ISSN: 1735-1308

Vol. 17 No. 2 (2020)

Best Reviewer


REVIEW


Purpose: Radical nephrectomy (RN) and partial nephrectomy (PN) are widely used for early-stage renal cell carcinoma (RCC). However, the results were inconsistent while comparing the efficiency of RN and PN. This study aimed to assess the perioperative effectiveness of RN and PN for treating RCC.

Material and Methods: PubMed, Embase, and the Cochrane Library electronic database were searched for studies on adults with RCC comparing RN and PN published until September 2019. The perioperative efficacy and safety outcomes were calculated using odds ratio (OR) and standard mean difference (SMD) with 95% confidence intervals (CIs) for dichotomous and continuous data, respectively. Subgroup analysis were conducted based on tumor stage and surgery methods for evaluation of the treatment effect on specific subsets.

Results: A total of 23 studies involving 30,018 patients with RCC were included in this meta-analysis. Notably, RCC treated with PN was associated with low incidences of hospital mortality (OR: 0.58; 95% CI: 0.38–0.89; P = 0.013) and reoperation rate (OR: 0.74; 95% CI: 0.58–0.95; P = 0.016) as compared to RN. However, PN was associated with an increased risk of overall postoperative complications (OR: 1.40; 95% CI: 1.17–1.68, P < 0.001), postoperative hemorrhagic complications (OR: 1.92; 95% CI: 1.28–2.87, P = 0.002), and urinary fistula (OR: 17.65; 95% CI: 5.35–58.30, P < 0.001) as compared to RN.

Conclusion: These findings suggested that PN was associated with lower incidences of hospital mortality and reoperation rate, whereas RN was associated with fewer complications.


ORIGINAL PAPER (ENDOUROLOGY AND STONE DISEASE)


Postoperative Progress after Stone Removal Following Treatment for Obstructive Acute Pyelonephritis Associated with Urinary Tract Calculi: A Retrospective Study

Shimpei Yamashita, Yasuo Kohjimoto, Masatoshi Higuchi, Yuko Ueda, Takashi Iguchi, Isao Hara

Urology Journal, Vol. 17 No. 2 (2020), 16 March 2020 , Page 118-123
https://doi.org/10.22037/uj.v0i0.4847

Purpose: We aimed to identify the prevalence and risk factors of three outcomes after stone removal following treatment for obstructive acute pyelonephritis (APN) associated with urinary tract calculi: immediate postoperative febrile urinary tract infection (UTI), stone recurrence, and APN recurrence during the follow-up period.

Materials and Methods: We retrospectively reviewed the charts of 107 patients who underwent stone removal following treatment for obstructive APN associated with urinary tract calculi. Logistic regression analysis was used to identify the factors that contributed to postoperative febrile UTI after stone removal. Cox proportional hazard analyses were used to identify the factors contributing to stone recurrence and APN recurrence during the follow-up period.

Results: Postoperative febrile UTI was observed in 23 out of  107 patients (21.5%). Multivariate logistic regression analysis revealed that female sex (P = .02) and having multiple stones (P < .01) were independently significant predictors of postoperative febrile UTI. One-year recurrence-free survival rates of stone disease and APN were 76.1% and 82.5%, respectively. Multivariable cox proportional hazard analyses revealed that presence of residual fragments was the only significant risk factor for stone recurrence (P < .01) and marginally significant for APN recurrence (P = .05).

Conclusion: Patients presenting with obstructive APN  frequently develop postoperative febrile UTI after active stone removal with the risk factors being female sex and having multiple stones. Residual fragments after stone removal in patients with obstructive APN can cause urolithiasis  and APN recurrence, indicating that complete removal of stone fragments ? 4 mm is imperative to the disease management.

Comparison of Hemodynamic Stability and Pain Control in Lateral and Prone Positions in Patients Undergoing Percutaneous Nephrolithotomy: A Randomized Controlled Trial

Fatemeh Roodneshin, Mahtab Poor Zamany Nejat Kermany, Pooya Rostami, Narges Ahmadzadeh, Babak Gharaei, Mohammad Reza Kamranmanesh

Urology Journal, Vol. 17 No. 2 (2020), 16 March 2020 , Page 124-128
https://doi.org/10.22037/uj.v0i0.4915

Purpose: Percutaneous nephrolithotomy (PCNL) is the preferred surgical treatment in many cases of kidney stones which is performed in different positions such as prone, lateral, and supine. This study was designed to evaluate whether patient position (lateral versus . prone) has an effect on the need for analgesia and onset of pain after surgery.

Materials and Methods: Patient with confirmed kidney stones (size ? 2 cm) who were candidates for PCNL were enrolled in this study. The required biochemical analyses were performed preoperatively. All patients  underwent spinal anesthesia by the same anesthesiologists and then were randomly divided into two separate groups as lateral (L) and prone (P) positions. The operations’ start and end time, required time for proper access into target calyces, additional need for analgesic or cardiac drugs, duration of analgesia, and onset of pain after PCNL were carefully recorded and then compared between the two groups.

Results: In total, 51 patients were evaluated of whom 39 were men and 12 were women. Mean duration of analgesia after PCNL surgery in P group (173 ± 8 min) was significantly longer than in L group (147±12 min) (P = .001). Furthermore, the amount of ephedrine usage in L group (3.6 ± 1.5mg) was significantly lower than in the P group (16.4 ± 12mg), suggesting more hemodynamic variations in the P group during the operation.

Conclusion: Our randomized control trial study shows that choosing the optimal position in the PCNL technique depends on  patient's condition. If hemodynamic control is of matter to the anesthesiologist, then lateral position is more appropriate. However, if control of pain and longer time of analgesia are important,  prone position may be preferred.


Safety and Efficacy of RIRS in Geriatric Patients: A Comparative Evaluation on an Age Based Manner

Kaan Gokcen, Gokce Dundar, Murat Bagcioglu, Mehmet Ali Karagoz, Gokhan Gokce, Kemal Sarica

Urology Journal, Vol. 17 No. 2 (2020), 16 March 2020 , Page 129-133
https://doi.org/10.22037/uj.v0i0.4921

Purpose:  In this retrospective study, we aimed to comparatively evaluate the efficacy and safety of RIRS procedure on an age-based manner in patients younger and above 65 years.

Materials and Methods: A total of 165 patients undergoing RIRS procedure for renal stones were divided into two groups on an age-based manner namely; Group 1 (n=122) patients aging < 65 years and Group 2 (n=43) patients aging above 65 years. Demographic and clinical data regarding the stone free rates, complication rates and need for secondary procedures were retrospectively evaluated.

Results: Of all the patients undergoing RIRS for kidney stones, 122 were below the age of 65 (73.9%) and 43 were above the age of 65 (26.1%). Mean age value for the patients aging more than 65 years was 74.16 ± 5.03 years and in addition to higher percentage of comorbidities, serum creatinine levels as well as ASA scores were also higher in this group when compared with younger counterparts. Although there was no statistically significant difference with respect to the operative duration, stone-free rates (SFR) and hospitalization period between the two groups, both complication rates and the need for additional interventions were higher in the older patient group (p = 0.038; p = 0.032). All complications noted in the both groups were minor (Grade I) complications according to the Clavien classification system.

Conclusion: RIRS procedure can be applied as an effective and safe treatment alternative for the minimal invasive management of renal stones in relatively older patients (> 65 years) with similar hospitalization as well as stone free rates noted in the younger patients. No procedure related severe complication was noted in these cases.

Role of Sexual Intercourse after Shockwave Lithotripsy for Distal Ureteral Stones: A Randomized Controlled Trial

Wenfeng Li, Yuansheng Mao, Chao Lu, Yufei Gu, Xin Gu, Bao Hua, Weixin Pan

Urology Journal, Vol. 17 No. 2 (2020), 16 March 2020 , Page 134-138
https://doi.org/10.22037/uj.v0i0.5400

Purpose: To explore whether sexual intercourse is beneficial to the clinical outcome of SWL for ureteral calculi of 7-15 mm in the distal ureter.

Materials and Methods: Between March 2016 and January 2017, 225 patents with a stone (7-15 mm) in distal ureter were randomly divided into three groups after SWL: Group 1 was asked to have sexual intercourse at least three times a week, Group 2 was administered tamsulosin 0.4 mg/d and Group 3 was received standard therapy alone and served as the controls. Stone free rate, time to stone expulsion, pain score at admission, number of hospital visits for pain and steinstrasse were recorded in 2 weeks.

Results: 70 patients in Group 1, 71 patients in Group 2 and 68 patients in Group 3 were enrolled to the study. At the end of the first week and the second week, the stone free rates for Group 1 (68.6%, 80.0%) and Group 2 (69.0%, 81.7%) were approximately the same, but were significantly higher than Group 3 (50.0%, 63.2%) (P = .031, P = .022). The VAS scores of Groups 1 and 2 were slightly higher than those of Group 3 (P = .233). The number of patients in Group 3 who visited the emergency room for pain was significantly higher than in the other two groups (P = .015). At the end of the second week, the incidence of steinstrasse in Groups 1 and 2 was significantly lower (2.9%, 2.8% vs 11.8%) (P = .034).

Conclusion: At least three sexual intercourses per week after SWL can effectively improve the stone free rate, reduce the formation of steinstrasse and relieve renal colic. It provides a choice for urologists in the SWL treatment of lower ureteral calculi.


Ultra-Mini-Percutaneous Nephrolithotomy for the Treatment of Upper Urinary Tract Stones Sized between 10-20 mm in Children Younger Than 8 Years Old

Heshmatollah Sofimajidpour, Mohammad Aziz Rasouli, Bushra Zarei, Masoumeh Hosseini

Urology Journal, Vol. 17 No. 2 (2020), 16 March 2020 , Page 139-142
https://doi.org/10.22037/uj.v0i0.5903

Purpose: With the invention of miniature devices, it has been advised to apply less aggressive methods for the management of upper urinary tract stones, especially in children. In the recent years, ultra-mini percutaneous nephrolithotomy (UMP) has been used for the treatment of upper urinary tract stones in order to perform surgeries with less complications and more acceptable outcomes. Results reported from different medical centers have been promising.

Materials and Methods: Twenty-two children aged less than 8 years old with upper urinary stones sized between 10-20 mm underwent UMP. Inclusion criteria was solitary unilateral kidney stone, stone size between 10-20 mm, normal renal function tests, absence of any congenital malformations, and history of previous ESWL failure. Data including age, sex, side of kidney involvement, size of stone, location of stone, duration of surgery, duration of hospitalization, stone composition, need for blood transfusion, damage to adjacent organs, postoperative fever, septicemia after surgery, need for narcotics, further need for a complementary method, stone-free rate, pre and post-operative hemoglobin levels, and urinary leakage from the access tract were extracted from patients' medical files and were recorded.

Results:  The mean age (± standard deviation) of children was 5.22 (±1.57) years. Fourteen (63.6%) patients were male. Fifteen (68.2%) renal stones were located in the right kidney, and 82% of patients had pelvis stones. 13 (59%) patients’ stones were composed of calcium oxalate. Stone-free rate was 95.5%. In none of the cases urinary leakage, septicemia after surgery, injury to adjacent organs, and need for blood transfusions was reported.

Conclusion: Ultra-mini percutaneous nephrolithotomy is an efficient and safe method for treating urinary stones sized between 10-20 mm in children.



ORIGINAL PAPER (LAPAROSCOPIC AND ROBOTIC UROLOGY)


Feasibility and Safety of Clipless and Sutureless Laparoscopic Adrenalectomy: A 7-Year Single Center Experience

Nasser Simforoosh, Behnam Shakiba, Mehdi Dadpour, Seyyed Erfan Mortazavi, Hamid Reza Hamedibazaz, Mahdyar Mahdavi

Urology Journal, Vol. 17 No. 2 (2020), 16 March 2020 , Page 143-145
https://doi.org/10.22037/uj.v0i0.5493

Purpose: Laparoscopic adrenalectomy (LAD) is considered the gold standard surgical method for resecting adrenal tumors. To date, only few small studies have investigated the safety of clipless laparoscopic adrenalectomy in which the adrenal vessels were controlled by the LigaSure system or bipolar coagulation. The aim of the present study was to evaluate the safety and feasibility of sutureless and clipless laparoscopic adrenalectomy operations performed in our center.

Materials and Methods: All patients with functional adrenal tumors, nonfunctional adrenal tumors larger than 5 cm and secondary adrenal metastases from the kidneys, lungs or breasts who had underwent an LAD procedure between 2012 to 2019 were included in our study. In all of the cases, complete coagulation of adrenal veins was achieved through bipolar cautery and no vascular staplers, clips or other energy sources were used for controlling the adrenal vessels whatsoever. Outcomes of interest included operation time, length of hospital stay, changes of serum hemoglobin level, and occurrence of major complications.

Results: Of a total 251 patients, unilateral right and left-side adrenalectomy was performed in 168 and 67 cases, respectively, and 16 cases had underwent bilateral adrenal resection. The mean age (SD) of patients was 40.7 (13.6) years old at the time of operation and the mean size (SD) of the adrenal lesions was 5.2 (3.1) cm as measured by the greatest diameter. Histological examination showed that the most common pathology of the resected adrenal glands was pheochromocytoma (n=78). None of the laparoscopic operations required a conversion to open surgery. Also, major bleeding or other serious complications did not occur in any of the cases either intraoperatively or postoperatively.

Conclusion: Clipless and sutureless laparoscopic adrenalectomy seems to be feasible and safe for removing adrenal tumors. Moreover, bipolar cautery is associated with an acceptable outcome for vessel closure.


ORIGINAL PAPER(UROLOGICAL ONCOLOGY)


The Association of Length of the Resected Membranous Urethra With Urinary Incontinence After Radical Prostatectomy

Yasuo Kohjimoto, Shimpei Yamashita, Kazuro Kikkawa, Akinori Iba, Nagahide Matsumura, Isao Hara

Urology Journal, Vol. 17 No. 2 (2020), 16 March 2020 , Page 146-151
https://doi.org/10.22037/uj.v0i0.4753

Purpose: To retrospectively determine whether recovery of urinary continence after radical prostatectomy is associated with the preoperative length of membranous urethra (MU), the amount of rhabdosphincter and the length of MU removed with the prostate.

Materials and Methods: The study cohort comprised 179 consecutive patients who underwent laparoscopic radical prostatectomy (LRP: n = 98) and robot-assisted radical prostatectomy (RARP: n = 81) at Wakayama Medical University between July 2010 and May 2014. The length of MU was measured by preoperative MRI. The amount of resected rhabdosphincter and the length of resected MU were assessed in hematoxylin and eosin sections at the apical margin of prostate specimens. Patient-reported urinary continence status was determined at 3, 6, 12 and 24 months postoperatively, with urinary continence considered as 0-1 pads/day. Kaplan-Meier analysis and the log-rank test were used to compare time to urinary continence recovery. Multivariate Cox regression analyses were performed to determine the predictors of urinary continence.

Results: RARP vs LRP (p = 0.02) and shorter length of resected MU (p = 0.01) showed significantly better postoperative continence recovery by log-rank test. Nerve-sparing, preoperative length of MU, and amount of resected rhabdosphincter did not significantly correlate with continence recovery. Only the length of resected MU was the independent factor for predicting postoperative urinary continence by multivariate Cox regression analysis (hazard ratio 0.84, p = 0.01).

Conclusion: These results demonstrated that the length of resected MU measured by specimen was an independent predictor of urinary incontinence after radical prostatectomy. Care should be taken to preserve maximal length of MU for optimal continence outcomes.

 

Evaluation of Two Ureter Sealing Methods During Radical Nephroureterectomy

Kun Pang, Bo Chen, Bo Jiang, Zhenduo Shi, Lin Hao, Zhiguo Zhang, Jianjun Zhang, Longcun Cai, Tian Xia, Zhenning Wei, Kun Fang, Dianjun Yu, Conghui Han, Xiaowen Sun

Urology Journal, Vol. 17 No. 2 (2020), 16 March 2020 , Page 152-155
https://doi.org/10.22037/uj.v0i0.4920

Purpose: To investigate the safety of electrocoagulation and thulium laser (Tm-laser) sealing methods of distal ureter resection during radical nephroureterectomy (NFU) in a porcine model.

Methods: 9 pigs were used in the study: 6 were used to measure the bursting pressure (BP) and 3 were used to measure the highest pressure during NFU. Twelve ureters were to measure BP after being sealed by electrocoagulation or Tm-laser (n = 6, each). Six experimental NFUs were performed in 3 pigs to measure the intraluminal pressure of all procedures.

Results: The mean BP in the electrocoagulation group (104.3 ± 25.0 cmH2O) was similar to that of the Tm-laser group (74.8 ± 23.3 cmH2O, P > .05). The peak intraluminal pressure (35.9 ± 7.6 cmH2O) during NFU was significantly lower than the BP (P < .05).

Conclusion: The effectiveness of the sealing was confirmed using both electrocoagulation and Tm-laser during NFU.



Potential Prognostic Role for SPOP, DAXX, RARRES1, and LAMP2 as an Autophagy Related Genes in Prostate Cancer

Leila Jamali, Afshin Moradi, Maziar Ganji, Mohsen Ayati, Behrang Kazeminezhad, Zahra Fazeli Attar, Hamid Ghaedi, Seyyed Mohammad Hossein Ghaderian, Morteza Fallah-Karkan, Arash Ranjbar

Urology Journal, Vol. 17 No. 2 (2020), 16 March 2020 , Page 156-163
https://doi.org/10.22037/uj.v0i0.4935

Purpose: Autophagy plays a critical role in PCa development. DAXX has a potent pro-survival effect by enhancing cell growth in PCa via suppression of autophagy. Here, we depicted a network governed by DAXX and SPOP by which the autophagy pathway is suppressed through the ubiquitination and modulation of key cellular signaling pathways mediators including LAMP2 and RARRES1.

Materials and Methods: Through network-based bioinformatics approaches, the expression levels of DAXX, RARRES1, LAMP2, and SPOP genes was assessed in 50 PCa tissues and 50 normal adjacent from the same sample as well as 50 benign prostatic hyperplasia (BPH) tissues by quantitative RT-PCR. The normal adjacent tissues were taken from regions more than 5mm away from the bulk of those tumor tissues with clearly distinct margins. RNA extraction, cDNA synthesis and Real-time Quantitative RT-PCR were done for assessment of gene expression. To evaluate the primary gene network centered on autophagy pathway, according to the Query-dependent weighting algorithm, these two networks were integrated with Cytoscape 3.4 software.

Results: We found that in PCa tissues the DAXX expression level was significantly increased (P < 0.001) and the expressions of SPOP, RARRES1, and LAMP2 were significantly down-regulated, when compared to both control groups including normal adjacent and BPH tissues. Moreover, significant correlations were observed between expression levels of all four genes. Additionally, ROC curve analysis revealed that LAMP2 had the most sensitivity and specificity.

Conclusion: These findings suggest that the contribution of SPOP, DAXX, RARRES1, and LAMP2 together could be a putative regulatory element acting as a prognostic signature and therapeutic target in PCa.


ORIGINAL PAPER (PEDIATRIC UROLOGY)


Concealed Penis after Circumcision: Is It Beneficial in Lowering Uropathogenic Colonization in Penile Skin and Preventing Recurrence of Febrile Urinary Tract Infections?

Mete Özkidik, Onur Telli, Nurullah Hamidi, Uygar Bagci, Adil Hüseyinov, Aytaç Kayis, Anar Ibrahimov, Tarkan Soygür, Berk Burgu

Urology Journal, Vol. 17 No. 2 (2020), 16 March 2020 , Page 164-168
https://doi.org/10.22037/uj.v0i0.5192

Purpose:  To  discuss  whether  concealed  penis  after  circumcision  lowers  perimeatal  urethral  and  glanular  sulcus  uropathogenic  bacterial  colonization  in  healthy  boys  with  no  urinary  tract  problems  and  prevents  attacks  of  febrile  urinary  tract  infections  in  non-healthy  boys  with  defined  urinary  tract  abnormalities.  

Materials and Methods:  This  case-control  study  was  conducted  in  Ibn-i  Sina  Hospital  and  retrospectively  collected  data  of   471 boys  were  analyzed.  All  patients  were  scanned  for  any  urinary  tract  abnormality  and  those  with  any  defined  abnormalities  were  classified  as  non-healthy  group. (123 patients)  Non-healthy  patients  were  divided  into  two  subgroups  as  concealed  (n:31)  and  non-concealed  (n:92)  penis  after  circumcision.  Healthy  patients  with  no  urinary  problems  were  divided  into  three  groups  as  circumcised  without  concealed  penis  (n:144),  with  concealed  penis  after  circumcision  (n:104)  and  uncircumcised  control  group  (n:100).  Bacterial  cultures  were  obtained  from  both  periurethral  meatal  and  glanular  sulcus  areas  by  adhering  strictly  to  the  rules  of  obtaining  bacterial  culture  to  avoid  false-positive  or  negative  culture  results.  Also  only  uropathogenic  bacterias  were  evaluated,  irrelevant  results  were  excluded.     

Results:  Mean  age  was  similar  in  healthy  population.  Comparison  of  three  groups  showed  that  there  was  a  significant  difference  in  both  cultures.(P = .026 for periurethral meatal region, P = .039 for glanular sulcus region)  In  post  hoc  analysis,  non-concealed  group  had  a  lower  rate  of  culture  positivity  in  both  areas  compared  to  other  groups.    Mean  age  was  also  similar  in  non-healthy  population.  Mean  follow-up  period  was  18.2  months.  Patients  with  concealed  penis  after  circumcision  had  a  significantly  higher  number  of  febrile  UTI  attacks  (20 attacks in 8 patients vs 7 attacks in 5 patients)  compared  to  non-concealed  group. (P = .019)  All  febrile  UTI  attacks  except  one  in  this  group  occurred  below  the  age  of  12  months. A  total  of  10 patients  in  both  healthy  and  non-healthy  groups  had  postoperative  hemorrhage  after  circumcision  and  only  1  patient  had  a  wound  infection.          

Conclusion:  Concealed  penis  after  circumcision  does  not  lower  perimeatal  urethral  and  glanular  sulcus  uropathogenic  bacterial  colonization  in  healthy  patients  and does not  protect  unhealthy  patients  from  febrile  urinary  tract  infection  attacks.  If  circumcision  is  planned,  concealed  penis  should  be  avoided  and  also  parents  should  be  informed  about  the  possible  risks  due  to  concealed  penis  before  the  procedure,  particularly  in  patients  with  urinary  tract  abnormalities.   



Purpose: To evaluate the clinical effects of open pyeloplasty via a mini flank incision in the treatment of infants with ureteropelvic junction obstruction (UPJO).

Materials and Methods: We retrospectively analyzed 85 cases of infants with UPJO in our hospital from Jan. 2015 to Jan. 2018. The cases were divided into two groups according to the procedure: open pyeloplasty (n=45) and laparoscopic pyeloplasty (n=40). After 12~24 months of follow-up, the clinical effects of the two groups were compared.

Results: There was no significant difference in age between the two groups (P = .1). The operation time, postoperative fasting time and the indwelling time of the perirenal drainage tube in the open group were shorter than those in the laparoscopic group (68.0 ± 15.3 minutes versus 79.6 ± 18.8, P = .002; 5 ± 1 hours versus 14 ± 8.2 hours, P =.001; 2.8 ± 0.8 days versus 3.7 ± 1.3 days, P = .001, respectively), and there was no significant difference in the volume of intraoperative bleeding (2.1±0.9 versus 2.2±0.6, P=.55). The number of recurrences and complications in both groups were 0 versus 2 (P = .22) and 5 versus 7 (P = .40), respectively.

Conclusion: Open pyeloplasty via a mini flank incision has the advantages of being minimally invasive, safe, effective, and easy to master, and it requires a short operation time. It is a reasonable option for the treatment of infants with UPJO despite this era of minimally invasive surgery.



ORIGINAL PAPER (KIDNEY TRANSPLANTATION)


Comparison of Removing Double-J Stent With and Without Cystoscopy in Kidney Transplant Patients: A Randomized Clinical Trial

Mohammad Nadjafi-Semnani, Nasser Simforoosh, Abbas Basiri, Ali Tabibi, Ali Nadjafi-Semnani

Urology Journal, Vol. 17 No. 2 (2020), 16 March 2020 , Page 173-179
https://doi.org/10.22037/uj.v0i0.5448

Purpose:  The ureteric stent can be attached to the Foley catheter in kidney transplantation to exclude cystoscopy for its removal. It is rarely practiced in renal transplantation. There has been no randomized trial to evaluate the outcome of this procedure on major urologic complications.

Materials and Methods: One hundred sixty-three kidney transplant patients were randomized into an intervention group in which the stent was attached to the Foley catheter and removed together and a control group in which stent was removed by cystoscopy. In both groups, stents were removed around the 8th post-operative day.

Results: From March 2016 to June 2017, out of 234 kidney transplants performed in our center, one hundred Sixty-three (69.6%) patients met the study inclusion criteria.  91patients (55.8%) were allocated to the intervention group. Mean days before JJ removal for intervention and control groups (“per-protocol” group) were 8.08 ± 1.52 and 8.57 ± 1.58, respectively (P = .09). There was no difference between groups regarding major urologic complications (P = .679). Visual analog scale pain scores were significantly higher in the control group (p = .001). The procedure reduced 63-120 USD from the cost of operation in the intervention group.

Conclusion: In selected kidney transplant patients, attaching stent to the Foley catheter and removing both of them early may be a safe maneuver regarding major urological complications, reduces pain, and eliminates the cost of cystoscopy.
Keywords: cystoscopy; double-J-stent; kidney transplantation; stent; ureteric stenting

ORIGINAL PAPER (FEMALE UROLOGY)


Association of Severity of Lower Extremity Arterial Disease and Overactive Bladder Syndrome: A Cross Sectional Study

Bahar Yuksel, Faruk Ozgor, Mazlum Sahin, Metin Savun, Murat Sahan, Ufuk Caglar, Omer Sarilar

Urology Journal, Vol. 17 No. 2 (2020), 16 March 2020 , Page 180-184
https://doi.org/10.22037/uj.v0i0.4886

Purpose: The aim of this study aim is to clarify the relationship between Overactive bladder syndrome (OAB) and severity of lower extremity ischemia by using Fontaine classification system.

Materials and Methods: Patients who were diagnosed with lower extremity arterial disease were enrolled into the study. The Fontaine score of each patient was taken and all patients completed the validated Turkish version of OAB-V8 questionnaire. Body mass index, serum creatinine, blood urea nitrogen, cholesterol and fasting plasma glucose levels were measured. The patients were divided into two groups. Patients with OAB-V8 score above 8 were enrolled into group 1 and patients with OAB-V8 score under 8 were enrolled into group 2.

Results:  At the end of study period, 181 patients who met the  inclusion criteria were enrolled into the study.  Patients with OAB ? 8 score (n= 79) were compared with  patients with OAB < 8 score (n= 102). The mean age and the mean BMI were significantly higher in patients with OAB ? 8 (P = .001 and P = .001, respectively). Also, HDL- cholesterol level was found significantly lower in group 1 patients  (P= .001). Multivariate regression analysis showed that presence of Fontaine score ? class 2b, age ? 60 years, BMI ? 30 kg/m2 , and HDL-cholesterol levels < 60 mg/dL were predictive factors for OAB.

Conclusion: The present study  demonstrated that incidence of OAB is higher in patients with severe lower extremity ischemic symptoms, older age, high BMI, and lower HDL-cholesterol level.

CASE REPORT


A Nonspecific Penile Ulcer Leading to the Diagnosis of Wegener’s Granulomatosis

Hassan Ahmadnia, Amin Hasanzadeh Haddad, Mohammad Reza Darabi Mahboub, Ali Akhavan, Ali Reza Akhavan Rezayat

Urology Journal, Vol. 17 No. 2 (2020), 16 March 2020 , Page 210-212
https://doi.org/10.22037/uj.v0i0.4526

The presented case describes a 53-year-old male who had been treated for non-specific cutaneous lesions for two months without any improvement. He was referred to our department after developing an erosive penile ulcer. Investigation for sexually transmitted diseases and Mycobacterium tuberculosis ended with negative results. Penile ulcer biopsy suggested the diagnosis of Wegener’s granulomatosis (WG). The patient presented with upper respiratory tract symptoms during this period. Measuring antineutrophil cytoplasmic antibodies (c-ANCA), confirmed the diagnosis. Immunosuppressive therapy was initiated and resulted in a favorable response.

Today, there are several methods to repair colon and rectal injury such as primary repair, stoma, resection with anastomosis and damage control only. To our best knowledge, there is no definite method published in literature about iatrogenic rectal injury during perineal urethroplasty in children. Here, we explain two 10 and 12-year old boys with iatrogenic rectal injury during perineal urethroplasty who  underwent primary repair. Based on our experience, primary repair of rectum in such condition is feasible, successful and  can be a good choice to avoid placing colostomy and secondary repair.
Keywords: complication; rectal injury; perineal urethroplasty; primary repair

LETTER


UNCLASSIFIED


Extracorporeal Shockwave Therapy Combined with Drug Therapy in Chronic Pelvic Pain Syndrome : A Randomized Clinical Trial

Seyed Mansour Rayegani, Mohammad Reza Razzaghi, Seyed Ahmad Raeissadat, Farzad Allameh, Dariush Eliaspour, Amir Reza Abedi, Atefeh Javadi, Amir Hossein Rahavian

Urology Journal, Vol. 17 No. 2 (2020), 16 March 2020 , Page 185-191
https://doi.org/10.22037/uj.v0i0.4673

Purpose: Chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS) is a nonspecific pelvic pain in the absence of signs of infection or other obvious local pathology for at least three of the last 6 months. Evidence for treatment approach is limited. So the aim of this study is to investigate the effect of extracorporeal shock wave therapy (ESWT) combined with pharmacotherapy in the treatment of CP/CPPS.

Materials and Methods: In this randomized clinical  trial, 31 patients with CP/CPPS were investigated in two groups: the intervention group (n=16) was treated with a combination of an alpha-blocker, an anti-inflammatory agent, a muscle relaxant and a short course of antibiotic in combination with 4 sessions of focused ESWT (a protocol of 3000 impulses, 0.25 mJ/mm2  and 3 Hz of frequency). The control group (n=15) received the aforementioned pharmacotherapy with 4 sessions of sham-ESWT . Follow-up was performed 4 and 12 weeks following ESWT by using the Visual Analogue Scale (VAS), International index of Erectile function (IIEF) 5, National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) and International Prostate Symptom Score (IPSS) questionnaires. Post void residual (PVR) urine and maximum flow rate (Qmax) were also assessed in both groups.

Results: The patients mean age was 43.7 ±12.6 years. In both groups, the mean scores of NIH-CPSI (total and sub-domains) and VAS showed statistically significant improvements after 4 and 12 weeks compared to the baseline (P < .001). In the intervention group, IPSS (mean difference: 4.25) and Qmax (mean difference: 2.22) were also significantly improved (P < .001).  There was a significant improvement in NIH-CPSI (mean difference: 1.1) and VAS scores (mean difference: 1.1) in the intervention group as compared to the control group (P < .01). Qmax, PVR and IIEF score were not statistically different in the two groups.

Conclusion: ESWT in combination with pharmacotherapy could improve the treatment outcome in patients with CP/CPPS.

The Role of Ciprofloxacin Resistance and Extended-spectrum beta-lactamase (ESBL) Positivity in Infective Complications Following Prostate Biopsy

Nesibe Korkmaz, Yunus Gurbuz, Fatih Sandikci, Gülnur Kul, Emin Ediz Tutuncu, Irfan Sencan

Urology Journal, Vol. 17 No. 2 (2020), 16 March 2020 , Page 192-197
https://doi.org/10.22037/uj.v0i0.4755

Purpose: To evaluate ciprofloxacin resistance (CR) and extended-spectrum beta-lactamase (ESBL) positivity in the rectal flora, antibiotic prophylaxis received, and post-biopsy infectious complications in patients undergoing prostate biopsy.

Material & Methods: Rectal swab samples collected from 99 patients suspected of prostate cancer two days before prostate biopsy were tested for microbial susceptibility and ESBL production. All patients were given standard ciprofloxacin and ornidazole prophylaxis. Ten days post-biopsy, the patients were contacted by phone and asked about the presence of fever and/or symptoms of urinary tract infection.

Results: Escherichia coli (E.coli) was the most common isolate detected in 82 (75%) of the rectal swab samples. Ciprofloxacin resistance was detected in 33% and ESBL positivity in 22% of the isolated E.coli strains. No microorganisms other than E.coli were detected in blood, urine, and rectal swab cultures of patients who developed post-biopsy complications. CR E.coli strains also showed resistance to other antimicrobial agents. The lowest resistance rates were to amikacin (n = 2, 7.4%) and nitrofurantoin (n = 1, 3.7%). Seven patients (7.6%) developed infectious complications. There was no significant difference in probability of hospitalization between patients with CR strains (14.3%) and those with ciprofloxacin-susceptible strains (14.3% vs. 4.7%; p = 0.194). However, strains that were both CR and ESBL-positive were associated with significantly higher probability of hospitalization compared to ciprofloxacin-susceptible strains (28.6% vs. 3.8%; p = 0.009).

Conclusion: The higher rate of infectious complications with CR and ESBL-positive strains suggests that the agents used for antibiotic prophylaxis should be reevaluated. It is important to consider local resistance data when using extended-spectrum agents to treat patients presenting with post-biopsy infectious complications.

Improved Long Ureteral Reconstruction With Ileum By Longitudinal Clipping And Mucosal Stripping: An Animal Study

Hao Gu, Shulian Chen, Yubo Wu, Lei Shen, Yihang Luo, Xu Li, Houjin Huang, Zeju Zhao

Urology Journal, Vol. 17 No. 2 (2020), 16 March 2020 , Page 198-203
https://doi.org/10.22037/uj.v0i0.5330

Purpose: To investigate the possibility of bridging long ureteral defects by longitudinal clipping and mucosal stripping of the pedicled segment of ileum (CMSPI).

Materials and Methods: Ten beagle dogs (five males and females aged 2-3 years) were used to model a defect of the entire ureter. An ileal segment was selected, and half of the intestinal segment was longitudinally resected, without mesenteric resection. The intestinal mucosa was removed. Then, the ileum was sutured to form a tube connecting the renal pelvis to the bladder. A 5F ureter stent was inserted into the ileum and removed 4 weeks after surgery. Intravenous urography (IVU) was used to observe the reconstructed ureters at 6 and 12 weeks after the operation. Blood samples were collected before surgery and during each radiological examination to assess electrolyte and renal function. Five dogs were randomly euthanized after each IVU. After macroscopic analysis, hematoxylin-eosin (H&E) staining was performed to observe the microscopic changes in the reconstructed ureter.

Results: All dogs were in good condition after surgery. Changes in blood electrolyte and renal function after surgery were not significant (Cl-P = .595; Ur P = .852). IVU demonstrated no ureteral obstruction or extravasation of the contrast agent; however, mild hydronephrosis were observed in three dogs. Macroscopic analysis indicated that the reconstructed ureter was intact without strictures. H&E showed that no mucosal structure was present on the luminal surface.

Conclusion: CMSPI is feasible for bridging long ureteral defects and has shown good efficacy in this preliminary study.

Purpose: The study aimed to compare the therapeutic effects of iPSC-derived MSCs (iPSC-MSCs) and adult MSCs for acute kidney injury (AKI) therapy.

Materials and Methods: Model rats with ischemia/reperfusion (I/R)-induced AKI were randomly divided into three groups (n=15 for each group) to receive transplantation of iPSC-MSCs, adult MSCs, or the saline control. After transplantation, engraftment and differentiation of both iPSC-MSCs and adult MSCs were detected in the transplanted sites. Serum creatinine and blood urea nitrogen (BUN) for renal function evaluation were measured, and histological assays were performed as well.

Results: Compared with the saline control, both iPSC-MSCs and adult MSCs significantly (p<0.05 or 0.01) improved the renal function. Furthermore, iPSC-MSCs showed comparable effects in ameliorating tissue damage, reducing cell apoptosis and promoting vascularization with adult MSCs.

Conclusion: This study compared the therapeutic effects of iPSC-MSCs and adult MSCs for AKI treatment. Both iPSC-MSCs and adult MSCs were observed with comparable effects in repair of AKI. The results indicated that iPSC-MSCs may serve as an alternative source of MSCs for stem cell-based therapy for AKI therapy.