ISSN: 1735-1308

Vol. 17 No. 3 (2020)

REVIEW


Purpose: The protective effect of recombinant human erythropoietin (rHuEPO) on kidney transplantation has not been established. Therefore, we conducted a systematic review and meta-analysis to evaluate the potential influence of rHuEPO on transplanted kidneys.

Materials and methods: To identify relevant studies, we searched electronic databases (PubMed, Medline, EMBASE, Ovid, the Cochrane Library, and major nephrology journals) from inception until June 15, 2018. Two independent reviewers assessed study quality. The systematic review and meta-analysis were performed with fixed- or random-effects models according to heterogeneity, and results are expressed as risk ratios (RR) or weighted mean differences.

Results: Six randomized controlled trials with a total of 435 patients met the inclusion criteria. rHuEPO, compared with placebo, had no statistically significant effect on delayed graft function (RR = 0.89, 95% confidence interval [CI] , 0.73 to 1.07; P = 0.22) and slow graft function (RR = 0.93, 95% CI, 0.60 to 1.43; P = 0.73). The rHuEPO and control groups did not differ in thromboembolic events, mortality, acute rejection, and blood transfusion. A significant difference was found in long-term estimated glomerular filtration rate (RR = 3.65, 95% CI, -4.45 to 11.75; P = 0.003).

Conclusion: Our findings suggests that rHuEPO has a limited nephroprotective effect in patients undergoing kidney transplantation and does not increase the susceptibility to adverse events.

ORIGINAL PAPER (ENDOUROLOGY AND STONE DISEASE)


Purpose: The aim of this study is to evaluate the impact of different pulse energy settings on dusting efficiency in flexible ureteroscopic lithotripsy (fURSL) for the treatment of upper urinary tract calculi.

Materials and Methods: Data of 88 consecutive patients who underwent fURSL for upper urinary tract calculi by a single surgeon in our department from August 2017 to August 2018 were reviewed retrospectively. Lumenis Power Suite 100W lithotripter with a 200 ?m laser fiber was used to comminute stones. According to energy settings, patients were divided into three groups- low energy group (LE: 0.3-0.6J), middle energy group (ME: 0.7-1.0J), high energy group (HE: 1.1-1.5J). Frequency was set at 30Hz in all patients. ANOVA and Chi square tests were applied to compare the difference of the mean lithotripsy and operation time, early stone-free rate (eSFR), overall stone-free rate (oSFR) and complication rate.

Results: A total of 32, 36 and 20 patients were included in the LE, ME and HE groups, respectively. There was no difference in the age, gender distribution or in any other stone characteristics among the three groups. The mean lithotripsy time of LE, ME, HE was  10.9 ± 7.6, 16.1 ± 7.0, 23.0 ± 15.0 min respectively. The mean operation time of the three groups was 16.9 ± 7.7, 22.3±7.1, 29.2±14.9 min respectively. There were significant differences on the mean lithotripsy time (P = 0.002) and the mean operation time (P = 0.001) among the three groups. The stone-free rate was 31.8% and 87.5% respectively in eSFR and oSFR. No statistical significance was detected among the three groups in terms of the eSFR (P = 0.89), oSFR (P = 0.86), and complication rate (P = 0.97).

Conclusion: In fURSL with dusting, low energy (0.3-0.6J) is more efficient than middle (0.7-1.0J) and high energy (1.1-1.5J). As energy increased, dusting efficiency decreased dramatically. Consequently, we recommend low pulse energy (0.3-0.6J) as the optimal dusting strategy for fURSL.

Is RIRS Safe and Efficient In Patients With Kidney Stones Who Had Previous Open, Endoscopic, or Percutaneous Kidney Stone Surgery? One Center Retrospective Study

Burhan Baylan, Sercan Sari, Mehmet Caglar Cakici, Volkan Selmi, Harun Özdemir, Hakki Ugur Ozok, Ahmet Nihat Karakoyunlu, Hikmet Topaloglu, Azmi Levent Sagnak, Hamit Ersoy

Urology Journal, Vol. 17 No. 3 (2020), 16 May 2020 , Page 228-231
https://doi.org/10.22037/uj.v0i0.4950

Purpose: In our study, we assessed the efficiency and reliability of retrograde intrarenal surgery secondary to open surgery for kidney stone treatment. Moreover, we compared the efficiency and safety of retrograde intrarenal surgery for the patients with previous history of open surgery, percutaneous nephrolithotomy, secondary retrograde intrarenal surgery (RIRS) and primary RIRS.

Materials and Methods: Data was retrospectively reviewed. Patients who had kidney anomalies, who had been stented due to ureteral stricture in the operation and who were < 18 years old, were excluded. There were 30 patients who underwent RIRS secondary to open surgery. The demographic and stone characteristic as well as intraoperative and postoperative data of the patients were recorded. 30 patients with similar demographic and stone characteristics to those patients were selected by match pairing method from patients who had previous PNL, RIRS history and had undergone primary RIRS. A total of 120 patients, in total 4 groups, were included in the study.

Results: Statistically significant difference was detected among the groups with regards to shock wave lithotripsy history and preoperative JJ stent rate. There was no statistically significant difference in terms of stone characteristics, intraoperative and postoperative data.

Conclusion: RIRS is an efficient and safe method for kidney stone treatment of the patients with previous history of open surgery, percutaneous nephrolithotomy and retrograde intrarenal surgery. It has a similar efficiency and safety for the patients who have undergone retrograde intrarenal surgery. This is the first study that compares the patients especially  with different previous surgery methods.

Purpose: The goal of this study is to compare the feasibility, safety, and efficacy of the preemptive indwelling of double-J stents (PI-DJS) versus the conventional preemptive indwelling of ureteral catheters (PI-UC) in percutaneous nephrolithotomy (PCNL) via a randomized, controlled clinical study.

Materials and methods: A total of 75 patients with complex renal calculi underwent PCNL surgery and were randomized, using random number table, to receive either a PI-DJS (37 cases) or a PI-UC (38 cases). All operations were performed by the same experienced surgeon. Several outcomes were measured, including duration of operation, time to establish passage, level of hemoglobin decline, rate of stone clearance and incidence of complications.

Results: Guided by B-ultrasound, percutaneous passages were successfully established in all patients who then underwent one-stage PCNL. The time required to establish a passage using a PI-DJS was 7.5min, whereas that of the group who received a PI-UC was 11.5min (P < 0.01). There was no significant difference between the two groups in terms of operation duration, postoperative Hb decline rate, stone clearance rate, and perioperative complication incidences (all P > 0.05).

Conclusion: PI-DJS during PCNL allowed for a reliable and stable reflux from the bladder into the renal pelvis to produce an artificial hydronephrosis without the formation of microbubbles, unlike conventional ureteral catheters.

Purpose: The aim of this study is to evaluate the effects of anesthesia methods on the success of urethral access and stone access achievement in endoscopic treatment of urolithiasis.

Materials and Methods: In this prospective randomized study, 105 patients who underwent primary ureterorenoscopy (URS) procedure for ureteral stones were evaluated. The patients were randomized into three groups by permuted block randomization according to the applied anesthesia method: General anesthesia (GA): 33 patients, Spinal anesthesia (SA): 31 patients, and Epidural anesthesia (EA): 31 patients. Ten patients, whose ureteral access was not successful, were dropped out. The success of the three anesthesia methods on the success of the ureter access and its effects on surgical outcomes were compared.

Results: There was no statistically significant difference among the three groups in terms of the demographic values and preoperative features except the American Society of Anesthesiologists (ASA) status. Dilatation and the access time to stone were statistically significantly longer in SA and EA group compared to the GA group. There was no statistically significant difference among the groups in terms of operation, lithotripsy time, stone-free rate (SFR), and complication rates. The Visual Analog Scale (VAS) scores in the 8th and 24th hours were statistically significantly higher in the GA group.

Conclusion: In patients who decided to undergo primary ureterorenoscopy procedure, it can be suggested to treat with GA to provide a better relaxation of the ureter if there are no contraindications.

The Clinical Efficacy and Safety of Flexible Ureteroscopic Treatment for Parapelvic Renal Cyst and Secondary Renal Stone

Jiaming Wen, Gang Xu, Gaofei He, Bohan Wang, XiaWa Mao, Shigeng Zhang

Urology Journal, Vol. 17 No. 3 (2020), 16 May 2020 , Page 243-247
https://doi.org/10.22037/uj.v0i0.5441

Purpose: To explore the efficacy and safety of flexible ureteroscopic incision and drainage and flexible ureteroscopic lithotripsy for treatment of parapelvic renal cyst combined with secondary renal stone.

Materials and Methods: 28 patients with parapelvic renal cyst combined with renal stone were treated with flexible ureteroscopic incision and drainage and flexible ureteroscopic lithotripsy simultaneously from May 2010 to December 2016. The follow-up was made 1, 3, 6?12 months and 2 years after surgical treatment in our outpatient department. Ultrasonic examination and CT were used to detect the residual stone and recurrence of renal cyst.

Results: The mean age of the patients was 45.3 ± 18.6 years. The average size of the parapelvic renal cysts was 4.3 ± 1.6 cm, including 27 with Bosniak category I and 1 patient with Bosniak II renal cysts. The mean size of the renal stones was 14.3 ± 3.9 mm. The mean operative time was 53.4 ± 20.7 minutes and the mean blood loss was 10.8 ± 5.6 ml. The mean hospitalization time was 3.2 ± 0.7 days. No severe complications were encountered. The complications included transient fever ( > 38°C) in 3 patients and significant hemorrhage in 1 patient. The stone-free rates one month and three months after operation were 89.3% and 96.4%, respectively. During the 2 years follow-up, the cyst recurrence rate was 14.3% and the stone recurrence rate was 7.1%.

Conclusion: In this study, we firstly demonstrated that it is safe and effective to treat both renal stone and parapelvic renal cyst simultaneously by flexible ureteroscopic lithotripsy and flexible ureteroscopic incision and drainage, with satisfactory stone free rate and low cyst recurrence rate.

Purpose: To report our single-center experience in encrusted ureteral stent management and to compare the utility of two different scoring systems, KUB (Kidney, Ureter, Bladder) versus FECal (forgotten, encrusted, calcified), in patient management.

Materials and Methods: We retrospectively analyzed the medical records of all patients who were found to have encrusted/retained ureteral stent and underwent various procedures to remove encrusted ureteral stent in our clinic between May 2014 and December 2018. Encrusted stent grading was performed using KUB and FECal grading systems. KUB system score is the sum of the stone burden scores of 3 different parts of an encrusted stent within the kidney, ureter and bladder determined using a scale from 1 to 5 according to the maximal diameter of encrustation. FECal grading system is based on the stone size, location and degree of stent encrustation and scored from Grade 1 to Grade 5.

Results: A total of 39 patients (29 males and 10 females) were included the study. The mean age of the patients was 46.4 ± 14.5 years, ranging from 13 to 71 years. The mean time from ureteral stent insertion to encrustation was 13.7 ± 26.4 months, varying between 2 and 120 months. The mean KUB score was 6.4 ± 2.4. According to FECal system, 53.8% of the patients were classified as Grade 1 and 15.4% as Grade 2. The encrusted ureteral stents of eight patients (20.5%) could be removed with the aid of a foreign body forceps inserted through a cystoscope. Fourteen patients (35.9%) underwent cystolithotripsy, seven (17.9%) underwent flexible ureterorenoscopy (URS), six (15.4%) underwent rigid URS, and three (7.7%) underwent combined percutaneous nephrolithotomy and URS beside stent removal. In multivariate regression analysis, largest encrustation diameter, FECal system grade and KUB score were found to be significant predictors of stone- and stent-free status (p<0.001 for all). Also, KUB score was found to be associated with the number of required procedures (r= .506, p= .001).

Conclusion: KUB encrusted stent scoring system might be useful in predicting the number of required procedures to achieve stone- and stent-free status. Pure intracorporeal endourologic procedures, percutaneous interventions or open surgery might be preferred according to the patient’s situation and the surgeon’s experience and preference.

ORIGINAL PAPER (LAPAROSCOPIC AND ROBOTIC UROLOGY)


A Comparison of Robot-Assisted Laparoscopic Ureteral Reimplantation and Conventional Laparoscopic Ureteral Reimplantation for the Management of Benign Distal Ureteral Stricture

Yucong Zhang, Wei Ouyang, Hao Xu, Yang Luan, Jun Yang, Yuchao Lu, Jia Hu, Zheng Liu, Xiao Yu, Wei Guan, Zhiquan Hu, Shaogang Wang, Zhangqun Ye, Heng Li

Urology Journal, Vol. 17 No. 3 (2020), 16 May 2020 , Page 252-256
https://doi.org/10.22037/uj.v0i0.5478

Purpose: To describe our experience and analyze the outcomes of robot-assisted laparoscopic ureteral reimplantation (RALUR) and conventional laparoscopic ureteral reimplantation (LUR) in treating benign distal ureteral stricture (DUS).

Material and Methods: Patients who underwent RALUR or LUR for DUS were retrospectively analyzed. All surgeries were performed by transperitoneal approach in a refluxing manner. Baseline characteristics, history of previous abdominal surgery, operative profile and follow-up data were collected and analyzed.

Results: Among 68 patients with DUS, 62 were diagnosed with unilateral DUS, including 28 patients underwent RALUR. The mean operative time of the RALUR group was 2.44 ± .45 hours, while the mean operative time of the LUR group was 3.09 ± .74 hours (P < .001). The average suturing time of LUR (39.59 ± 3.78 min) is about 2 times that of RALUR (20.04 ± 3.5 min) (P < .001). The success rate of the RALUR group and the LUR group were 89.3% and 82.4% respectively (P = .494). In multiple linear regression model, the modality of surgery was the only variable that influences operative time (Beta = -.964, P < .001), suturing time (Beta = -1.899, P < .001) and hemoglobin decline (Beta = -.611, P = .020).

Conclusion: Basically, the postoperative outcomes are similar but robotic surgery offers a quicker surgery and anastomosis.

ORIGINAL PAPER(UROLOGICAL ONCOLOGY)


Clinical Implications of Peripheral CD3+CD69+ T-Cell And CD8+CD28+ T-Cell Proportions in Patients Prior to Radical Prostatectomy

Yu Zhang, Ziye Zhang, Lina Zhang, Sheng Zhao, Jing Zhao, Qing Ye, Yingli Gao, Chenyi Jiang, Di Cui, Shujie Xia, Bangmin Han, Yifeng Jing

Urology Journal, Vol. 17 No. 3 (2020), 16 May 2020 , Page 257-261
https://doi.org/10.22037/uj.v0i0.5103

Purpose: To investigate the clinical implications of CD3+CD69+ T-cells and CD8+CD28+ T-cells in the peripheral blood of patients prior to radical prostatectomy.

Materials and Methods: A total of 91 prostate cancer (PCa) patients and 50 benign prostatic hyperplasia (BPH) patients were enrolled from January 2016 to December 2017. The proportions of CD3+CD69+ T-cells and CD8+CD28+ T-cells in the peripheral blood of PCa and BPH patients were detected by flow cytometry, and the association of these T-cell populations with pathological Grade Group and pathological TNM classification was evaluated. Data analysis was performed with SAS version 9.4 software.

Results: The proportions of CD3+CD69+ and CD8+CD28+ T-cells in peripheral blood were higher in PCa patients than those in BPH patients. Multivariate analysis identified a higher CD3+CD69+ T-cell proportion as a risk factor for PCa (odds ratio (OR) = 4.783, P = 0.0013), but the diagnostic efficacy of the CD3+CD69+ T-cell proportion (area under the curve (AUC)=0.6833, P = 0.0003) for PCa was still inferior to that of the tPSA level (AUC=0.7531, P < 0.0001). The AUCs for CD3+CD69+ T-cell and CD8+CD28+ T-cell proportions for PCa were 0.6959 (P = 0.0372) and 0.6935 (P = 0.0395), respectively, among men with tPSA levels of 4.0-10.0 ng/mL. A lower CD3+CD69+ T-cell proportion was associated with higher pathological Grade Group (P=0.0074).

Conclusion: The proportions of CD3+CD69+ T-cells and CD8+CD28+ T-cells in peripheral blood are potential diagnostic indicators for PCa. The preoperative proportion of CD3+CD69+ T-cells in peripheral blood may have prognostic value in terms of the pathological Grade Group in PCa.

Minimal Residual Disease Defines the Risk and Time to Biochemical Failure in Patients with Pt2 and Pt3a Prostate Cancer Treated With Radical Prostatectomy: An Observational Prospective Study

Nigel P Murray, Socrates Aedo, Cynthia Fuentealba, Eduardo Reyes, Anibal Salazar, Marco Antonio Lopez, Simona Minzer, Shenda Orrego, Eghon Guzman

Urology Journal, Vol. 17 No. 3 (2020), 16 May 2020 , Page 262-270
https://doi.org/10.22037/uj.v0i0.5174

Purpose: To compare Gleason score (GS), pathological stage, minimal residual disease (MRD) and outcome after prostatectomy radical for prostate cancer.

Patients and Methods: 290/357 men with GS 6 or 7 and pT2 or pT3a disease treated with radical prostatectomy participated. Blood and bone marrow were obtained one month after surgery. Circulating prostate cells (CPCs) were detected using differential gel centrifugation and immunocytochemistry with anti PSA, micro-metastasis weas detected using immunocytochemistry with anti-PSA. Biochemical failure free survival (BFFS) and restricted mean survival times (RMST) were calculated according to GS and stage. MRD was classified as negative, patients only positive for micro-metastasis and patients positive for CPCs; BFFS and RMST were calculated according to MRD sub-type.

Results: GS7 (HR 3.03) and pT3a (HR 3.68) cancers were associated with a higher failure rate, shorter time to failure and associated with CPC positive MRD (p < 0.001), while G6 and pT2 with MRD negative disease (p<0.001). Men with CPC (+) MRD were at high risk of early treatment failure; 15% BFFS at 10 years, RMST 3.0 years. Men positive for only micro-metastasis were at risk of late failure, 50% BFFS at 10 years, RMST 8.0 years compared with MRD negative patients; 80% BFFS at 10 years, RMST 9.0 years.

Conclusion: The sub-type of MRD identifies Gleason 6 pT2 patients with a poor prognosis and Gleason 7 pT3a patients with a good prognosis and could be used to classify men according to personal risk characteristics for the use of adjuvant treatment.

Genetic Polymorphism of Mismatch Repair Genes and Susceptibility to Prostate Cancer

Paniz Khooshemehri, Seyed Hamid Jamaldini, Seyed Amir Mohsen Ziaee, Mahdi Afshari, Mahshid Sattari, Behzad Narouie, Mehdi Sotoudeh, Vahideh Montazeri, Negar Sarhangi, Mandana Hasanzad

Urology Journal, Vol. 17 No. 3 (2020), 16 May 2020 , Page 271-275
https://doi.org/10.22037/uj.v0i0.5051

Purpose: Mismatch repair (MMR) is one of the DNA repair systems that correct mispaired bases during DNA replication errors. Polymorphisms in genes can increase susceptibility to the development of prostate cancer (PCa). In this study, we investigated mutL homolog 1 (MLH1) -93G>A (rs1800734) and mutS homolog 3 (MSH3) (rs26279) polymorphisms with the risk of PCa.

Materials and Methods: In this study of Iranian population, 175 histopathologically confirmed (PCa) patients and 230 benign prostate hyperplasia (BPH) as the controls were recruited. The genotypes of MLH1 and MSH3 were determined by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) method.

Results: There was no significant difference of MLH1 (P = 0.4) and MSH3 (P?=?0.5) genotype distributions among PCa cases and controls. And also patients with PCa were not significant differences compared to those without in stage of cancer, grade of tumor, perineural invasion, and vascular invasion.

Conclusion: Our results did not show adequate evidence for any significant association of MLH1 and MSH3 polymorphisms and PCa .

ORIGINAL PAPER (FEMALE UROLOGY)


The Prevalence of Lower Urinary Tract symptoms (LUTS) and incontinence in Iranian Women

Mahtab Zargham, Abbas Ali Pourmomeny, Mahsa Soltanmohamadi

Urology Journal, Vol. 17 No. 3 (2020), 16 May 2020 , Page 276-280
https://doi.org/10.22037/uj.v0i0.5053

Purpose: Lower Urinary Tract Symptoms (LUTS) affect many women worldwide. The prevalence of LUTS among Iranian women has not been reported. The aim of the present study was to evaluate the prevalence of Lower Urinary Tract Symptoms and its bother rate among women ?20 years old living in Isfahan, a central province of Iran.

Materials and Methods:

This was a descriptive cross-sectional study. The data was collected using a population-based survey on women aged ?20 years selected from the general population of Isfahan (a central province of Iran. A total of 2609 women were approached for the study. After obtaining demographic features, the participants completed the Persian version of the International Consultation on Incontinence Modular Questionnaire for Female Lower Urinary Tract Symptoms (ICIQ-FLUTS).

Results: 95.5% of the participants had at least one Lower Urinary Tract Symptoms. The most common symptoms were urgency (82.4%) and stress urinary incontinence (44.5%).  Nocturia (one or more occasions) was also noted in 60.7%. The highest bother rate was related to urgency.

Conclusion: The prevalence of Lower Urinary Tract Symptoms was high in the studied women. Among Lower Urinary Tract Symptoms, urgency and nocturnal enuresis were the most and the least frequent symptoms. However, the bother rate of the symptoms was relatively low.

ORIGINAL PAPER (ANDROLOGY)


Effectiveness of Sexual Skills Training Program on Promoting Sexual Intimacy and Satisfaction in Women in Tehran (Iran): A randomized clinical Trial Study

Fatemeh Salehi Moghaddam, Shahnaz TorkZahrani, Azam Moslemi, Seyyed Ali Azin, Giti Ozgoli, Narges Joulaee Rad

Urology Journal, Vol. 17 No. 3 (2020), 16 May 2020 , Page 281-288
https://doi.org/10.22037/uj.v0i0.4690

Purpose: The purpose of this study was to evaluate the effectiveness of sexual skills training on intimacy and sexual satisfaction in women.

Materials and Methods: This is a randomized clinical trial study with parallel design. 70 participants (n=35 each) were divided into 2 groups as control and intervention groups. Women were selected in multiple steps. Some requirements for inclusion criteria were: obtaining a standard score of marital satisfaction, women with a record of 6-24 months of marital life, not having a record of abortion, stillborn birth and not being in pregnancy period, not having a child, not suffering from an acute or chronic and serious disease, not having a surgery on pelvic organs, minimum elementary education of the couples and being Iranian. Some factors for exclusion criteria were: women’s absence in more than 2 training classes, pregnancy during the study. Data collection was conducted through four questionnaires: demographic characteristics, marital satisfaction, sexual satisfaction and sexual intimacy. Validity and reliability of the questionnaires were measured through content validity and Chronbach Alpha, respectively. The data extracted from the questionnaires were analyzed using SPSS software, version 18.0. For data analysis, descriptive statistics, independent t-test, paired t-test, or non-parametric tests were applied. Significance level of the test was considered p<0.05.

Results: The results showed that sexual skills training leads to promotion of sexual satisfaction (p<0.001) and sexual intimacy (p<0.001) among the women in intervention group and the impact of training was stable two months after completion of intervention.

Conclusion: In total, the training lessons gave positive views to participants towards their sexual issues so that they formed realistic and positive sexual expectations, healthier sexual behaviors and self-expressions and consequently, gained more sexual knowledge that made them able to experience more intimacy and satisfaction in sexual relationships with their spouses.    

ORIGINAL PAPER (RECONSTRUCTIVE SURGERY)


Boomerang Technique, The Buccal Mucosal Grafting Harvesting Model for Long Urethral Stricture Urethroplasty; A Case Series

Jalil Hosseini, Morteza Fallahkarkan, Hojjat Salimi, Saleh Ghiasy

Urology Journal, Vol. 17 No. 3 (2020), 16 May 2020 , Page 289-293
https://doi.org/10.22037/uj.v0i0.5534

Purpose: Currently, three methods are implicated in cases of long urethral stricture including harvesting buccal mucosa of inner cheeks, harvesting lip mucosa and finally lingual mucosal graft. This study evaluated the feasibility, safety and morbidity of our “Boomerang shape” technique used for graft retrieval from the inner cheeks to repair long urethral defect cases which are usually 12-15 cm in length and 2.5 cm in width.

Materials and Methods: The Kilner-Doughty mouth retractor is inserted to give access to the donor site. Initially, the internal surface of the right/left cheek is cleaned with a solution containing 10% povidone-iodine. Then, Stensen’s duct, located at the level of the second molar is identified and the desired size of the graft is measured and marked in a boomerang shape, 1.5 cm from the Stensen’s duct and 1.5 cm from the edge of the cheek. To decrease submucosal bleeding from the harvest site, 1% lidocaine combined with a 1:100,000 epinephrine solution is injected using a 25-gauge long needle. The outlines of the graft are drawn by using a scalpel through the mucosa. Then, the outlined graft is sharply dissected and removed, leaving the muscle intact. A 5-0 polyglactin continuous suture is used for the closure of the harvest site. The standard graft harvested from the cheek should be 12-15 cm in length and 2.5 cm in width.

Results: Between 2017-2019, five adults have had their mucosal grafts harvested by the “Boomerang shape” technique in our center. No donor site complications were observed. Moreover, no urethral strictures or diverticulum occurred and the functional outcomes were satisfactory in all patients.

Conclusion: Our routine technique of harvesting the buccal mucosa from the cheek is secure and easily performable by any surgeon. It has minimal incidence of intra and post-operative complications.

CASE REPORT


Bilateral Primary Renal Lymphoma Presented As Homogenous Renal Enlargement And Acute Interstitial Nephritis

Wei Lei, Hanmin Wang, Wang Di, Ma Feng, Li Li, Sun Shiren

Urology Journal, Vol. 17 No. 3 (2020), 16 May 2020 , Page 317-320
https://doi.org/10.22037/uj.v0i0.4596

Primary renal lymphoma(PRL) is an extremely rare form of extranodal lymphoma andexhibitsas single (10-20%), multifocal nodules (60%), renal invasion from contiguous retroperitoneal disease (25-30%), diffuse infiltration (20%) or perirenal involvement (10%)[1] .Here we report a case of bilateral primary renal lymphoma in a 13 year-old boy who presented with homogenous nephromegaly and acute interstitial nephritis(AIN).The renal biopsy revealed primary renal T lymphoblastic lymphoma. Hyper-CVAD regimen was initiated and the renal function had been recovered after the first round of chemotherapy. To our knowledge, there have only been three reports of primary renal T lymphoblastic lymphoma including ours so far. All the three patients were young and showed as AIN and bilateral renal enlargement. We also reviewed 16 cases of PRL presenting with AIN and enlarged kidneys that have been reported since 1997. Although PRL is quite rare, it must be taken into account when making a differential diagnosis of AIN. Renal biopsy is the gold standard and intensive chemotherapy can preserve the renal function.

We herein report a case of left renal Wilms’ tumor and right renal hamartoma combined with hypospadias and incomplete orchiocatabasis in a 10-month-old boy. In the literature to date, no case has been reported. The preoperative abdominal computerized tomography (CT) scan was suggestive of bilateral nephroblastomas, and clinical diagnosis was bilateral renal tumors with external genitals malformation, a syndrome? Finally, this case was used by B-ultrasonic guided percutaneous biopsy to help determine the nature of bilateral renal tumors. Afterwards, the boy underwent preoperative chemotherapy, surgery ( a left radical nephrectomy and right wedge excision of the renal tumor) and postoperative chemotherapy. After 3 years of follow-up, there was no evidence of tumor recurrence, the renal function was normal, and the boy’s height, weight and intelligence were also within normal range. Owing to no similar cases as a reference, we discussed the preoperative imaging diagnosis, final etiological diagnosis and appropriate treatment of this disease. Long-term follow-up with a sufficient number of cases may be needed to optimize methods of diagnosis and define optimal treatment options for patients with this extremely rare disease.

LETTER


EDITORIAL


UNCLASSIFIED


Protective effects of colchicine on testicular torsion/detorsion-induced ischemia/reperfusion injury in rats

Kerem Han Gozukara, Oguzhan Ozcan, Tümay Ozgur, Yusuf Selim Kaya, Okan Tutuk

Urology Journal, Vol. 17 No. 3 (2020), 16 May 2020 , Page 294-300
https://doi.org/10.22037/uj.v0i0.4918

Purpose: To evaluate the short-term use of colchicine on preventing ischemia-reperfusion injury after surgery in an experimental animal model.

Materials and Methods: A total of 40 rats were divided into five groups (n = 8). Sham (Sh), ischemia-reperfusion (I/R), I/R and colchicine-treated for once per-operatively (I/Rc1), I/R and colchicine-treated for 5 days postoperatively (I/Rc5), and I/R and placebo given for 5 days (I/Rp) groups. Testicular torsion was created by rotating the testicle 720o in clockwise direction and held for 3 hours. In group I/Rc1 30 minutes before detorsion, p.o. 1 mg/kg mL infusion of colchicine was given only once. In group I/Rc5, colchicine continued p.o. once daily for five days. Tissue malonyldialdehite (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) were measured for evaluating the oxidative stress. Apoptosis levels shown with Caspase-3 staining and mean seminiferous tubular diameter (MSTD), germinal epithelial cell thickness (GECT), and mean testicular biopsy score (MTBS) were used to evaluate the germ cell damage.

Results: Decreased protein MDA levels therewithal increased SOD, CAT and GPx levels achieved in I/Rc5 group when compared to I/R group and did not differ from the I/Rp group (p<0.05). MSTD, GECT, and JS were better in I/Rc5 than I/Rp which showed the natural course of I/R damage in testis (p<0.005). Caspase 3 positivity, as an apoptosis indicator, were significantly lower (p<0.05) in I/Rc5 group in comparison with I/R, I/Rc1, and I/Rp groups.

Conclusion: The usage of colchicine as a complementary treatment after definitive surgery reduce early-onset ischemia-reperfusion damage and diminishes apoptosis.

Purpose: Circumcision is a common human urologic surgery performed in males with redundant prepuce to prevent the transmission and reduce the risk of urologic diseases. However, the optimal circumcision method for elderly men remains to be determined. Herein, the current study was conducted to characterize the efficacy of four different kinds of circumcision for elderly males with redundant prepuce.

Methods: This retrospective study included 132 elderly males diagnosed with redundant prepuce who underwent circumcision at the outpatient department. Among them, 38 cases were subjected to traditional surgery (Group A), 23 cases to sleeve circumcision (Group B), and 42 cases to Shang Ring circumcision (Group C) and 29 cases to suturing device circumcision (Group D). Subsequently, the operation time, loss of blood, postoperative pain, complications, wound healing, and the satisfaction were respectively compared and analyzed.

Results: The operation time of these 4 groups was calculated to be 27.3 ± 2.39 min, 30.4 ± 2.23 min, 6.3 ± 1.33 min, 7.6 ± 1.29 min, in Group A, Group B, Group C, Group D, respectively (P < 0.05). Besides, the loss of blood was 15.6 ± 2.84 mL, 11.8 ± 1.73 mL, 1.3 ± 0.44 mL, 3.7 ± 1.41 mL, respectively (P < 0.05). The elderly males who underwent Shang Ring circumcision exhibited the highest postoperative pain score, the longest pain duration, the longest healing time, the lowest recovery satisfaction rate and the highest operation experience satisfaction rate (P < 0.05).

Conclusion: Taken together, all four types of male circumcision present with advantages and drawbacks. The traditional male circumcision and sleeve circumcision led to longer operation time and more bleeding, but no additional medical equipment was needed. Meanwhile, the Shang Ring circumcision caused the shortest operation time and the least bleeding, accompanied by the longest pain duration and recovery time. Therefore, the application of sleeve circumcision or a suturing device was recommended for elderly males suffering from redundant prepuce.

Effects of 1% lidocaine instillation on overactive bladder induced by bladder outlet obstruction in rats

Hyo Jin Kang, Sang Woon Kim, Yong Seung Lee, Sang Won Han, Jang Hwan Kim

Urology Journal, Vol. 17 No. 3 (2020), 16 May 2020 , Page 306-311
https://doi.org/10.22037/uj.v0i0.5111

Purpose:

Lidocaine is a common local anesthetic and antiarrhythmic drug that acts via the local anesthetic effect of blocking voltage-gated sodium channels in peripheral neurons. To evaluate lidocaine as a therapeutic agent, we investigated optimal concentrations and effects of intravesical lidocaine instillation in a bladder outlet obstruction (BOO)-induced rat model of overactive bladder (OAB).

Materials and Methods:

To determine the therapeutic dosage of lidocaine, 16 female Sprague-Dawley (SD) rats (mean weight = 200 ± 20 g) were divided into four treatment groups: those receiving saline, 0.5% lidocaine, 1% lidocaine, and 2% lidocaine (n = 4 per group). Twenty-four additional SD rats were divided into two groups to investigate the effect of 1% lidocaine treatment in rats with BOO and normal rats (n = 12 per group). Cystometry was performed by infusing physiological saline and lidocaine into the bladder at a slow infusion rate (0.04 mL/min). Cystometric parameters were analyzed using PowerLab®. The expression of c-Fos, a protein expressed by C-fibers in the spinal cord (L6), was investigated via western blotting.

Results:

Among the test lidocaine doses, only 1% lidocaine increased the intercontraction interval (ICI) (control mean = 500.56 ± 24.4 s; treatment mean = 641.0 ± 49.3 s; p < .01) without changes in threshold pressure and basal pressure. In the BOO-induced OAB group, the ICI increased significantly after instillation of 1% lidocaine (control mean = 135.8 ± 12.87 s; OAB-group mean = 274.2 ± 33.21 s; p < .01). Detrusor overactivity and non-voiding contraction were observed in the control group but not in rats with BOO after lidocaine instillation. The expression of c-Fos in C-fibers in the spinal cord (L6) decreased significantly after 1% lidocaine treatment in rats with BOO.

Conclusion:

Intravesical instillation of 1% lidocaine improves cystometric parameters without deterioration of contractility by blocking excessive C-fiber activity in the rat model of BOO-induced OAB. Therefore, instillation of 1% lidocaine has minimal effects on normal nerves while blocking nerves that contribute to OAB. Our findings suggest that intravesical instillation of 1% lidocaine is a useful treatment for OAB.

Purpose: To investigate the pain intensity and tolerability of a new catheter applied to urethral surface anesthesia during rigid cystoscopy in male patients, and explore the prospects of its application and the anesthetic method in hospitals at primary levels.

Materials and Methods: 252 adult male patients were randomly divided into the experimental group and the control group.1% lidocaine solution was irrigated into the posterior urethra of the experimental group using the new catheter before cystoscopy, while the control group was administered with lidocaine gel. Both groups were assessed by visual analogue scale(VAS) with their pain perceived during administration of lidocaine (control group) /during insertion of catheter and administration of lidocaine (experimental group) (T1),during the insertion of cystoscope (T2),at the beginning of cystoscopy (T3),The third minute of cystoscopy (T4), during the first urination after the procedure (T5), as well with the maximum pain(Pmax) perceived during the whole procedure. The fluctuations of blood pressure and heart rate in each group before, after and during the procedure were recorded, and the anesthesia costs in both groups were calculated.

Results: Except a slightly higher score in T1, the scores of VAS in experimental group were lower than those of control group in T2,T3 and T4. The Pmax of the control group was 4.92(SD=1.20), which was higher than in the experimental group of 3.89(SD=0.95,P<0.01).There was no significant difference on blood pressure variation in both groups. While heart rate variation in experimental group was lower than that in control group (16.3%,SD=3.4 vs. 22.6%,SD=5.0, P<0.01).No obvious complications were found in both groups. The anesthesia cost of the experimental group is about 1.53 dollars, with 1.75 dollars lower than that of the control group.

Conclusion: It is tolerable and beneficial to apply the new catheter for male urethral anesthesia. It can significantly relieve the pain during rigid cystoscopy in male patients, and is low in cost and easy in operation. Thus this method is worth being recommended to hospitals, especially at community hospitals or primary hospitals.