in
terms of final temperature and alteration amount (P = .001). The mean VAS scores were significantly lower in the
warm fluid group compared with the others groups at recovery, and 8hrs post-operatively (P = .03). Assessment
of shivering rates revealed that 3(15%) patients in warm solution group shivered compared to8 (40%) patients in
cold fluid group (P = .018).

Conclusion: Warm irrigation solution during PCNL results in significantly decreased hypothermia, mean postoperative
pain score and shivering. Hence use of warm irrigation fluid for this matter is recommended.

Short-term Alteration of Renal Function and Electrolytes after Percutaneous Nephrolithotomy

Subhabrata Mukherjee, Rajan Kumar Sinha, Tarun Jindal, Pramod Kumar Sharma, Soumendra Nath Mandal, Dilip Karmakar

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 530-535
https://doi.org/10.22037/uj.v0i0.4558

Purpose: To analyse the changes in renal function and serum electrolytes in the early post-operative period of
percutaneous nephrolithotomy (PCNL).

Materials and Methods: A total of 110 patients with normal renal function, who underwent PCNL in our institute
were evaluated prospectively. Haemoglobin percentage, packed cell volume, blood urea nitrogen, serum creatinine
and serum electrolytes, namely sodium, potassium, chloride and ionized calcium were measured on the day before
surgery and after 72 hours of the procedure. Renal function was assessed by Cockcroft-Gault formula and estimated
glomerular filtration rate was calculated by modification of diet in renal disease formula.

Results: Serum creatinine increased significantly from a mean value of 0.89 ± 0.199 mg/dL to 0.96 ± 0.252 mg/dL
(P = 0.0002) and both creatinine clearance and estimated glomerular filtration rate experienced a significant fall -
from a median value (interquartile ranges) of 82.99 (72.37 to 96.88) mL/min to 75.38 (63.89 to 94.05) mL/min in
case of creatinine clearance (P = 0.0004) and from a mean value of 95.18 ± 19.87 mL/min/1.73 m2 to 89.30 ± 23.14
mL/min/1.73 m2 in case of estimated glomerular filtration rate (P = 0.003). Furthermore, there were significant
drops in both haemoglobin percentage and packed cell volume. There were no significant alterations in serum electrolytes
- sodium and potassium (mmol/L) [Median (IQR)] changed from a pre-operative figure of 137.5 (134.0 to
140.0) and 3.85 (3.60 to 4.10) to a post-operative value of 138 (135.0 to 140.0) and 3.85 (3.50 to 4.10) respectively.

Conclusion: Even though there is no significant variation in serum electrolytes, PCNL causes significant reduction
in renal function in the early post-operative period.

The Impact of Sheath Size in Miniaturized Percutaneous Nephrolithotomy in Adult Patients; A Matched-pair Analysis

Akif Erbin, Burak Ucpinar, Alkan Cubuk, Ozgur Yazici, Harun Uysal, Metin Savun, Seref Basal, Mehmet Fatih Akbulut

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 536-540
https://doi.org/10.22037/uj.v0i0.4676

Purpose: The miniaturized percutaneous nephrolithotomy (mPNL) can be performed by using a very wide range of different access sheaths (14-22 Fr).It has been well known that tract size is one of the main parameters affecting the complication rates in PNL. We aimed to compare 21 Fr with 16.5 Fr mPNL tract sizes in adult patients.

Material and Methods: From May 2013 to April 2018, 604 patients with kidney stone underwent mPNL in our department. The study was designed as retrospective and match-pair analysis was the preferred method for the formation of groups.  The 21 Fr mPNL cases were matched with 16.5 Fr mPNL cases at a 1:1 ratio, according to the patients’ age, gender, body mass index, American Society of Anesthesiologists (ASA) score, stone characteristics (stone size, opacity and localization) and hydronephrosis. Patients with solitary kidney, renal anomalies, musculoskeletal abnormalities, and pediatric patients (< 18 years old) were excluded from the study. Both groups (21 Fr and 16.5 Fr) were compared in terms of demographics, stone characteristics, operative data and post-operative outcomes.

Results: A total of 260 patients were included in the study (130; 21 Fr mPNL group and 130; 16.5 Fr mPNL group). The operation time was significantly shorter in 21 Fr group (21 Fr; 85.2±37.5, 16.5 Fr; 101.7±37.7 minutes, p: 0.001). Complete stone clearance rates were 76.9% and 62.3% in 21 Fr and 16.5 Fr mPNL, respectively (p: 0.01). There was no significant difference between the groups in terms of overall operative and post-operative complications. However, in subgroups analysis, post-operative fever was higher in 16,5 Fr mPNL (4 patients in 16.5 Fr, no patients in 21 Fr group, p: 0.044); steinstrasse, renal colic and post-operative JJ stent requirement rates were higher in 21 Fr mPNL procedure (p: 0.018, p: 0.031 and p: 0.046, respectively). The hospitalization time was significantly higher in 21 Fr (p: 0.01).

Conclusions: Although 21 Fr mPNL procedure has advantages such as better success rates and shorter operation time, some post-operative complications (steinstrasse, renal colic, post-operative JJ stent requirement) are against of 21 Fr mPNL when compared with 16.5 Fr mPNL procedure. Further randomized prospective studies with larger patient volume are needed to confirm these results.

Retrograde Intrarenal Surgery Following Laser Endopyelotomy; Sequential Procedures for Ureteropelvic Junction Obstruction and Nephrolithiasis

Ibrahim Kartal, Can Tuygun, Ahmet Nihat Karakoyunlu, Fatih Sandikci, Burhan Baylan, Hamit Ersoy

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 541-546
https://doi.org/10.22037/uj.v0i0.5205

Purpose: This study was designed to evaluate the effectiveness and safety of retrograde intrarenal surgery (RIRS)
following retrograde laser endopyelotomy (rLEP) in concomitant ureteropelvic junction obstruction (UPJO) and
stone disease.

Materials and Methods: Patients with concomitant UPJO and renal stone disease who were first treated in our
clinic by rLEP for obstruction and then RIRS for stone disease were enrolled. Study period went from 2012 to
2017. RIRS following rLEP was performed earliest at the sixth week. Patients who underwent rLEP were matched
with those with normal anatomy at a 1:1 ratio based on the propensity scores. Additionally, clinical results were
compared in order to evaluate the effects of rLEP surgery on RIRS. Subsequently, patients who underwent RIRS
following rLEP were independently evaluated and factors affecting the success of sequential procedures were
investigated.

Results: The sole difference between those that underwent RIRS following rLEP (n=27) and controls with normal
anatomy that underwent RIRS was in operative times (p = .011). Evaluation of potential success factors in
the sequential rLEP-RIRS group revealed that primary etiology, obstruction length less than 1cm, smaller stone
size and presence of single stone showed significant effects (p = .047, p = .030, p = .040, p ? .001, respectively).
RIRS following rLEP generated an 81.5% stone-free and, after a median follow-up time of 32 months, a 74.1%
obstruction-free rate.

Conclusion: RIRS following rLEP in patients with UPJO and renal stones is an effective treatment method. It can
be used safely in patients with single stones < 2cm, short obstruction lengths, and presence of primary etiology.

ORIGINAL PAPER (LAPAROSCOPIC AND ROBOTIC UROLOGY)


Modified Mini-laparoscopic Surgery Optimized the Laparoscopic Decortication of Renal Cyst

Wei Chen, Zhi-Bing XU, Lei XU, Chen Cang, Jian-Ming Guo

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 547-551
https://doi.org/10.22037/uj.v0i0.5029

Purpose: This study was to introduce the modified mini-laparoscopic surgery for renal cyst and investigate its
advantages on operative time, cosmetic effect and pain reduction by comparison with laparo-endoscopic single site
surgery (LESS) and conventional laparoscopic surgery.

Methods and patients: Between May 2015 and October 2018, 140 consecutive patients with benign renal cyst
underwent laparoscopic decortication of renal cyst. Of which, 48 cases were in mini-laparoscopic surgery group
(M group), 56 cases in LESS group and 36 cases in conventional laparoscopic surgery group (C group). The operative
time, blood loss, visual analog scale (VAS) and Scar Cosmesis Assessment and Rating (SCAR) Scale was
recorded.

Results: The mean operative time in M group (26.08±7.70 min) and C group (28.56 ± 7.99 min). was significantly
less than that in LESS group (47.32 ±10.53 min) (P < 0.01). Mean blood loss did not differ between the 3 groups
(P > 0.05). Mean VAS pain scores in M group were significantly lower than that of LESS group and C group on
postoperative day (POD) 1 and 3 (P < 0.01). The SCAR scale of POD 30 in C group (6.25 ± 1.0) was significantly
higher than that in M group (0.77 ± 0.59) and LESS group (0.98 ± 0.70). The postoperative course was uneventful
with no morbidity within 1to 6 months of follow-up.

Conclusion: Modified mini-laparoscopic decortication of renal cyst have more comprehensive advantages comparing
with LESS and conventional laparoscopic surgery. It is convenient and offered significant cosmetic benefit
and reduced incisional pain.

ORIGINAL PAPER(UROLOGICAL ONCOLOGY)


Multiparametric MRI for the Diagnosis of Tumor Type in Patients Suspicious of Inner Gland Prostate Cancer

Zahra Ghane, Fariborz Faeghi, Mahyar Ghafoori, Abolfazl Payandeh

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 552-557
https://doi.org/10.22037/uj.v0i0.4998

Purpose: The current study aimed to evaluate multiparametric MRI for the diagnosis of type of tumor (benign or
malignant) in patients suspicious of inner gland prostate cancer.

Materials and Methods: This cross-sectional study was conducted on 44 consecutive patients with a clinical
impression of prostate cancer who were referred to the MRI department of Payambaran Hospital, Tehran, Iran
for confirmative diagnostic evaluation. Cases suspected of tumor relapse and those who previously underwent
treatment for prostate cancer were excluded. Multiparametric MRI was performed for every patient by using a 1.5
Tesla device with an integrated endorectal and pelvic-phased array coil. All patients subsequently underwent MRItransrectal
ultrasound fusion biopsy. The diagnostic value of each sequence was then investigated individually and
in combination with other techniques by comparing the results with histological findings from MRI–TRUS fusion
biopsy.

Results: Among the techniques, T2-weighted imaging (T2W) had the highest sensitivity and specificity while
dynamic contrast enhanced (DCE) technique had the least. Diffusion-weighted imaging (DWI) and magnetic resonance
spectroscopy (MRS) had a similar sensitivity and specificity and did not significantly differ from T2W.
Adding functional techniques to T2W did not improve diagnostic indices compared to T2W alone. Quantitative
evaluation of apparent diffusion coefficient (ADC), DWI, and MRS showed that all techniques were able to differentiate
between benign and malignant tumors. However, the quantitative combination of these sequences decreased
diagnostic performance.

Conclusion: T2W is the best technique for the diagnosis of type of tumor in terms of benignancy or malignancy
in patients suspicious of inner gland prostate cancer. Adding functional imaging measurements to T2W does not
improve its diagnostic value.

The Association of A Number of Predictive Factors for The Recurrence of Papillary Urothelial Neoplasm of Low Malignant Potential: Prognostic Analysis From Multiple Academic Centers

Ki Hong Kim, Seung Hwan Lee, Sun Il Kim, Byung Ha Chung, Kyo Chul Koo, Jin Seon Cho, Woo Jin Bang, Jong Yeon Park, Sung Joon Hong

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 558-562
https://doi.org/10.22037/uj.v0i0.4519

Purpose: To identify clinically useful predictors for the recurrence of papillary urothelial neoplasm of low malignant potential (PUNLMP), we reviewed the clinical information of patients who were diagnosed and treated in multiple tertiary-care academic facilities.

Materials and Methods: Between February 2007 and April 2015, 95 patients diagnosed with PUNLMP after transurethral resection of bladder (TURB) were included in this study. Age, gender, body mass index, smoking history, the presence or absence of previous history of urothelial neoplasm, the presence or absence of gross hematuria, cytological results at the time of diagnosis, tumor diameter, and multiplicity of tumor were estimated as variables
for analysis. Cox regression tests were used for identifying predictive factors for recurrence of PUNLMP.

Results: Sixty-nine cases of PUNLMP were de novo primary bladder PUNLMPs without known urothelial lesions in the urinary tract, and 26 PUNLMPs were identified on surveillance biopsies of patients with a previous history of urothelial neoplasm. During the follow-up period, recurrences developed in 13 patients (13.7%). Recurrence rates were 4.2% and 9.5% at 12 and 24 months, respectively. On univariate and multivariate Cox regression analyses, previous history of urothelial neoplasm [95% confidence interval (CI): 0.057-0.604, hazard ratio (HR) = 0.185, P = .005] and multiplicity of tumors [95% CI = 0.064-0.584, HR = 0.193, P = .004] were identified as independent predictors for recurrence-free survival of patients with PUNLMP.

Conclusion: Tumor multiplicity and previous history of urothelial neoplasm are independent prognostic factors for
prediction of recurrence of PUNLMP. More careful and closer follow-up should be recommended for PULNMP
patients with tumor multiplicity or a previous history of urothelial neoplasm.

Purpose: Biochemical failure after radical prostatectomy has been defined based on retrospective studies in men who underwent RP for localized prostate cancer. Nevertheless, retrospective strategy and possibility of extra-prostatic extension overshadowed the accurateness of the aforementioned cut-off value. To define a more precise PSA nadir value, we estimated serum PSA after cystoprostatectomy in cases with bladder urothelial cancer and no evidence of prostate cancer.

Materials and Methods: Study population consists of 52 subsequent patients who underwent radical cystoprostatectomy for muscle-invasive bladder cancer between December 2010 and December 2013. Patients with prostate adenocarcinoma and/or high grade prostate intraepithelial neoplasia were excluded from enrollment. Other exclusion criteria were prostate involvement with urothelial carcinoma, neoadjuvant or adjuvant chemotherapy and radiation therapy. Between all cases, 41 were enrolled for study. Serum PSA level was measured using immunochemiluminescence method among 6 months to 3 years after operation in study participants.

Results: Forty-one patients with mean age of 66.4 ± 8.9 were assessed in this study. Average serum PSA level after radical cysto-prostatectomy was .037 ± .031 ng/mL (from .002 to .1). Serum PSA level was not impressed with type of diversion or interval between operation and PSA measurement. Average serum PSA level in this study was meaningfully lesser than .2 ng/mL which is contemplated as PSA nadir value after RP.

Conclusion: Serum PSA level of 0.2 ng/mL as the definition for biochemical recurrence after RP may delay salvage treatment. Our results showed that cut off value of ?0.1 ng/mL may be more precise in the era of early salvage treatment.

ORIGINAL PAPER (PEDIATRIC UROLOGY)


Ischemia Modified Albumin and D-dimer in the Diagnosis of Testicular Torsion: An Experimental Model

Fatma Sarac, Selman Yeniocak, Akif Erbin, Esma Yucetas, Kamile Altundal, Burak Ucpinar, Ayse Saygili, Macit Koldas

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 567-571
https://doi.org/10.22037/uj.v0i0.4974

Purpose: We aimed to investigate the potential early diagnostic value of ischemia modified albumin (IMA) and D-dimer in testicular torsion.

Material and Methods: A total of 42 prepubertal Wistar-Hannover rats (26-30 days old, weighing 75-125 grams) were used in the study. They were randomly divided into 2 groups as torsion (21 rats) and control (21 rats). Both torsion and control groups were subdivided into three subgroups as 30th, 120th and 240th minutes. Intraperitoneal injection of 70 mg/kg ketamine (Ketalar, Pfizer, Istanbul, Turkey) plus 10 mg/kg of xylazine (Rompun, Bayer, Istanbul, Turkey) were used for general anesthesia. In the control group, scrotal incision was made and the left testis gently extracted. Then, intracardiac blood and testicular tissue were obtained at 30th, 120th and 240th minutes. In torsion group, testicular ischemia was achieved by rotating left testis 720° clockwise and maintained by fixing the testis. Blood and testicular samples were obtained at 30th, 120th and 240th minutes. All animals were sacrificed after completion of the study.

Results: There was a statistically significant difference between the IMA and D-dimer levels at 30th, 120th and 240th minutes of torsion group when compared with the control group (p = .001). When compared in terms of pathological changes at 30th, 120th and 240th minutes, significant difference was found for all 3 periods (p = 0.039, p = 0.014, p = 0.03, respectively). The D-dimer and IMA estimated torsion with reasonable accuracy [Area under the curve (AUC)= 0.771 (p = 0.003, 95% confidental interval: 0.620-0.922) and AUC = 0.706 (95% confidental interval: 0.549-0.863, p = 0.022), respectively.

Conclusion: The elevated D-dimer and IMA serum levels observed in the experimental testicular torsion model
seem to have a potential role as a serum marker in the early diagnosis of testicular torsion.

ORIGINAL PAPER (KIDNEY TRANSPLANTATION)


Expression Levels of lncRNAs in the Patients with the Renal Transplant Rejection

Mohsen Nafar, Shiva Kalantari, Sayyed Mohammad Hossein Ghaderian, Mir Davood Omrani, Hamid Fallah, Shahram Arsang-Jang, Tahereh Abbasi, Shiva Samavat, Noshin Dalili, Mohammad Taheri, Soudeh Ghafouri-Fard

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 572-577
https://doi.org/10.22037/uj.v0i0.5456

Purpose: Long non-coding RNAs (lncRNAs) include a vast portion of human transcripts. They exert regulatory roles in immune responses and participate in diverse biological functions. Recent studies indicated dysregulation of lncRNAs in the process of transplant rejection. In the current study, we aimed at identification of the expression of five lncRNAs (OIP5-AS1, FAS-AS1, TUG1, NEAT1 and PANDAR) in association with the process of transplant rejection.

Material and Methods: We assessed expression of these lncRNAs in the peripheral blood of 61 kidney transplant receivers including 29 transplant rejected patients and 32 transplant non-rejected patients using real time PCR technique.

Results: Expression of FAS-AS1 was significantly higher in rejected group compared to non-rejected group in males, however, differences between case and control groups were insignificant among females. For other lncRNAs no significant differences were detected between two study groups. Quantile regression model showed that patients’ gender was an important parameter in determination of FAS-AS1 expression (Beta=-9.46, t=-2.82, P=0.007) but not for other lncRNAs expressions. Significant pairwise correlations were detected between expression levels of lncRNAs in a disease related manner.

Conclusion: Based on the higher expression of FAS-AS1 in patients with transplant rejection, this lncRNA might be associated with the pathogenesis of renal transplant rejection.

ORIGINAL PAPER (RECONSTRUCTIVE SURGERY)


Efficacy of Using Non-tunneled Dialysis Catheters During Arteriovenous Fistula till its Maturation: A Retrospective Study

Gholam Hossein Kazemzadeh, Maziar Bazrafshan, Mohammad Mahdi Kamyar, Adeleh Hashemi Fard

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 578-580
https://doi.org/10.22037/uj.v0i0.5120

Purpose: Due to high prevalence of diabetes mellitus and subsequent nephropathy, the need for access to start and continue dialysis has been increased. In this study, we aim to study the efficacy and complications of non-tunneled catheters (NTC) till fistula maturation because of being easy and cheap implementation as well as similar complications compared to tunneled catheters (TC).

Materials and Methods: In this retrospective observational study, 247 patients with first-time AVF creation referred to Vascular Surgery Centre of Mashhad University of Medical Sciences, Iran, were recruited since March 2016 to December 2017. Only 153 patients who have completed the study, and were monitored every two weeks in case of un-maturation along with the status of temporary catheters.

Results: Mean age of patients was 49.9 ± 7.74 years, and 75 (49%) were females, which was comparable with literature. Preference of NTC implementation was at right jugular because of the easy access to central vein and less chance of complications. Catheter location was at right internal jugular in 61.4% of the patients. Out of 24 femoral cases, 18 was done at femoral. AVF location was done at left/right cubital in most cases (52.3%). The rate of infection was 15.0%, which was less than NTC’s infections reported in the literature.

Conclusion: Use of non-tunneled catheter in the form of outpatient in the period of AVF maturation time is recommended
due to similar complication rate.

ORIGINAL PAPER (FEMALE UROLOGY)


Postoperative Outcomes Following Tension-Free Vaginal Mesh Surgery for Pelvic Organ Prolapse: A Retrospective Study

Aki Oride, Haruhiko Kanasaki, Tomomi Hara, Satoru Kyo

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 581-585
https://doi.org/10.22037/uj.v0i0.4631

Purpose: We retrospectively reviewed the postoperative outcomes of patients who underwent tension-free vaginal mesh (TVM) surgery in our institution.

Methods: In total, 195 TVM surgeries were performed at the Shimane University School of Medicine from January 2010 to May 2016 in patients with Pelvic Organ Prolapse–Quantification (POP-Q) stage II or higher. Perioperative complications and problems arising following surgery were assessed from medical charts.

Results: Among the 195 patients, only 1 patient required blood transfusion due to massive intraoperative blood loss. None of the patients experienced intraoperative complications, such as injury to the bladder or rectum during surgery. Mesh exposure was observed in 10 patients (5.1%). Overall, 6 of these 10 patients were asymptomatic, and surgical treatment was required in only 1 patient. Mesh exposure occurred at significantly higher frequencies in patients aged less than 60 years. Postoperative recurrence of POP, which was defined as recurrence over POP-Q stage 2, was noted in 13 of the 195 patients (6.6%). Re-operation was performed in 1 patient in whom recurrence was observed within 3 months postoperatively. Recurrence of POP was likely to occur in patients with higher POP-Q stages. Overall, 31 of the 195 patients (15.9%) required medication for postoperative stress urinary incontinence (SUI) after surgery. Among these, 2 patients underwent surgical treatment for SUI.

Conclusion: Outcomes following the TVM procedure were satisfactory. However, caution should be exercised
against mesh exposure in younger patients and recurrence of POP in patients with advanced POP-Q stage.

ORIGINAL PAPER (ANDROLOGY)


Detection of Polymorphisms in MTHFD1 G1958A and Its Possible Association with Idiopathic Male Infertility

Amir Afshin Khaki, Asghar Tanoomand, Abolfazl Hajibemani, Beheshteh Abouhamzeh

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 586-591
https://doi.org/10.22037/uj.v0i0.4647

Purpose: The role of male infertility is important in human infertility pathology. Spermatogenesis is a complex developmental process which is regulated by a number of genes. Methylenetetrahydrofolate dehydrogenase1 (MTHFD1) is involved in the synthesis of purine, pyrimidine, and methionine. The aim of this study was to identify the MTHFD1, G1958A polymorphism and its association with idiopathic male infertility in Iranian population.

Materials and Methods: This case-control study was conducted on 200 Iranian men, 100 cases with idiopathic infertility (experimental group) and 100 normal men (control group). The subjects were assessed for the MTHFD1 G1958A polymorphism, using the polymerase chain reaction-restriction fragment length polymorphism technique (PCR-RFLP). The chi-square test was used to determine the association between MTHFD1 G1958A polymorphism and male infertility, using SPSS software. P ? 0.05 was considered significant.

Results: Totally, the frequency of A allele and AA homozygous genotype was found 51% and 47.3% respectively, with 52.5% and 30% in the experimental group versus 42% and 21% in control group. There was a statistically significant correlation between the frequencies of A allele (95 % CI = 1.028- 2.265, OR = 1.526, p = 0.035) and AA homozygous (% CI = 0.995- 4.494, OR = 2.114, 95 p = 0.05) genotype with the MTHFD1 G1958A polymorphism (P ? 0.05).

Conclusion: These results suggest that the polymorphism in MTHFD1 G1598A gene could be considered as an important genetic disorder associated with the etiology of male infertility.

The Effect of Aerobic Training on Serum Levels of Adiponectin, Hypothalamic-Pituitary-Gonadal Axis and Sperm Quality in Diabetic Rats

Mohammad Parastesh, Abbas Saremi, Akbar Ahmadi, Mojtaba Kaviani

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 592-597
https://doi.org/10.22037/uj.v0i0.4728

Purpose: The present study aims to investigate the effects of aerobic training on adiponectin, sex hormones, and sperm parameters in Streptozotocin–Nicotinamide induced diabetic rats.

Material and Methods: In the experiment, 52 eight-week-old Sprague Dawley rats (200-250 g) were randomly assigned into three groups: healthy control, diabetic control, and diabetic aerobic training. Diabetes was induced by intraperitoneal injection of nicotinamide solution and STZ solution. The aerobic training protocol was performed for ten weeks. Finally, blood serum was used to assess FSH, LH, testosterone and adiponectin levels. Data were analyzed using ANOVA and Tukey's post hoc test using SPSS-22 software at 0.05 level of significance.

Results: Results showed an increase in serum adiponectin levels in aerobic training group, which let to a significant difference between aerobic training group and diabetic control group (3.8±1.1 ?vs 1.6±0.6, P = .42). In addition, aerobic training caused significant increases in serum testosterone level and LH in diabetic aerobic training group, so that significant differences were observed between serum testosterone (5.7±2.3 vs 6.6±1.8, P = .117), LH (4.7±1 vs 5.6±2.8, P = .746) and FSH (5.9±5 vs 4.4±1, P = .596) of diabetic aerobic training group and healthy control group. Sperm parameters in the diabetic aerobic training group including sperm count (26±13.2 vs 11.7±5.7, P = .03, motility (40±6.5%vs 32.5±1.1%, P = .41) and viability (41.7±7.2% vs 29.78±16.2%, P = .000) presented significant differences compared to diabetic control group.

Conclusion: Short term aerobic training can improve serum adiponectin levels and sperm parameters, including sperm count and sperm motility through increasing serum testosterone, LH and FSH levels in type 2 diabetic rats.

CASE REPORT


Bladder Malakoplakia Simulating Neoplasm in a Young Girl: Report of a Case and Review of Literature

Seyed Mohammad Reza Rabani, Seyed Hossein Rabani

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 614-615
https://doi.org/10.22037/uj.v0i0.4428

Malakoplakia is a granulomatous disorder caused by infectious process. It was described by Von Hanseman in 1901 for the first time and then by Michaelis and Gutman in 1902.  Although the most frequent site of involvement is genitourinary tract, various organs have been reported to be affected. The peak age incidence is about 50 years and it is rare in childhood. In this paper we report a case of bladder malakoplakia which to our knowledge is the youngest with isolated bladder malakoplakia that has been reported.

Laparoscopic Repair of a Ureterosciatic Hernia with Urosepsis

Kyong Tae Moon, Hee Ju Cho, Jae Duck Choi, Jung Yoon Kang, Tag Keun Yoo, Jeong Man Cho

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 616-618
https://doi.org/10.22037/uj.v0i0.4459

Hernias of pelvic floor are very rare condition, and herniations of ureter into sciatic foramen are extremely rare condition which is globally reported only by 32 cases. Clinical aspects of ureterosciatic hernias appeared variously according to the degree of hydronephrosis, inflammation and infection of kidney due to ureter obstruction. Herein, we report our experience of laparoscopic repair in a patient with ureterosciatic hernia combined urosepsis.

UNCLASSIFIED


The Effect of Anticholinergics for Prevention of Storage Symptoms After Prostate Photovaporization

David Alejandro Martin Way, Rocio Barrabino Martin, Ignacio Puche Sanz, Francisco Javier Vicente Prados, Jose Manuel Cozar Olmo

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 598-602
https://doi.org/10.22037/uj.v0i0.4297

Purpose: To evaluate the efficacy of oral anticholinergics as a preventive strategy of storage symptoms and urinary incontinence associated with the early postoperative period after Greenlight laser photovaporization of the prostate (PVP). To analyze potential variables related to the onset of these symptoms.

Materials and methods: Retrospective study of 105 patients who underwent PVP using a 180-W Greenlight laser (XPS). Patients were divided into two groups, depending on whether they were or weren´t prescribed anticholinergics when discharged (oral solifenacin 5 mg for 1 month after surgery). Differences between both groups were analyzed according to IPSS, ICIQ-SF and OABq-SF scores at 1 and 6 months. The potentially predictive variables of the symptomatology after undergoing PVP that we analyzed included age, prostate volume, PSA, IPSS, ICIQ-SF, OABq-SF, Qmax, previous use of a permanent urinary catheter, energy used, and laser application time.

Results: 58 patients in the group with anticholinergics and 47 in the group without anticholinergics were compared. No significant differences were observed between both groups in IPSS (p = .521), ICIQ-SF (p = .720) or OABq-SF (p = .851) at 1 and 6 months after surgery. Regardless of the use of anticholinergics, there was a significant score improvement between the first and second checkup in all the questionnaires: there was a significant decrease in the mean IPSS (p < .001) and the mean score of the eighth IPSS question on patient’s quality of life (p = .026), ICIQ- SF (p = .010) and OAB-q related to symptoms (p = .001) as well as a significant increase in the mean OAB-q score regarding quality of life (p = .005). None of the variables analyzed showed a significant relation to the storage-symptom rate, rate of incontinence, or ICIQ-SF and OABq-SF scores.

Conclusions: The use of solifenacin 5 mg after Greenlight laser PVP is not an effective preventive treatment for storage and incontinence symptoms associated with this procedure, which seem to self-limit over time.

Clinical and Bacterial Risk Factors for Development of Post-Prostate Biopsy Infections

Amir Hasanzadeh, Peter Black, Mohammad Reza Pourmand, Gholamreza Pourmand

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 603-608
https://doi.org/10.22037/uj.v0i0.4603

Purpose: To research on clinical and bacterial risk factors and their relationship with post-prostate biopsy infection (PBI).

Materials and Methods: In this prospective cohort study, rectal swabs were collected from 158 men prior to prostate biopsy and cultured selectively for identify ciprofloxacin-resistant (FQ-R) gram-negative bacteria. The patient characteristics, phylogenetic background, sequence typing and pulsed field gel electrophoresis (PFGE) pattern were compared in two groups of FQ-R E. coli rectal and clinical isolates.

Results: In total, PBI was observed in 20 (12.5%) cases; the most of these subjects were FQ-R-colonized. (17/73 [24%] vs 3/85 [3.5%]; P < 0.001). FQ-R colonization, diabetes, hospitalization and UTI were independent risk factors (95% CI: 1.1-20.1, OR = 4.73; 95% CI: 1.7-25.3, OR = 6.57; 95% CI: 1.9-27.5, OR = 7.22; and 95% CI: 1.2-14.3, OR = 4.05; respectively),  that increased the rate of PBI (All P < 0.05). Despite the increase in infections among patients colonized with strains of E. coli ST131, its prevalence was near significance between colonized and infected groups (P = 0.07). The PFGE patterns and antimicrobial susceptibility profiles of rectal and clinical isolates in 13 patients were similar which is remarkably important and informative.

Conclusions: The most PBIs originate from FQ-R E. coli rectal colonization. Rectal culture screening and assessment of clinical risk factors can predict the incidence of PBI in patients.

The Therapeutic Effect of Intravesical Instillation of Platelet Rich Plasma on Recurrent Bacterial Cystitis in Women: A Randomized Clinical Trial

Mahboubeh Mirzaei, Azar Daneshpajooh, Alireza Farsinezhad, Zeinab Jafarian, Mohammad Reza Ebadzadeh, Narjes Saberi, Mohammad Teimorian

Urology Journal, Vol. 16 No. 06 (2019), 24 December 2019 , Page 609-613
https://doi.org/10.22037/uj.v0i0.5239

Purpose: Recurrent bacterial cystitis is a common infection in women and there are concerns about its antibiotic therapy. Platelet rich plasma has antimicrobial and tissue repairing effects. We investigated the effect of platelet rich plasma as an intravesical therapy to prevent recurrence of bacterial cystitis.

Materials and Methods: Thirty women with a history of recurrent bacterial cystitis were randomly assigned into two groups: 1) platelet rich plasma and 2) control groups. The first group received 10 mL of platelet rich plasma with intravesical instillation plus 40 mL of normal saline. The control group only received 50 mL of normal saline. We did the instillation once a week for four weeks in both groups. We followed up the participants two and 12 months after the last instillation with a questionnaire (the international consultation on incontinence questionnaire in overactive bladder) and result of their urine culture.

Results: A significant decrease was observed in the number of bacterial cystitis recurrences in the platelet rich plasma group compared to the control group 12 months after the instillation (4 vs. 1, P = 0.004). Also, there was a significant improvement in the questionnaire’s score two (3.6 ± 2.58 vs. 0.66 ± 1.63, P = 0.002) and 12 months (3.4 ± 2.77 vs. 0.006 ± 1.83, P < 0.001) after instillation in the platelet rich plasma group compared to control group. There was no adverse effect 12 months after instillation.

Conclusion: Platelet rich plasma can significantly decrease the recurrence of bacterial cystitis up to a year after instillation without any side effect.