ISSN: 1735-1308

Vol. 17 No. 1 (2020)

Best Reviewer


ORIGINAL PAPER (ENDOUROLOGY AND STONE DISEASE)


Purpose? Isothermic irrigation decreases the reduction in core temperature and shivering in patients undergoing transurethral resection of prostate gland but this effect has not been studied in patients undergoing endoscopic urethral stone treatment surgery. The current study is designed to study the effect of isothermic hydration on core temperature in patients scheduled for endoscopic urethral stone treatment surgery under spinal anesthesia. 

Materials and Methods? Sixty patients allocated randomly into two groups. In GroupW (n = 30) irrigation fluid at 37°C was used whereas at room temperature in GroupRT (n = 30). Spinal anesthesia was performed at L3-L4 interspace with 15mg of hyperbaric bupivacaine. Core temperature, shivering, and hemodynamic parameters were measured every minute until 10th minute and five minute intervals until the end of operation. Shivering and surgeon comfort was also recorded. The primary outcome was the core temperature at the end of surgery. Frequencies, means, standard deviations, percentages, chi-square tests, independent samples t-test, and Mann Whitney U tests were used where eligible for the statistical analysis.

Results? Baseline core temperature was 36.6 ± 0.4°C in GroupW and 36.6 ± 0.5°C in GroupRT (P = .097) which decreased to 36.0 ± 0.5°C and 35.2 ± 0.7°C respectively (P = .018) at the end of operation.  Shivering was observed in 36.7% (n = 11) in GroupRT and 6.7% (n = 2) in GroupW (P = .012). Hemodynamic parameter changes and demographic data were not significant between groups.

Conclusion? Isothermic irrigation decreases both the reduction in core temperature and the incidence of shivering while increasing the surgeon comfort.

Is Absence of Hydronephrosis a Risk Factor for Bleeding in Conventional Percutaneous Nephrolithotomy?

Hee Youn Kim, Hyun-Sop Choe, Dong Sup Lee, Je Mo Yoo, Seung-Ju Lee

Urology Journal, Vol. 17 No. 1 (2020), 26 January 2020 , Page 8-13
https://doi.org/10.22037/uj.v0i0.4826

Purpose: There is conflict of evidence regarding whether absence of hydronephrosis is a risk factor for bleeding in percutaneous nephrolithotomy (PNL). Moreover, among the stone complexity scoring system used for PNL (Guy’s stone score, the S.T.O.N.E. nephrometry and the CROES nomogram), only the S.T.O.N.E. nephrometry score incorporates hydronephrosis as a risk factor. Therefore, this study aimed to compare perioperative outcomes according to the presence or absence of hydronephrosis in percutaneous nephrolithotomy (PCNL) patients and to investigate whether absence of hydronephrosis is a risk factor for blood transfusion rate.

Materials and Methods: 281 patients who had undergone PCNL between December 2009 and April 2017 were divided according to the absence or presence of hydronephrosis (group I and group II, respectively). Perioperative outcomes were compared between the two groups. A multivariable regression analysis was performed to investigate whether hydronephrosis was a risk factor for blood transfusion rate.

Results: Patients without hydronephrosis showed significantly longer operation time and admission period, lower stone-free rate and higher blood transfusion rate compared to patients with hydronephrosis (p < 0.05, p = 0.002, p = 0.011, and p < 0.05, respectively). Multivariate logistic regression analysis showed that hydronephrosis was a significant risk factor for blood transfusion (OR, 95% CI and p value was 0.353, 0.163-0.761 and 0.008, respectively).

Conclusion: Based on the results of the current study, we found that absence of hydronephrosis was a significant risk factor for blood transfusion in conventional PCNL.

Initial prospective study of ambulatory mPCNL on upper urinary tract calculi

Ye Tian, Xiushu Yang, Guangheng Luo, Yandong Wang, Zhaolin Sun

Urology Journal, Vol. 17 No. 1 (2020), 26 January 2020 , Page 14-18
https://doi.org/10.22037/uj.v0i0.4828

Objective: To explore the feasibility and safety of ambulatory mPCNL (mini percutaneous nephrolithotomy) on upper urinary tract calculi.

Methods: Clinical data of 18 patients received ambulatory mPCNL during Aug. 2017 to Jan. 2018 and 23 patients treated with routine inpatient mPCNL of the corresponding period were collected. All the patients included received 16Fr channel PCNL under the guidance of Doppler ultrasound. A 6Fr double J stent was placed in the ureter for internal drainage, and either an indwelling 14Fr open nephrostomy tube was placed or the puncture channel was filled with absorbable hemostatic materials alone, depends on the bleeding condition of the puncture channel and the intraoperative conditions. Preoperative parameters and surgery time, complications, total hospitalization costs and hospital stay time between the two groups were compared.

Results: Preoperative parameters regarding age (P=0.057), sex distribution (P=0.380), ASA score (P=0.388), Calculi CT value (P=0.697), and the S.T.O.N.E. score (P=0.122) were comparable between the two groups. Maximum diameter of calculi (cm) of the conventional hospitalization group, however, was larger than the ambulatory surgery group (P=0.041). There were no significant differences in the mean surgery time (P=0.146), postoperative hemoglobin drop (P=0.865), Calculi-free rate on the next day after surgery (P=0.083) and postoperative fever rate (P=0.200) between the two groups. With regard to tubeless rate (P<0.001), total hospitalization costs (P=0.003) and hospital stay time (P<0.001), there were significant advantage favored ambulatory mPCNL.

Conclusions: For patients with simple upper urinary tract calculi and relatively good performance status, ambulatory mPCNL is feasible as it’s equally safe and efficient as compared with routine inpatient mPCNL. Moreover, ambulatory mPCNL decreases hospitalization costs and hospital stay time. Nevertheless, perioperative management should be carefully conducted, and well-designed studies are warranted.

Purpose: The aim of this study was to investigate the effects of listening to different music types during extracorporeal shock wave lithotripsy (SWL) on the patients’ pain control, anxiety level, and satisfaction.

Materials and Methods: This study was a prospective single-blinded, paral­lel-group randomized clinical trial with balanced ran­domization [1:1]. A total of 150 patients who underwent first-session SWL were included in the study. The patients were randomly divided in to five groups (30 participants in each group) as follows: headphones were not put on and no music was played in Group 1 (control group); headphones were put on but no music was played in Group 2; Turkish art music was listened to with headphones in Group 3; Western classical music was listened to with headphones in Group 4; thetype of music the patient liked was listened to with headphones in Group 5. Demographic data related to patients and procedure, State-Trait Anxiety Inventory-State Anxiety (STAI-SA), Visual Analog Scale (VAS) scores, willingness to repeat procedure (0: never 4: happily), and patient satisfaction rates (0: poor 4: excellent) were recorded immediately after the procedure.

Results: There was a statistically significant difference between groups in terms of median VAS scores (7, 6, 4.5, 5, and 4, respectively, P<.001), whereas the VAS scores in Groups 3, 4, and 5 were significantly lower than those in Group 1 and 2 (P<.001). The median STAI-SA scores between the groups were significantly different (45, 45, 42, 45, and 40, respectively, P<.001), while the anxiety levels in Groups 3, 4, and 5 were significantly lower than those in Group 1 (P=.008, P=.018, and P<.001, respectively). Moreover, there were statistically significant differences between the groups in terms of willingness to repeat the procedure and patient satisfaction rates (P<.001).

Conclusions:  Music therapy during SWL reduced the patients' pain and anxiety scores, moreover listening to the patient’s preferred music type provided greater satisfaction. Listening to the patient’s preferred music type could be standardized and routinely used during SWL.

ORIGINAL PAPER (LAPAROSCOPIC AND ROBOTIC UROLOGY)


Purpose: Radical prostatectomy is one of the most common urological surgeries. Inguinal hernia is a well-known complication of radical prostatectomy. There are many controversies about selection of surgical techniques for repair of inguinal hernia. Traditionally laparoscopic approach was contraindicated for patients with history of lower abdominal surgery, but recent studies showed that it could be safe and successful and even has some advantages over open repair. In this prospective study we evaluated outcomes of laparoscopic hernia repair in patients who previously underwent radical prostatectomy.

Materials and Methods: In this prospective study, 34 consecutive patients diagnosed with inguinal hernia after radical retropubic prostatectomy underwent laparoscopic transabdominal inguinal repair and followed up for outcomes and complications.

Results: The surgery duration was 167.44 ± 52.85 min (75-230 min). No intraoperative complications occurred. Patients were discharged within 20.79 ± 4.76 hours (12-34 hours). 69.8% of cases (30 patients) needed analgesic administration. No conversion to open surgery occurred. There were 9.3% (4 hernias) hernia recurrences. We followed patients for 9.9 ± 5.33 months (2-19 months).

Conclusion: It is concluded that TAPP for inguinal hernia repair after radical prostatectomy has good results and is effective. But according to rate of recurrence, its safeness is conflicting. We notice no major complication in our patients during the time of follow up. This may be due to safety of the operation in the proposed patients.

ORIGINAL PAPER(UROLOGICAL ONCOLOGY)


Preoperative Neutrophil-lymphocyte Ratio as a Predictor of Overall Survival in Patients with Localized Renal Cell Carcinoma

Damian Widz, Przemyslaw Mitura, Pawel Buraczynski, Pawel Plaza, Marek Bar, Michal Cabanek, Grzegorz Nowak, Anna Ostrowska, Krzysztof Bar

Urology Journal, Vol. 17 No. 1 (2020), 26 January 2020 , Page 30-35
https://doi.org/10.22037/uj.v0i0.4541

Purpose: The neutrophil-to-lymphocyte ratio (NLR), as an indicator of the systemic inflammatory response, predicts adverse outcomes in many malignancies. We investigated its prognostic significance in patients with non-metastatic renal cell carcinoma.

Materials and Methods: We retrospectively evaluated data of 196 consecutive non-metastatic RCC patients who underwent radical or partial nephrectomy between 2010 and 2012 at a single center. Overall survival (OS) was assessed using the Kaplan-Meier method and compared using the log-rank test. We applied univariate and multivariate Cox regression models to evaluate the prognostic value of dichotomized NLR for OS.   

Results: At a median follow up of 68 months, high NLR (? 2,69) correlated with worse survival outcome (P = .006 in log-rank test) and higher tumor stage (P = .035). Univariate and multivariate analysis identified elevated NLR (P = .039), as well as age (P = .002), high Fuhrmann grade (P = .002) and high pathologic T stage (P < .001), as significantly associated with overall survival.

Conclusion: In our cohort, an elevated neutrophil-to-lymphocyte ratio is significantly associated with worse OS on univariate and multivariate analysis. Consequently, the NLR is an easily acquired biomarker, which may be useful in pretreatment patient risk stratification.

Prognostic Value of Platelet Counts in Patients with Metastatic Prostate Cancer Treated with Endocrine Therapy

Kenji Shimodaira, Jun Nakashima, Yoshihiro Nakagami, Yosuke Hirasawa, Takeshi Hashimoto, Naoya Satake, Tatsuo Gondo, Kazunori Namiki, Makoto Ohori, Yoshio Ohno

Urology Journal, Vol. 17 No. 1 (2020), 26 January 2020 , Page 36-41
https://doi.org/10.22037/uj.v0i0.4735

Purpose: The endocrine therapy is effective for patients with advanced prostate cancer, but the disease eventually becomes refractory to treatment. The aim of this study was to investigate prognostic factors and to develop a risk stratification model for survival in patients with advanced prostate cancer undergoing endocrine therapy.

Materials and Methods: This study included 197 patients with stage IV prostate cancer who were treated with endocrine therapy as primary treatment at Tokyo Medical University, Tokyo, Japan, between January 1999 and November 2012. Prognostic values including baseline clinical laboratory values before endocrine therapy for stage IV prostate cancer were examined. Patients (n = 30) who were not followed or for whom data were unavailable or who were treated with radiotherapy were excluded from the study. Excluding these patients, we retrospectively analyzed 167 patients who were treated with endocrine therapy as the primary treatment. Disease-specific survival (DSS) was evaluated using the Kaplan-Meier method, and prognostic factors were identified using the Cox proportional hazard model analysis.

Results: In univariate analyses, patients with a performance status (PS) ? 2, platelet count ? 3.0× 105 µ/L, prostate specific antigen (PSA) > 50 ng/mL, alkaline phosphatase (ALP) > 350 U/L, lactate dehydrogenase (LDH) > 240 IU/L, and Gleason score (GS) ? 8, hemoglobin (Hb) < 12 g/dL, extent of disease (EOD) ? 3 and poorly differentiated adenocarcinoma showed significantly lower DSS than their respective counterparts. Neutrophil-to-Lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and white blood cell (WBC) count were not significantly associated with DSS. In a multivariate Cox proportional hazard model, PS and platelet count were independent prognostic factors. Based on the hazard rate (HR) calculated by the following formula: HR = exp (0.82 × PS + 1.38 × platelet count) patients were stratified into 3 risk groups. The differences in DSS rates among the 3 groups were statistically significant.

Conclusion: These results suggest that PS and platelet count are independent prognostic factors and that a combination of these factors can be used to stratify metastatic prostate cancer patients treated with endocrine therapy according to their DSS risk.

Comparison of Different Rectal Cleansing Methods for Reducing Post-Procedural Infectious Complications After Transrectal Ultrasound-Guided Prostate Biopsy

Jong Eun Lee, Sang Soo Shin, Taek Won Kang, Jin Woong Kim, Suk Hee Heo, Yong Yeon Jeong

Urology Journal, Vol. 17 No. 1 (2020), 26 January 2020 , Page 42-49
https://doi.org/10.22037/uj.v0i0.4583

Purpose: To compare the efficacy of three different rectal cleansing methods for reducing post-procedural infectious complications after transrectal ultrasound (TRUS)-guided prostate biopsy.

Materials and Methods: A total of 451 consecutive patients who underwent TRUS-guided prostate biopsy were prospectively included in this study. All patients received targeted antimicrobial prophylaxis and underwent bowel preparation through laxative administration. The patients were divided into three groups on the basis of the method of rectal cleansing immediately before the procedure. Group I patients (n=165) underwent cleansing of the perianal skin using povidone-iodine cotton balls; group II patients (n=116) received an injection of povidone-iodine solution (0.1 g/mL) into the anal and lower rectal canals; and group III patients (n=170) received direct manual cleansing of the mucosal surface of the anus and lower rectum using povidone-iodine cotton balls. The three groups were compared regarding the incidence of post-procedural infectious complications, re-hospitalization rates, and mean length of hospital stay using one-way ANOVA, the Chi-square test, and multiple logistic regression analysis.

Results: Post-procedural infectious complications occurred in 21.8%, 11.2%, and 6.5% of groups I, II, and III, respectively (P < .001). The incidence of overall infectious complications was significantly lower in group II (95% CI: 0.232–0.958, OR = 0.472, P = .038) and group III (95% CI: 0.129–0.555, OR = 0.267, P < .001) than in group I. Re-hospitalization rates were 9.7%, 2.6%, and 0.6% in groups I, II, and III, respectively (P < .001). The incidence of re-hospitalization was significantly lower in group II (95% CI: 0.070–0.869, OR = 0.247, P = .029) and group III (95% CI: 0.007–0.421, OR = 0.055, P = .005) than in group I. The mean length of hospital stay was significantly longer in group I than in group III (P = .009).

Conclusion: Combined with targeted antimicrobial prophylaxis, direct manual cleansing of the mucosal surface of the anus and lower rectum using povidone-iodine cotton balls was most effective in preventing post-procedural infectious complications among the three different rectal cleansing methods.

ORIGINAL PAPER (PEDIATRIC UROLOGY)


The Management of Phimosis Seen after Circumcision with Thermocautery

osman akyüz, Kamil Çam

Urology Journal, Vol. 17 No. 1 (2020), 26 January 2020 , Page 50-54
https://doi.org/10.22037/uj.v0i0.5138

Objective: One of the most frequent complications after circumcision by thermocautery is phimosis. In this study, we aimed to present the functional and cosmetic results of the modified sleeve technique for the correction of this iatrogenic phimosis.

Materials and Methods: The study group included iatrogenic phimosis cases who underwent circumcision using thermocautery during the last eight years. Initially, steroid creams were applied on these patients for six weeks. Patients who did not respond to this treatment underwent surgery using the modified sleeve technique. Control visits were performed at the first and fourth postoperative weeks.

Results: A total of 32 patients with a median age of 5.1±1.1 years were included in the study out of 13285 circumcisions by thermocautery. No positive treatment outcomes were obtained by topical steroids, and all patients proceeded to surgery by modified sleeve technique. Median operative time was 25±2.3 minutes. Cosmetic and functional outcomes were satisfactory in all cases.

Conclusion: There is no place for topical steroids in management of iatrogenic phimosis after thermocautery is observed, thus, early surgery is advised to avoid emotional stress. Our modified sleeve technique can achieve maximum cosmetic and functional outcomes without leading to extreme shortening of the penile skin and mucosa.

ORIGINAL PAPER (KIDNEY TRANSPLANTATION)


The Frequency and Risk Factors of Delayed Graft Function in living Donor Kidney Transplantation and Its Clinical Impact on Graft and Patient Survival in Part of Middle East

Mohsen Nafar, Pedram Ahmadpoor, Torki Al Otaibi, Fahad E Alotaibe, Meteb M Albugami, Wael Habhab, Ali Abdulmajid dyab allawi, Nooshin Dalili, Denis Glotz

Urology Journal, Vol. 17 No. 1 (2020), 26 January 2020 , Page 55-60
https://doi.org/10.22037/uj.v0i0.5263

Delayed graft function (DGF) is a form of acute renal failure which results in increased post-transplantation allograft immunogenicity and risk of acute rejection episodes in addition to decreased long-term survival. Its incidence and risk factors have been extensively studied, especially after deceased donation. Until now, only few data has been  published on DGF in living donor kidney transplant recipients. The present study was performed to investigate the frequency and risk factors of DGF among living- kidney transplant recipients. In this retrospective study, data had been collected from existing local hospital registries in three countries (Iran, Kingdom of Saudi Arabia (KSA) , and Kuwait ).

ORIGINAL PAPER (RECONSTRUCTIVE SURGERY)


Persian version of Patient-Reported Outcome Measure for Urethral Stricture Surgery (USS-PROM) Questionnaire, Validation and Adaptation Study

Ali Tayyebi azar, Morteza Fallah-Karkan, Mohammad Ali Hosseini, Babak Kazemzadeh Azad, Abtin Heidarzadeh, Jalil Hosseini

Urology Journal, Vol. 17 No. 1 (2020), 26 January 2020 , Page 61-67
https://doi.org/10.22037/uj.v0i0.4937

Purpose: The aim of the present study was translation, cross cultural adaptation and face validity evaluation of the Persian version of Patient-Reported Outcome Measure for Urethral Stricture Surgery (USS-PROM) Questionnaire.

Materials and Methods: This study was assessed: translation, translation quality, reverse translation and comparison of the english version, Content validity, internal consistency and stability. Content validity presents by index of content validity (CVI) and the content validity ratio (CVR). Internal consistency reliability was tested by Cronbach’s ?, and test-retest reliability was evaluated by Intraclass Correlation Coefficient (ICC) assessed by Guttman two way mixed absolute agreements.

Result: Frothy males with history urethroplasty and mean age of 41.4±9.08 (range of 19 to 52) years old; enrolled.  In the case of mean scores of difficulty from the 16 translated items, 80% had easy translation. In terms of translation quality, 92% were the satisfactorily clear. In terms of similar concept, 92% were satisfactory. The overall quality of the translation was satisfactory at 88%. The translated questionnaire has a good internal consistency (Cronbach's alpha as 0.84). CVI and the CVR, test-retest ICC evaluation were appropriate/acceptable in all questions. The questionnaire ICC was .791(CI 95%, .678-.876). Two main different aspects of the questionnaire consisted of urinary symptoms (question 1-10) and Quality of life (question 11-15) Cronbach's alpha were .800 and .671 respectively.

Conclusion: The Persian version of the questionnaire has acceptable cultural adaptation and face Validity. Further studies should be done using this translated tool to determine its applicability in the urethroplasty patients.

Purpose: The most common option for the management of urethral stricture (US) is direct visual internal urethrotomy (DVIU), because it is an easy and minimally invasive technique but the low success and high recurrence rates of this technique make urologists research for different types of therapeutic alternatives in stricture treatment. In this study we aimed to compare the internal urethrotomy with amplatz dilation for the treatment of male US.

Materials and Methods : A total of sixty patients, who have been operated due to urethral stricture were enrolled into this study. Group 1 was treated with amplatz renal dilators and the group 2 was treated with cold knife urethrotomy. All patients were evaluated for Qmax preoperatively and at the first, 3rd, 9th and 12th months postoperatively.

Results: In the 3 month uroflowmetry results, mean Q max values were 15.6±2 ml/sec in amplatz group and 15.5±1.6 ml/sec in DVIU group. There was no statisticaly difference between the two groups. However the Q max values in the postoperative 9 and 12 months were significantly decreased in the DVIU group. In the DVIU group 9 recurrences (36%) appeared and 2 of these reccurrences were in the first 3 months, whereas in the amplatz group no recurrences appeared in the first 3 months. The urethral stricture recurrence rate up to the 12 month follow up was statistically significant for group 1 when it is compared with group 2. 

Conclusions: In our experience, amplatz dilation is a good option as the initial treatment for urethral stricture.

ORIGINAL PAPER (FEMALE UROLOGY)


Long-term Outcome of Synthetic Mesh Use in Iranian Women with Genital Prolapse

Parvin Bastani, Sakineh Hajebrahimi, Fatima Mallah, Parastoo Chaichi, Fatemeh Sadeghi Ghiasi

Urology Journal, Vol. 17 No. 1 (2020), 26 January 2020 , Page 73-77
https://doi.org/10.22037/uj.v0i0.4866

Purpose: To evaluate the long-term outcome of synthetic mesh use in the treatment of women with Pelvic organ prolapse (POP).

Materials and Methods: We evaluated the outcome of synthetic mesh implantation by vaginal surgery method in 153 women (mean age of 53.66±9.31 years) with POP grade >2 in the anterior compartment. Demographic findings, baseline symptoms as well as subjective and objective outcome were recorded during the follow-up period of 36.89±11.33 months.   

Results: POP relapse occurred in 3.3% indicative of 96.7% anatomical success rate. Patients’ common baseline findings were frequency (72.5%), stress and urge incontinence (59.5% and 47.7%). Subjective outcome were vaginal pain (13.7%), dyspareunia (9.2%) and tension feeling (8.5%), while objective outcomes were mesh exposure (3.9%), urge incontinence (11.1%) and vaginal infection (1.3%). Stress incontinence was completely treated following surgery. There was significant improvement in dyspareunia, vaginal pain, urge and stress incontinence (all p < 0.001) and fecal incontinence (p = 0.02). After surgery, 88.42% were satisfied of the surgery outcome.

Conclusion: POP surgery with synthetic mesh has acceptable results, considerable improvement in symptoms and high rate of satisfaction during follow-up; however, side effects are not uncommon but tolerable.    

ORIGINAL PAPER (ANDROLOGY)


Protective Effect of Gallic Acid on Testicular Tissue, Sperm Parameters, and DNA Fragmentation against Toxicity Induced by Cyclophosphamide in Adult NMRI Mice

zahra Mehraban, Marefat Ghaffari Novin, Mohammad Ghasem Golmohammadi, Mohsen Sagha, Seyed Ali Ziai, Mohammad Amin Abdollahifar, Hamid Nazarian

Urology Journal, Vol. 17 No. 1 (2020), 26 January 2020 , Page 78-85
https://doi.org/10.22037/uj.v0i0.4858

Purpose: This study aimed to investigate the protective effect of Gallic acid (GA) on the Cyclophosphamide (CP) toxicity induced in the reproductive system.

Materials and Methods: After a pilot study for dose responses of Gallic acid ,Forty adult male NMRI mice were divided into 5 groups (n=8): control, sham (NaCl Serum: 0.2mL per day), CP (15 mg kg-1 per week; IP), GA (12.5 mg kg-1 per day ; IP) and GA (12.5 mg kg-1 per day ; IP) +CP(15 mg kg-1 per week; IP). After treatment, the left testis was detached and used for Histological examination and right testis used for Malondialdehyde (MDA) measures. Left caudal epididymis was placed in the Ham’s F10 medium and released spermatozoa were used in order to analyze sperm parameters. Sperm DNA fragmentation was assessed by Sperm Chromatin Dispersion (SCD) method.

Results:  In the CP group, there was a significant increase in the sperm DNA fragmentation (% 57.89 ± 23.91) compared with control group (% 24.52 ± 10.27). That was significantly improved by GA  (12.5 mg kg-1 per day ; IP)  in GA+CP group (% 28.4 ± 8.85) compared to CP group (p< .001).

A significant increase was reported about MDA levels in CP group (6.26 ± 2.59) in compared with the control group (4.30 ± 2.05), But GA (3.24 ± 1.33) decreased it in GA+ CP group                                           (p< .01).  The histopathological investigation revealed marked testicular atrophy in CP group, whereas GA diminished these deviations (P< .05).

Conclusion: Gallic acid can modify the reproductive toxicity of cyclophosphamide in NMRI mice and increase the antioxidant capacity of testis tissue.

CASE REPORT


Virtual Three-Dimensional Magnetic Resonance Fetal Cystoscopy: A Novel Modality for Precise in Utero Evaluation of Urinary Tract

Abdol-Mohammad Kajbafzadeh, Behnam Nabavizadeh, Reza Seyed Hossein Beigi, Pariya Alinia, Seyed Ali Mirshahvalad

Urology Journal, Vol. 17 No. 1 (2020), 26 January 2020 , Page 102-104
https://doi.org/10.22037/uj.v0i0.4569

Urogenital anomalies are the most prevalent anomalies detected during pregnancy. Timely detection of these conditions could facilitate proper post-natal management and improve outcomes. In some cases, precise delineation of fetal urinary tract utilizing ultrasonography is not feasible. Moreover, sometimes the ultrasound study is technically limited. Magnetic resonance imaging could clarify the diagnosis in these situations. Prenatal ultrasonography indicated hydronephrosis and a 14 mm cystic lesion at right ureterovesical junction in a 25-week fetus. However, fetal magnetic resonance urography was not able to precisely clarify the condition and extension of ureterocele into the urethra. Fetal magnetic resonance virtual cystoscopy clearly demonstrated anatomy and extension of ureterocele. This modality provides three-dimensional cystoscopic-like view of urinary bladder and facilitates postnatal management.

A Rare Case Report of Undescended Testis: Both on One Side

Davoud Tasa, Ahmad Fotoohi, Farhang Safarnejad, Anvar Elyasi

Urology Journal, Vol. 17 No. 1 (2020), 26 January 2020 , Page 105-106
https://doi.org/10.22037/uj.v0i0.4573

Undescended Testis is a medical term that uses for any testis which is not in its normal place (bottom of the scrotum). UDT can be classified as unilateral and bilateral. Unilateral UDT is more common than bilateral UDT. There is a very rare condition in which both testicles are on the same side and have not descended.

We report in this article a 3 years old boy by a chief complaint of bilateral testicular mass absence. Diagnostic evaluation has been done but testes was abcent in scrota.  Exploring laparoscopy has been done and rare cases of UDT diagnosed, in which both testicles was on left side of the pelvis by two separate spermatic cord. The shorter spermatic cord fixed in the left scrotum and the longer one fixed on the right side. The testis was normal in follow up examinations.

PICTORIAL UROLOGY


UNCLASSIFIED


Gender and workforce in urology – use of the BG index to assess female career promotion in academic urology

Jenny Jaque, Eileen M Wanke, Ruth Müller, Jan Bauer, Daniela Ohlendorf, Stefanie Mache, Doris Klingelhöfer, David Quarcoo

Urology Journal, Vol. 17 No. 1 (2020), 26 January 2020 , Page 86-90
https://doi.org/10.22037/uj.v0i0.4116

Purpose: Today, the majority of medical graduates in countries such as the UK, the US or Germany are female. This poses a major problem for workforce planning especially in urology. We here use first the first time the previously established Brüggmann Groneberg (BG) index to assess if female academic career options advance in urology.

Methods: Different operating parameters (student population, urology specialist population, urology chair female:male (f:m) ratio) were collected from the Federal Office of Statistics, the Federal Chamber of Physicians and the medical faculties of 36 German universities. Four time points were monitored (2000, 2005, 2010 and 2015). From these data, female to male (f:m) ratios and the recently established career advancement (BG) index have been calculated.

Results: The German hospital urology specialists’ f:m ratios were 0.257 (499 female vs. 1944 male) for 2015, 0.195 for 2010, 0.133 for 2005 and 0.12 for 2000. The career advancement (BG) index was 0.0007 for 2000, 0,0005 for 2005, 0.094 for 2010 and 0.073 for 2015. The decrease from 2010 to 2015 was due to an increase in the f:m ratio of hospital urologists and female medical students.

Conclusion: The BG index clearly illustrated that there is an urgent need for special academic career funding programs to counteract gender problems in urology. The BG index has been shown to be an excellent tool to assess female academic career options and will be very helpful to assess and document positive or negative changes in the next decades.

The Association of Phosphodiesterase 5 Inhibitor on Ischemia-Reperfusion Induced Kidney Injury in Rats

Jong Kil Nam, Jung Hee Kim, Sung Woo Park, Moon Kee Chung

Urology Journal, Vol. 17 No. 1 (2020), 26 January 2020 , Page 91-96
https://doi.org/10.22037/uj.v0i0.4173

Purpose: Ischemia-reperfusion (IR) causes various damage in renal tissues. The aim of the present study was to evaluate the renoprotective effect of phosphodiesterase 5 inhibitor (PDE5I) on IR induced renal injury in a rat model.

Materials and Methods: Thirty adult male, 12-week-old, Sprague-Dawley rats were divided into three groups. Renal IR injury was induced by occlusion of the bilateral renal pedicle for 45 min followed by reperfusion for 24 h. The rats were sacrificed for collecting blood and tissue specimens. IR rats were administered daily oral Tadalafil (group I) or no pills (group II), while sham-operated animals were treated with no pills (sham group). The pill was diluted with distilled water and administered to rats for 15 days, orally. Renal histopathology, function, pro-inflammatory and inflammatory cytokines and mediators were assessed by serum creatinine, western blot assay and immunohistochemistry.

Results: Compared with sham group, rats that underwent renal IR operation exhibited a significant increase in concentration in serum creatinine (p< .01) and tissue pro-inflammatory and inflammatory mediators. In group I, however, tadalafil significantly suppressed elevation of the serum creatinine and increased the levels of endothelial nitric oxide synthase and decreased the level of intercellular adhesion molecule-1 (ICAM-1) than group II (p< .05). Moreover, tadalafil prevented IR-induced expression of pro-inflammatory mediators such as monocyte chemotactic protein-1 (MCP-1) (p< .05).

Conclusion: Tadalafil significantly promotes functional recovery after renal IR injury and effectively inhibits the induction of pro-inflammatory and inflammatory mediators. The results substantiate Tadalafil as a protective agent against IR-induced renal injury.

Treatment Satisfaction with Flexible-dose Fesoterodine in Patients with Overactive Bladder who were Dissatisfied with Previous Anticholinergic Therapy: A Multicenter Single-Arm Clinical Study

Jin Bong Choi, Kang Jun Cho, Won Hee Park, Dong Hwan Lee, Young-Ho Kim, In Rae Cho, Hana Yoon, Young Sik Kim, Joon Chul Kim

Urology Journal, Vol. 17 No. 1 (2020), 26 January 2020 , Page 97-101
https://doi.org/10.22037/uj.v0i0.4650

Purpose: We investigated treatment satisfaction with flexible-dose fesoterodine in patients with overactive bladder (OAB) who were dissatisfied with previous anticholinergic therapy.

Materials and Methods: The subjects were prescribed fesoterodine 4 mg for 4 weeks and fesoterodine 4 mg or 8 mg for another 8 weeks. The primary end point of this study was patients’ satisfaction after 12 weeks of fesoterodine treatment on a five-point Likert scale. Secondary end points included a change in the number of daytime micturition, urgency incontinence episodes, urgency episodes, and nocturnal micturition in a 24-hour period from baseline to final assessment.

Results: Overall, 84 patients were assigned to the treatment group in this study and 63 patients completed the 12-week treatment course. A final fesoterodine dose of 4 mg and 8 mg was used by 45 (71.4%) and 18 (28.6%) patients, respectively. The satisfaction and dissatisfaction rates at 12 weeks were 69.9% and 14.2%, respectively. Mean changes in the daytime micturitions (9.73 ± 4.72 vs. 7.76 ± 2.86), urgency episodes (7.73 ± 5.68 vs. 3.71 ± 4.09), and nocturnal micturitions (2.13 ± 1.36 vs. 1.68 ± 1.12) in 24 hours improved significantly with flexible-dose fesoterodine treatment (P < .05). Most adverse events were mild and none were severe.

Conclusion: The flexible dose fesoterodine represents an alternative treatment modality in patients with OAB who are dissatisfied with previous anticholinergic therapy in Korea.